Attention Deficit Hyperactivity Disorder (ADHD) assessment – Referrals and Medication

As a practice we are committed to supporting patients with neurodevelopmental diagnoses, both children and adults.

This information is for those who patients who are concerned or suspect that they may have ADHD and would like to be referred to the NHS for an ADHD.

Attention Deficit Hyperactivity Disorder (ADHD) can affect many aspects of a person’s life. However, diagnosis is complex and GPs (General Practitioners) are not able to make a diagnosis of ADHD and a referral is needed to an ADHD specialist. If an ADHD diagnosis is subsequently made by the specialist, they may choose to offer medications to help manage the symptoms. These medications are potentially dangerous and therefore require careful monitoring.

This guide will explain how the referral process works, how referrals are initiated and what you can expect if you are diagnosed. This information is based on national and local guidance, specifically NICE guidance.

ADHD referrals for children

The person who needs to initiate the referral will depend on the education age of the child:

• Pre-School – The referral is to be discussed with the Childs Health Visitor or Early Years Setting – they can be contacted by calling: 01522 843000
• School Age – The referral is undertaken by the school
• Home Schooled Children – the referral is undertaken by the GP
• Supporting evidence will be required regardless of who is initiating.

If the NHS Mental Health Team confirm a diagnosis of ADHD, they may initiate treatment and may offer medication; initially this will need to be obtained directly from the specialist consultant. Once the Mental Health Team are confident the patient is stabilised on their medication, they may feel it is appropriate for the patient to obtain their medication from the GP Surgery.

In order for us to prescribe this type of medication, the Mental Health Team will need to send a Shared Care Agreement to your GP. This is an agreement with an NHS Consultant for the GP which stipulates any monitoring needed to continue to prescribe the ADHD medication safely.

Please note, the GP is only able to continue prescribing and monitoring a patient if a Shared Care Agreement with an NHS provider is in place.

ADHD referral for adults (18 Years+)

Due to the unprecedented demand for ADHD diagnosis and treatment nationally and locally across all age groups, all referrals are sent to the Single Point of Access Team to determine the clinical appropriateness for referral / assessment triage. Those not meeting this threshold will be referred back to their GP with self-help and signposting. If the referral is accepted, this will be forwarded to an approved provider. Currently the waiting time is approximately 16 weeks for initial assessment.

Which provider will assess me?

Nottingham and Nottinghamshire City ICB have commissioned several providers to support referrals. All providers who carry out NHS services must hold an NHS Standard contract which means they have passed the due diligence checks set by the NHS. Due to pace of change we are unable to provide you with a list of providers.

If the provider confirms a diagnosis of ADHD, they may initiate treatment and may offer medication; initially this will need to be obtained directly from the specialist consultant. Once they are confident you are stabilised on the medication, they may feel it is appropriate for you to obtain their medication from the GP Surgery.

In order for us to prescribe this type of medication, they will need to send us a Shared Care Agreement. This is an agreement with an NHS Consultant for the GP which stipulates any monitoring needed to continue to prescribe the ADHD medication safely.

Please note, we are only able to continue prescribing and monitoring a patient if a Shared Care Agreement with an NHS provider is in place.

Right to choose

Under NHS England’s Right to Choose legislation patients can exercise their right to see any appropriate health service provider. This provider can be anywhere in England, as long as the provider holds an NHS Standard contact detailed above.

Please let us know if you want to use a preferred provider, this information will be added onto the referral form, however, please be aware that all referrals will initially be sent to the Single Point of Access Team for triage and upon acceptance they will then consider the Right to Choose provider request.

Please note: If the provider of choice does not hold an NHS Standard Contract with Nottingham and Nottinghamshire ICB due diligence checks will need to be carried out before the referral can be sent onto them, this may delay the referral.

Things to consider when choosing a Right to Choose Service:

It is important to understand that many of the Right to Choose services can offer diagnosis but are often unable to prescribe medication, even if deemed appropriate. This means that you may be able to obtain a diagnosis, but often you will need a further referral to a local NHS or different right to choose service should they recommend you need to start medication to control your symptoms.

Before a local service will take over your care, they may require you to complete their own assessment as not all assessments carried out by Right to Choose services are universally accepted and this may delay further treatment and follow up. Unfortunately, this is not something which can be easily avoided as most medications suggested for these conditions are ones that GPs do not prescribe without the support of a specialist clinic under a ‘Shared Care Agreement’. In line with most GP services our policy is not to enter into shared care agreements unless under an approved NHS right to choose provider

Private Providers

You may choose to be referred to a Private Provider for your ADHD assessment due to the long waiting times for an NHS appointment, or simply out of preference. In this instance, the prescribing and monitoring of any medication must continue under the care of the Private Provider, and we will be able to prescribe ADHD medication or arrange monitoring on a Shared Care Agreement.

