To ask if you've ever successfully challenged a GP refusal to prescribe under a shared care agreement

Instead of understanding that people going private are saving the NHS time and money, the default reaction is to want to penalise them for it.

TBF this is similar to the hatred against private school parents, even though they save the country £££.

Really? To justify their poor behaviours?

Wow. I mean just wow.

Plan of action:

1. Complain to pals
2. Go through GP complaint process
3. Meet with your MP
4. Ask your consultant to prescribe and put you on her NHS list
5. Don't kill yourself

Nhs can agree sca's with someone diagnosed by another hcp that isn't a psychiatrist. The problem is they can do what they like so even if it's a perfectly legit diagnosis, the sca is watertight, your GP can still say no because they simply don't want to.

Causing issues for the patient, a waste of resource for the nhs service by reassessing someone who already has a diagnosis.

Is it for ADHD? If so, there have been concerns about private psychiatrists (or even other professionals) being quick at diagnosing it. Considering how expensive it is to go through the assessment privately, how many patients would be really pissed off to then be told that they don't have it!

Privately, those consultants don't have to follow any specific guidelines and are not being regulated on their rate of diagnosis. They can diagnoses what they want to all their patients.

It is sad to say, but they are clinicians out there who are really in it for the money.

This is why policies have been introduced and GPs have to adhere to them.

I agree that it is a real pity for those who are genuinely seriously affected by the disorder and cannot function without medication. Don't blame the NHS though, blame the new cultural trend that sees everyone wanting a diagnosis, ie. excuse to justify their poor behaviours.

That's not true either. A Dr or an registered prescriber (so could be a nurse prescriber) can prescribe as long as they're experienced in the field.

Which is why a gp can't prescribe off their own back. They're controlled drugs.

It would be completely illegal to pay someone based on the amount of positive diagnoses they make.

Sorry, I meant for GP/shared care medication needs to be prescribed by a doctor i.e. consultant psychiatrist. I was just confirming that it's not only psychiatrists who can diagnose ADHD.

Yes and no. It can be diagnosed by a range of HCP. Many other HCP can also prescribe if qualified to.
The issue can come into play if they want to slot in to a NHS SCA agreement which states diagnosis by consultan paed/psychiatrist.

Nope. A range of professionals with the appropriate training can diagnose ADHD. But only a doctor can prescribe medication.

I have a shared care agreement with a private provider. If I’m not reviewed by the Consultant, the shared care agreement will cease.

People absolutely do come away without diagnosis. I know of several.

I’m not sure this is true. ADHD requires a Consultant Psychiatrist to diagnose regardless of nhs or private?

I have a shared care agreement between a private Consultant and NHS GP

Sometimes the diagnosis is not the same as it would be on the NHS. ADHD for example would be diagnosed by a paediatrician or psychiatrist on nhs but private providers it could be an AHP (nurse, pharmacist for example) this has caused issue with’right to choose’ diagnosis. As SCG usually stipulates diagnosis by consultant and with that person available for escalation if required. If the diagnosis bit does not ‘match’ then you can’t really progress anywhere.

"However if you have sought private treatment you can't have an expectation that the NHS will automatically start picking up the tab for ongoing treatment that was started in the private sector. "

I disagree with this. A lot. Trying to think of a good example. ADHD? Or ASD is a good example? Ok, so some private consultants might diagnose because it's in their interests. But then you want an nhs diagnosis, because it's considered to be the gold standard.

But you should then be able to go back into the nhs. Actually you should be entitled even more, because we've now established that you actually have the condition and need the medication. Can you not see the irony? I can!

You only went private in desperation because the nhs is failing. You of all people should be allowed back in.

I would pay privately if I needed to for something serious for me or my family

When my mum ran out of NHS options for her breast cancer treatment and there were new drugs available that had a good chance of helping but didn't have NICE approval for her age and stage we as a family paid for her to have them privately. She used up all her savings for 6 months treatment. They didn't seem to help much tbh so maybe NICE were right but anyway I understand and have empathy with wanting to pay.

However if you have sought private treatment you can't have an expectation that the NHS will automatically start picking up the tab for ongoing treatment that was started in the private sector. The GP might choose to do that but they are within their rights not to. They are likely to do it if it's a standard primary care medication that is being recommended they are unlikely to do it if it's a secondary care only medication. Otherwise the GP could find themselves being instructed to prescribe lots of strange things that they don't ethically agree with. There are some private practitioners with some odd ideas out there.

