ADHD Referral Pathways & Prescribing
Right to Choose ADHD Prescribing
ADHD medications are specialist drugs that need to be initiated by a specialist. Only once a stable dosing has been achieved a GP may take over prescribing under a Shared Care Protocol (SCP). ADHD medications have clear monitoring requirements to be prescribed safely, and it is the responsibility of the GP, the Specialist, and the Patient, to adhere to these requirements. Typically, the patient would need to be seen at least annually by a Specialist, and have an interim 6 monthly weight, height, BP and HR check overseen in General Practice. The GP should be a point of contact if any issues arose on the medication, and the Specialist should be available for advice and input as required.
As a practice we routinely enter shared care with NHS Providers, and with providers commissioned by the NHS through NHS Right to Choose using the South East London Adult Referrals Triage Service.
In recent years we have experienced a growth in private sector providers. It is not appropriate, fair, or possible for us at practice level to undertake a quality judgement on the multiple private ADHD services that request shared care with us, and there is currently no national guidance on this issue. Therefore, we do not routinely enter Shared Care with private ADHD providers. However, should a patient receive ADHD care as a private patient from an organisation that is also an NHS Right to Choose provider, we would consider entering a comparable SCP. Adherence to the terms of the SCP, including continuing to have at least annual review in the private sector where applicable, is conditional to the practice continuing to prescribe the ADHD medication, and essential for safe prescribing. We will also consider entering shared care with local trusted private providers.
However at 306 Medical Centre, we are under no obligation to enter shared care with any of these organisations and may decline to do so should we have any concerns about the ADHD assessment process, or SCP provided.
We are aware that the contractual arrangements between the NHS and these providers are not open ended, and we reserve the right to discontinue either private or NHS shared care with these organisations should they fall out of the NHS Right to Choose System. This is in the interests of safe prescribing and the need for NHS quality assurance.
Any new requests for Shared Care will be reviewed and given consideration on a case by case basis by the GP.
You can find the Right to Choose options following the link: Right to Choose – ADHD UK – Your NHS options
ADHD Referral Pathway – Children
If a child is suspected to have ADHD, the special educational needs coordinator (SENCO) at their school is the key point of contact for referral to NHS services. The SENCO can assess the child’s needs, potentially offer support within the school, and if necessary, make a referral to a specialist ADHD assessment service. While a GP can also make a referral, the SENCO’s involvement is often preferred as they can provide crucial information about the child’s learning and behaviour in the school environment.
Here’s a more detailed explanation:
The role of the SENCO
- Assessment and support – SENCOs are trained to identify and support children with special educational needs, including those with ADHD.
- Referral pathway – They can initiate the referral process for ADHD assessment within the NHS system, often via a dedicated Neurodevelopmental Pathway.
- School-based support – SENCOs can implement strategies and interventions within the school setting to help manage ADHD symptoms.
Referral process
- Initial contact – Parents can discuss their concerns with the school’s SENCO.
- Information gathering – The SENCO will gather information about the child’s behaviour and learning difficulties, often through questionnaires and observations.
- Referral to specialist services – If the SENCO, with parental consent, deems it necessary, a referral will be made to a specialist ADHD assessment service.
- GP involvement – The GP can also make a referral, but often, the SENCO’s input is preferred due to their specific knowledge of the child’s educational needs.
Important Considerations
- Waiting lists – Be aware that waiting lists for ADHD assessments can be long.
- Right to choose – In England, you have the right to choose which NHS provider you are referred to, allowing you to potentially access services with shorter waiting times.
- Ongoing support – While waiting for assessment, it’s important to continue providing support at home and in school.
- Other professionals – Other professionals like educational psychologists, therapists, and school nurses may also be involved in the assessment and support process.
What happens at an ADHD assessment
- The assessment will be with one or more ADHD specialists, such as a paediatrician, or a child and adolescent psychiatrist.
- The specialist will talk with you and your child to find out more about any symptoms, and about family life. They’ll also ask about your child’s development, such as how old they were when they learned to do things like walking or reading.
- There may be some forms to fill in before the appointment or as part of the assessment.
- The ADHD specialist will usually contact a SENCO or teacher, or both, to see how your child is doing at school.
- They may also ask your child to do a computer-based test to help assess their symptoms.
- If your child is diagnosed with ADHD, the specialist will discuss what this means and what happens next, including what treatment and support may be available.
Lifestyle
There are things you can do to help support a child or young person with their ADHD symptoms.
Do
- Make time for physical activities they enjoy, as exercise is a good focus for their energy.
- Encourage them to get regular sleep. The Royal College of Psychiatrists website has advice on dealing with sleep problems.
- Help them to have a healthy, balanced diet and regular mealtimes.
- If some foods and drinks seem to affect their symptoms, keep a food and drink diary to see what these are. You can share this information with their school.
Support at school and at home
Discuss with a SENCO what adjustments or support may help at home and school.
This may include:
- splitting up tasks, like doing homework or sitting down to eat, into 15 to 20 minute slots with a break in between each slot
- giving clear and simple instructions one at a time in a calm voice
- writing a to-do list and putting it somewhere easy to see
- giving praise when a child or young person does well, or making a reward chart
Useful Links:
Southwark Information Advice and Support Team:
Contact Details:
Tel: 0207 525 3104
Email: sias@southwark.gov.uk