A shared care agreement allows GPs to prescribe specialist medications under the oversight of a specialist, who continues to review the patient’s treatment. Although there are established local shared care agreements with NHS specialists, these are not in place for private prescribers and so we do not accept shared care agreements with private specialists. This means that any medication requiring a shared care agreement that is initiated by a private clinician will need to be prescribed directly by that clinician.

Can I transfer from a private provider to NHS provider?

If following assessment, you wish to transfer your ADHD treatment to the NHS, you will need to be referred to the NHS mental health specialist team for assessment and confirmation of your ADHD diagnosis. The NHS consultant will ascertain whether the NHS criteria for a prescription of ADHD medication has been met.

If this criterion is met, a Shared Care Agreement can be formed between the NHS consultant and the GP. Until this is established the clinical responsibility of prescribing and monitoring of the patient, and their medication should remain with the Private Provider.

Please note there is no obligation nor mandatory requirement for a GP to enter into any Shared Care Agreement.

What happens if my referral is rejected?

All referrals are sent to the Single Point of Access Team to determine the clinical appropriateness for referral / assessment triage. If the referral is not accepted, we will write to you to inform you of the decision and give you an opportunity to provide further evidence to support a resubmission. If the referral resubmission is rejected a further time, we will write to let you know, at this point we will signpost you to the organisations that may help you.

Signposting information on ADHD

• ADHD UK – Homepage – ADHD UK
• The ADHD Foundation Neurodiversity Charity – SNAP Charity
• Tips for everyday living | ADHD and mental health | Mind
• ADHD in children and young people – NHS

It is the policy of this practice to respect the privacy, dignity, cultural and religious beliefs of all of our patients.

If you would like a chaperone to be present during a physical or intimate examination by a doctor or other healthcare professional who may be consulting at the surgery or if you would prefer to be examined by a same sex doctor or healthcare professional then please let us know and we will do our best to comply with your wishes. Please mention this to one of our receptionists ot the healthcare professional you are seeing for your consultation.

Similarly there may be occasions when the doctor or healthcare professional you are seeing feels it appropriate for a chaperone to be present . If this is the case then they will tell you and explain the reasons why.

Intimate examinations may include genital, rectal or breast examinations.

All practice staff who act as chaperones have received appropriate training. This includes regular updates.

In the event that a chaperone is not available at the time of the appointment, we may postpone the examination or propose that the patient is examined by another doctor ( for example a doctor of the same sex) if at all possible. If the doctor feels that to delay the examination would not be in your best interests this will be explained at the time but the final decision will be yours.

Practice Complaints Procedure

Patient feedback is important to us as it helps us to improve the service we provide to patients. We take patient complaints seriously and will attempt to address your concerns to your satisfaction.

How do I make a complaint?

If you wish to complain please contact the Practice Manager Keely Wilson either in person, by phone or in writing:

Tel: 0115 939 2444 

Address: Stapleford Care Centre, Church Street, Stapleford, Nottingham, NG9 8DA.

If you would prefer to send in a written complaint then a form to help you to do this can be downloaded here:

If you are complaining on behalf of someone else, the practice needs to know that you have their permission to do so.

What Happens Next?

The complaint will be acknowledged within 3 working days.  The practice will respond, after investigation, within the timeframe specified to you at the acknowledgement stage of the process.  Some complaints may take longer to address but you will be informed of a response time.  If this cannot be met, the practice will keep you informed.

Please be assured making a complaint will not adversely affect your ongoing healthcare at the practice.  We will deal with you fairly, compassionately and will endeavour to resolve the situation to a satisfactory conclusion.

Wherever possible, we aim to learn from complaints and take action to avoid similar occurrences. 

How do I complain to someone Independent?

GP Practices would prefer to have the opportunity to answer complaints ourselves in the first instance. However, you may pass your complaint directly to:

Patient Experience Team

Nottingham and Nottinghamshire Integrated Care Board

Sir John Robinson House

Sir John Robinson Way

Arnold

Nottingham

NG5 6DA

Tel: 0115 8839570

Email: nnicb-nn.patientexperience@nhs.net

If you would like further information please follow the link to the ICB website: Patient Experience and Complaints – NHS Nottingham and Nottinghamshire ICB

As a practice we are registered under the Data Protection Act 1998 under section PO67 Health Care Administration. This means that we hold computer data of every patient’s medical history, which is used by the GP’s each time a patient visits the surgery and by other members of the practice team in the course of their day- to-day work.

The ethics of the medical profession deem that disclosures will only be made in accordance with a strict code of professional confidentiality. You are entitled to see a copy of your medical records upon request, although a fee may be payable.

Freedom of Information

Information about the General Practitoners and the practice required for disclosure under this act can be made available to the public. All requests for such information should be made to the practice manager.