A shared care agreement isn't just the consultant writing a letter saying 'GP prescribe that'. It is an actual written agreement saying what each sides responsibilities are. GPs might choose to enter into shared care agreements with some private providers and not with others.

Sometimes GPs refuse to prescribe things that I have recommended as an NHS consultant BTW but because we have a long term working relationship we usually figure things out.

Exactly as Hollyknight says the consultants are the business. It is certainly in their interests to diagnose people.

ADHD is a rather speculative matter. It's a spectrum condition so it just depends where you put the cut off how many people you diagnose. It's not like there's a scan or a blood test you can diagnose it with. It would not be some kind of registration risking issue to make a few soft diagnoses it's just a difference of opinion.

There's a whole Panorama programme about it.

www.bbc.co.uk/programmes/m001m0f9

I don't know what the condition that the op has, but my DD has adhd and her gp was happy to do shared care with a private consultant.

This was after she was diagnosed privately and had six months of private prescriptions and titrating to get the correct dose.

The expectation was she went back to the consultant if the dose needed changing and she has done that twice.

She's now changed GPs as she moved. The new one doesn't do shared care so she's paying 60 quid every two weeks.

(She has multiple physical and mental diagnoses and uses a wheelchair).

Obviously she'd prefer to just pay the NHS prescription charge but getting that seems to involve getting re-diagnosed on the nhs with multi year waits, so in the meantime we pay.

We have experience of multi year waits as she dropped out of school due to severe illness and we had to get seen privately to even get investigated. She has an auto-immune condition which requires lifelong meds but thankfully despite the private diagnosis because it is easily confirmed using blood tests all her GPs have been happy to take over the prescriptions.

Private clinics are profit-making businesses. They are usually owned by the consultants who work there. They aren't working for a big company...they are the big company. Just look at Psychiatry-UK - probably the most popular private online psychiatry service carrying out ADHD assessments in the UK right now, right? Their consultants are partners in the business. So it is to their benefit as a business and as individuals to diagnose and set up treatment plans for as many people as possible. Some clinics even give commission-based bonuses. And many consultants have their own private businesses where they will see patients.

It's not unusual for consultants to work for the NHS, and out of a private clinic, and see private patients on their own.

My surgery accepts shared care but not for private diagnoses of ADHD or ASD.

The ADHD clinic said it's because they feel an NHS diagnosis is the gold standard. In other words they don't trust some private diagnoses.

It is really difficult. The NHS offers either the 2 week wait - very impressive and efficient IME. Or, the standard pathway which could be weeks, months or years, or even just
"computer says no". I got the last option a few years back and in desperation I contacted my MP. Somehow she got me an appointment and I moved up to the few weeks option. I was then diagnosed with something quite serious and became very unwell quite quickly. If she hadn't intervened I might have had to scrape up the money to go private, get my diagnosis, then what? It is really hard to navigate and I don't blame anyone for trying to get help any way they can. OP I am sorry you are in a difficult situation. I hope you manage to find a way through.

I agree with @StormingNorman and disagree with @MitskiMoo :

MitskiMoo
Honestly, it sounds like you thought you could beat the system because you could afford the private consultation. This used to happen a lot, especially with operations. They paid for the private diagnosis then jumped the queue. It's either/or, not both.

Beat the system? You mean try to get healthy and live a full life?

Trying to Make me feel bad? As if I'm cheating the system? For paying to see someone?

Op hasn't said what her condition is. And this is AIBU. As a pp suggested, she'll get better advice from others experiencing it if she posts exactly what condition it is , in health section. But not the traffic of AIBU.

But. May I encourage some sympathy and empathy from all.

If you've ever had a medical condition or been in pain then you'd know that it can be so all consuming that you'd do just about anything.

Why wouldn't we pay, if we could afford to, privately, if the nhs is failing us. You'd be a bit silly to not recommend to a friend that she doesn't at least consider going private, if she can afford to, to get say a pain killer if in bad pain. Shame nhs forces us to, but needs must.

I paid to be seen privately for a broken back in 4 places, when nhs made so many bodges my care was poor over the last 2 years. I'd pay again, believe me!!

My friend paid privately for meds, and an adhd and ASD diagnosis, all the family had been badly affected when the dd hadn't left the house for months, and the nhs waiting time has just changed from 2 years. To 8. Yes, 8 years. You wouldn't pay? Get real.

Or at least appreciate that some conditions are so awful, the pain so bad. For certain conditions. If you can afford to, it's a shame we have to. But why would anyone NOT say try and get some sort of pain relief. Eg go to see a £60 physio privately whilst waiting for nhs ? You'd be mad not to! If you can afford it.