ADHD Referral Pathways & Prescribing

Right to Choose ADHD Prescribing

ADHD medications are specialist medicines that should be initiated by an appropriately qualified specialist. Once a patient has reached a stable dose, prescribing may be transferred to the GP under a Shared Care Protocol (SCP), where the GP agrees to participate in shared care.

ADHD medications have specific monitoring requirements to ensure that they are prescribed safely. Responsibility for meeting these requirements is shared between the GP, specialist and patient.

Typically, patients receiving ADHD medication under shared care should have at least an annual review with the specialist, with appropriate interim monitoring undertaken in General Practice. This will generally include measurements such as weight, height, blood pressure and heart rate, as clinically appropriate. The GP should be a point of contact for problems arising during treatment, while the specialist should remain available to provide advice and clinical input when required.

NHS Right to Choose

As a practice, we routinely enter into shared-care arrangements with NHS providers and with providers commissioned by the NHS through NHS Right to Choose, including providers accessed through the South East London Adult Referrals Triage Service.

In recent years, there has been significant growth in the number of private-sector ADHD providers. It is not appropriate, fair or practicable for the practice to undertake an individual quality assessment of the numerous private ADHD services that may request shared care. There is also currently no single national framework that requires GP practices to enter into shared-care arrangements with private ADHD providers. For these reasons, we do not routinely enter into shared-care arrangements with private ADHD providers.

However, where a patient has received ADHD assessment and treatment privately from an organisation that is also an NHS Right to Choose provider, the practice may consider entering into a comparable shared-care arrangement. This will be considered on an individual, case-by-case basis and is not automatic.

Where the practice agrees to prescribe under shared care, continued prescribing will be conditional upon the patient and specialist adhering to the terms of the SCP. This includes the patient continuing to receive the required specialist reviews, including at least annual specialist review where stipulated by the SCP, and ensuring that all required monitoring is completed. These arrangements are essential to ensure safe prescribing.

Practice discretion

At 306 Medical Centre, participation in a Shared Care Protocol is subject to the agreement of the GP and the practice. We are not required to enter into shared care with any particular organisation, and may decline a request where there are concerns regarding the assessment process, clinical information provided, the proposed SCP, monitoring arrangements, or other aspects of the proposed shared-care arrangement.

We are also aware that contractual arrangements between the NHS and individual providers may change over time. The practice therefore reserves the right to review and, where clinically or contractually appropriate, discontinue shared-care prescribing arrangements with a provider if that provider ceases to operate within the NHS Right to Choose framework or no longer meets the requirements on which the shared-care arrangement was based.

Any new request for shared care will be reviewed by a GP on a case-by-case basis. Agreement to shared care should not be assumed simply because a provider is an NHS Right to Choose provider.

Finding an NHS Right to Choose provider

Information about ADHD assessment and treatment options available through NHS Right to Choose can be found here:

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.

In Southwark, we consider the SENCO-led pathway to be the most effective starting point for most children suspected of having ADHD. This allows the school to gather relevant information, provide appropriate support and ensure that the educational evidence required for specialist assessment is available.

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 – SENCOs can initiate the referral process for ADHD assessment within the NHS system, often via a dedicated Neurodevelopmental Pathway or other appropriate specialist service.

School-based support – SENCOs can implement strategies and interventions within the school setting to help manage difficulties associated with ADHD while an assessment is being arranged.

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, learning and functioning at school, often through questionnaires, observations and information from teachers.

Referral to specialist services – If the SENCO, with parental consent, considers that a specialist ADHD assessment is appropriate, a referral can be made to the relevant NHS specialist assessment service.

GP involvement – The GP can also make a referral and may be involved at any stage. However, the SENCO’s input is often preferred because of their specific knowledge of the child’s educational needs and functioning in the school environment.

NHS Right to Choose

In England, eligible patients may have the right to choose an alternative NHS provider for specialist assessment.

For ADHD, this can include NHS-commissioned independent providers offering ADHD assessment and related services. These providers may be accessed through NHS Right to Choose where the relevant eligibility and contractual requirements are met.

Right to Choose is an NHS pathway and is different from paying privately for an ADHD assessment.

There are a number of NHS-commissioned independent providers, and the services offered can vary. Waiting times, age criteria, geographical requirements and whether the provider offers assessment, diagnosis and subsequent treatment can differ between providers.

Families considering NHS Right to Choose should discuss the options with the clinician making the referral and check the provider’s current eligibility and service arrangements.

Important Considerations

Waiting lists – Be aware that waiting lists for ADHD and neurodevelopmental assessments can be long. Waiting times can vary considerably between services and providers.

NHS Right to Choose – Where eligible, families may be able to choose an alternative NHS provider, including an NHS-commissioned independent provider, which may offer a different waiting time or service model.

Ongoing support – While waiting for assessment, it is important to continue providing appropriate support at home and in school. Support should not have to wait for a formal ADHD diagnosis.

Other professionals – Other professionals such as educational psychologists, therapists, paediatricians, school nurses and mental health professionals may also be involved in assessment and support.

What happens at an ADHD assessment

The assessment will be with one or more ADHD specialists, such as a paediatrician, child and adolescent psychiatrist, or another appropriately qualified healthcare professional with expertise in ADHD.

The specialist will talk with you and your child to find out more about any symptoms and how they affect everyday life. They will also ask about family life and your child’s development, such as when they reached developmental milestones including walking, talking or reading.

There may be some forms to complete before the appointment or as part of the assessment.

The ADHD specialist will usually contact a SENCO or teacher, or both, to understand how your child is doing at school.

They may also use questionnaires, observations or other assessment tools. A computer-based test may sometimes be used to help assess symptoms, but this is not sufficient on its own to diagnose ADHD.

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 ADHD symptoms.

Do:

Support at school and at home

Discuss with the SENCO what adjustments or support may help at school and at home.

This may include:

Useful Links

Southwark Information Advice and Support Team (SIAS)

Common Assessment Framework | Southwark Council

NHS Right to Choose

Information about NHS Right to Choose and available NHS-commissioned providers can be discussed with your GP or other appropriate referrer.

Contact Details

Southwark Information Advice and Support Team (SIAS)

Tel: 0207 525 3104
Email: sias@southwark.gov.uk