Access to Records

In accordance with the Data Protection Act 1998 and Access to Health Records Act, patients may request to see their medical records. Such requests should be made through the practice manager and may be subject to an administration charge. No information will be released without the patient consent unless we are legally obliged to do so.

All GP practices are required to declare the mean earnings (e.g. average pay) for GP’s working to deliver NHS services to patients at each practice.

“The average pay for GPs working in the Saxon Cross Surgery in the last financial year was £26,334 before tax and national insurance.  This is for 9 part time GPs who worked in the practice for more than six months

It should be noted that the prescribed method for calculating earnings is potentially misleading because it takes no account of how much time doctors spend working in the practice, it should not be used to form any judgement about GP earnings, nor to make a comparison with any other practice.

Disclaimer

NHS England requires that the net earnings of doctors engaged in the practice is publicised, and the required disclosure is shown above.  However it should be noted that the prescribed method for calculating earnings is potentially misleading because it takes no account of how much time doctors spend working in the practice, and should not be used to form any judgement about GP earnings, nor to make any comparison with any other practice.

 Updated March 2023

How sharing information in your medical records can help the NHS to provide better care

A modern information system has been developed, which will make increased use of information from medical records with the intention of improving health services. The system is being delivered by the Health and Social Care Information Centre (HSCIC) and NHS England on behalf of the NHS.

It is important that the NHS can use this information to get a complete picture of what is happening across health and social care and to plan services according to what works best. The new system will provide joined-up information about the care received from all of the different parts of the health service, including hospitals and GP practices.

Your date of birth, full postcode, NHS Number and gender rather than your name will be used to link your records in a secure system, managed by the HSCIC. Once this information has been linked a new record will be created. This new record will not contain information that identifies you. The type of information shared, and how it is shared, is controlled by law and strict confidentiality rules.

The new system will also provide information that will enable the public to hold the NHS to account and ensure that any unacceptable standards of care are identified as quickly as possible. Information will help to:

• find more effective ways of preventing, treating and managing illnesses
• guide local decisions about changes that are needed to respond to the needs of local patients
• support public health by anticipating risks of particular diseases and conditions, and help us to take action to prevent problems
• improve the public’s understanding of the outcomes of care, giving them confidence in health and care services
• guide decisions about how to manage NHS resources so that they can best support the treatment and management of illness for the benefit of patients

It is important that you read the leaflet How information about you helps us to provide better care ,so that you understand how information in medical records can be used to improve the way that healthcare is delivered.

If you are happy for your information to be used then you do not need to do anything. But if you have concerns you should talk to your GP.

If you do not want information that identifies you from being shared outside your GP practice, talk to a member of staff at your practice. They will make a note of this in your medical record. This will prevent your information being used other than where necessary by law, such as in case of a public health emergency. You will also be able to restrict the use of information held by other places you receive care from. However, this will not affect the care you receive.

You can change your mind at any time and as many times as you wish. Just speak to your GP practice and ask them to record your wishes. For example, if you state that you are happy for your information to be used then you later decide that you object, tell your GP and the HSCIC will then ensure that any information they have from your GP practice and that could identify you is removed.

Information from GP practices will begin to be extracted and sent to the HSCIC in the autumn 2013. The GP data will be linked with the hospital data already held by the HSCIC.

For more information about how data is collected and shared, including confidentiality, download the FAQ for patients  produced by the HSCIC and NHS England.

Source : NHS Choices – Your Records

Click here to view the practice privacy notice

Read our Shared Care Plans Statement

There is a new Central NHS Computer System called the Summary Care Record (SCR). It is an electronic record which contains information about the medicines you take, allergies you suffer from and any bad reactions to medicines you have had.

Why do I need a Summary Care Record?

Storing information in one place makes it easier for healthcare staff to treat you in an emergency, or when your GP practice is closed.

This information could make a difference to how a doctor decides to care for you, for example which medicines they choose to prescribe for you.

Who can see it?

Only healthcare staff involved in your care can see your Summary Care Record.

How do I know if I have one?

Over half of the population of England now have a Summary Care Record. You can find out whether Summary Care Records have come to your area by looking at our interactive map or by asking your GP

Do I have to have one?

No, it is not compulsory. If you choose to opt out of the scheme, then you will need to complete a form and bring it along to the surgery. You can use the form at the foot of this page.

More Information

For further information visit the NHS Care records website.

The NHS operate a zero tolerance policy with regard to violence and abuse and the practice has the right to remove violent patients from the list with immediate effect in order to safeguard practice staff, patients and other persons. Violence in this context includes actual or threatened physical violence or verbal abuse which leads to fear for a person’s safety. In this situation we will notify the patient in writing of their removal from the list and record in the patient’s medical records the fact of the removal and the circumstances leading to it.