Medication for ADHD

 

The journey from diagnosis to receiving medication for ADHD is complex and difficult for most people, so it is important that you understand that this is not as simple as getting a prescription from your GP and filling it like you usually would.

 

SHARED CARE AGREEMENTS

 

Obtaining shared care agreements for ADHD medication in Scotland can be challenging, particularly for individuals diagnosed privately. Shared care agreements (SCAs) involve collaboration between a patient's GP and a specialist, allowing the GP to prescribe and monitor medication while the specialist oversees the treatment. However, several factors complicate this process:

 

  • GP Discretion and Refusal

GPs are not legally obligated to enter into shared care agreements. They may refuse if they lack confidence in managing ADHD treatment or if they feel the agreement places undue responsibility on them. This is particularly common when the diagnosis is from a private provider, as some GPs may require re-assessment by an NHS psychiatrist before agreeing to shared care.

  • NHS Policy Restrictions

As of June 2024, many GP practices in Scotland have ceased accepting shared care requests from private healthcare providers. This policy shift is due to concerns over funding and the expertise required to manage ADHD care effectively.

  • Regional Variability

There is significant regional variation in the availability and acceptance of shared care agreements. Some areas have well-established protocols, while others do not, leading to inconsistent access to care across the country.

 

Financial Implications

 

When a GP refuses to enter into a shared care agreement, patients may be required to pay for prescriptions privately. This can be financially burdensome, especially since ADHD medications are often not available through NHS prescriptions without a shared care arrangement.

 

Some NHS regions, such as NHS Highland, are still in the process of developing clear shared care protocols for ADHD treatment. This lack of standardization can lead to delays and confusion for both patients and healthcare providers.

 

Patients diagnosed privately often face additional hurdles, as NHS services may require re-assessment before agreeing to shared care. This can lead to extended waiting times and continued private treatment costs.

 

What does this mean for you?

 

Before you engage in assessment for ADHD, it's important that you try and explore what your options will be if you do indeed receive a positive diagnosis:

 

INITIALLY:

 

  • Firstly, speak to your GP and ask if they accept private diagnoses - some may not do this or may require more information about whom has been your assessing clinician if they are not within the NHS.  Always ask anyone you are considering to assess you, for their registration information i.e. their HCPC membership number, whom they are regulated by (which professional body) and how long they have been certified as a diagnostician for ADHD.  

 

  • Secondly, ask your GP whether they agree to support Shared Care Agreements - some GP's may, but never assume!  If the GP refuses to support this, then you can ask that they explain in writing why they have made this clinical decision.  At times it can be best to speak to the practice manager to determine whether it is just the GP you have spoken to thatb is refusing or whether it is a practice rule - there may be another GP within the practice who will consider.  

 

  • If the practice refuses to assist you, you can go onto their ADHD pathway waiting list - IF they have one - not all regions have a neurodevelopmental pathway for ADHD (especially for adults).  If you dod ecide to go onto the waiting lists, be prepared to wait for a long time - in excess if 4 years is standard in Scotland at the moment.  The plus side of doing so, is that you may be able to be referred for support in the meantime i.e. assistance from Occupational Therapy through your Community Mental Health Team.

 

  • You can write to your MP about advocacy and concerns for provision.  Check who your local MP is here.

 

  • Consider factoring in the cost of paying for a private prescription yourself - Please be aware that costs vary greatly depending on where you are and who is providing your prescription. 

 

  • If you reach out to a private prescriber, you will need your diagnostic report which states your diagnostic outcome, a copy of your medical summary (which includes your medications and medical history from GP) and they may also ask you to complete some questionnaires prior to your appointment.  Please be aware that you will need to give your GP advanced notice if you need this and may be asked to submit a Subject Access Request (SAR).  This can take up to 7 days, so schedule this well in advance of your titration consultation to ensure you have everything you need to leave with your initial prescription.

 

  • Contact your local pharmacy and check if they current stock or manage prescriptions for ADHD - most are likely to, but they will be able to advise you how long you may have to wait for them to order these once you have given them the physical prescritption.  Please note that pharmacies are unable to accept emails or digital copies of your prescription as the medication for ADHD is a controlled drug.  They require the physical copy, signed and registered with appropriate health professionals.