ADHD/Autism Assessments and Prescribing in General Practice

The waiting lists for Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) assessments on the NHS are currently several years long or the services are closed to new referrals. 

As a result of this many patients are choosing to get their assessments done privately or asking for a referral under the right to choose scheme. 

Before getting a private assessment, it is very important that you familiarise yourself with our policy on prescribing following a private diagnosis. 

ADHD and ASD are specialist fields and therefore GPs cannot start patients on treatments for these conditions. If medication is deemed necessary, it should be initiated by the specialist. 

Shared Care Prescribing in the NHS

On the NHS, once a patient has been well established on a stable dose of their medication (usually after a period of least 3 months) the consultant may ask the GP to take over prescribing of the medication as part of a ‘shared care’ agreement. As part of this the GP will agree to support the specialist by providing physical health checks at regular intervals as well as issuing the monthly prescriptions. The specialist is also required to keep the patient under their care and review them at least annually.

If this does not take place or if the patient does not attend their physical health checks, the GP cannot safely prescribe the medication and will therefore end the shared care agreement. 

For GPs to agree to shared care it is essential that we are satisfied with the following:

• An appropriate diagnosis has been carried out, in line with NICE guidance, by a specialist psychiatrist, paediatrician or other appropriately qualified healthcare professional with training and expertise in the diagnosis of ADHD or ASD
• A full clinical and psychosocial assessment has been carried out
• A full developmental and psychiatric history has been taken
• An assessment of the patient’s mental state has been recorded
• Any possible contraindications to medication have been considered such as past medical history, family history, substance misuse and other medication use/drug interactions
• Pre-treatment physical health checks have been completed such as height, weight, heart rate and blood pressure. A pre-treatment ECG may also be needed in some cases.
• The medication is listed in the Oxfordshire Formulary (see Oxfordshire Clinical Commissioning Group  Formulary) as being appropriate for prescribing in primary care.
• The specialist gives assurances that they will continue to provide ongoing monitoring. This includes monitoring of appropriate physical observations, ADHD /ASD symptoms, psychiatric status and potential for misuse and diversion of medication.

GPs are under no obligation to agree to shared care. If we do not have adequate evidence of all of the above, we will reject the shared care agreement and advise that ongoing prescriptions need to come from the specialist. 

Prescribing following a private diagnosis

Shared care agreements are only applicable within the NHS and national guidance makes it very clear that for reasons of safety and equity, the private and NHS sectors should be kept separated as much as possible. It can’t be assumed possible to “pick and mix” parts of care from each. 
If you choose to go privately, this means that you should not rely on the NHS sharing ADHD care (and costs) at any future date. If we are not familiar with the service you have seen and cannot be assured that all the principles of shared care have been fulfilled (and will be adhered to in the long term), we will not agree to take over prescribing of any medication the specialist has recommended. Please also note that requests from private providers for physical health checks to be done on the NHS as part of a pre-treatment work up will be rejected as these should be done by the private medical service. 

Due to these reasons, we would strongly encourage you to contact us first before referring yourself for an ADHD/ASD assessment to let us know which private service you intend to use. If we are not familiar with the service, we would advise that you research the service thoroughly to ensure that they provide the quality of assessment needed for shared care to be considered. If the assessment does not reach the required standards, ongoing prescriptions on the NHS will not be possible.

Therefore, please do consider from the outset that you may need to pay for all of your medication privately in the long term. It is therefore very important that the private provider fully informs you about these costs. You also need to be prepared to pay for ongoing private appointments for your medication reviews up until the time that you have received a specialist review on the NHS (assuming you have been referred for one). 

Please note that receiving a private ADHD or ASD diagnosis will not reduce wait times or result in a faster assessment on the NHS. You will therefore need to be prepared to continue to pay for private appointments or prescriptions until you have had your specialist assessment on the NHS (assuming shared care with general practice is not applicable). 

Right to Choose Referrals

Certain private companies have been commissioned by the NHS to provide ADHD/ASD assessments and you can ask to be referred to these by your GP under the NHS right to choose (RTC) scheme.
Under the NHS RTC, you will not have to pay for your assessment and treatment as this will be covered by the NHS. Please note that if you self-refer, RTC does not apply and you will be required to pay.
Please note that if you are already on the waiting list for an NHS assessment and would like to change to a RTC provider you will need to contact the NHS service directly to ask that you are removed from their waiting list before any RTC referral can be completed. This is because you cannot be on two waiting lists for the same service.

If you are interested in being referred for an assessment under the RTC scheme please contact us and ask for further information on this. We will then send you a list of services that are available as well as a list of essential criteria to check. Once you have let us know which service you’d like to be referred to, we will ask you to complete any necessary self-assessment forms and arrange a GP appointment to discuss the referral.