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

Private companies have performance related pay 😄 I truly have no idea if this is the case in private healthcare, just joking.

I think you are mixed up. The poster was saying private services will misdiagnosed adhd and autism for financial gain. I don't believe that to be true, at least for the bigger organisations because the individual won't benefit from diagnosing you as they'll be salaried or paid by the hour. Not paid per positive diagnosis.

That wholly depends on how you're seeing them. If they're a one man band you're paying them. If they're a big company, which are big business in adhd, you're very likely paying the company, not the clinician. A lot of those clinicians will be nhs clinicians moonlighting I imagine.

If you're paying a lone consultant, yes perhaps there is financial incentive but I imagine it's a small minority of crooked clinicians who would do this. Misdiagnosis someone for financial gain absolutely would risk their registration. Why would it not?

I don't know what you mean. You pay your consultant for the ongoing consultations. Take ADHD for example, during titration you have to see your consultant on average every 3 months, then every 6-12 months. You have to pay for those sessions and that money goes to the consultant. It is no risk to their registration.

Apologies if I’m getting you mixed up. Yet someone here was thinking GPs won’t prescribe because of cost constraints or whatever else, in other words not extending the same thought that they just wouldn’t want to risk their registration or be unethical.

You must remember also some medications are too expensive on the NHS so not licenced but can be consultant prescribed

correct however my consultant was a He in this case

If you take the emotion out of it, the GPs job is to keep you safe (including proper safe monitoring via specialist) and themselves safe (not losing their job, or being subject to demoralising complaints when things go wrong and they’ve prescribed above their knowledge level, or L eaving family without the main earner etc). Don’t look at this in an adversarial way.

True, but who do you think that money is going to?

Because it's not going to the assessor or the prescriber. Because they'll either be salaried and paid regardless, or self employed and payed by the hour.

There is no way that they personally could financially benefit from that, unless they are a one man band I suppose.

But even so, it would be so unethical and so easily uncovered I can't imagine many professionals would risk their registration over it.

Because if they diagnosis you and start you on a treatment plan, you have to have regular ongoing reviews. These ongoing reviews cost £hundreds each time.

Also there's not a financial incentive to make the diagnosis because you would surely pay whether you got the diagnosis or you didn't!

Of course they do! There are some terrible private providers out there but not all. And let's remember a lot of these private providers are employing NHS staff to assess also. Do you think they're professional in one job and not the other?

Bad providers have been highlighted but let's not tar everyone with the same brush, especially those you'd see through the nhs anyway!

How much ongoing input will your diagnosing consultant have? With shared care, there has to be ongoing monitoring between you and the specialist, and ongoing rapid communication between the consultant and the GP. In my practice, if the consultant doesn't agree to respond to GP inquiries within 48 hours and consult with the patient face-to-face every 6-12 months, they will not agree to shared care. You can't just go private to get a diagnosis then present that to your GP and expect them to provide you with prescriptions.

That makes a lot of sense from the GP perspective that it's about the ongoing back up

As an NHS specialist who does not do private work I am afraid to say that there are a number of Wild West private sector providers whose diagnoses and treatment plans I would not recognise.

NHS Drs largely have to prescribe with governance frameworks and agreed guidelines which private Drs don't have to. Some of my patients have absolutely been harmed by paying for dodgy opinions and treatments in the private sector.

There is obviously a financial incentive to make the diagnosis and prescribe the treatment that patient who are paying privately want. Whoever heard of anyone coming away from a private clinic without the ADHD or ASD diagnosis they were looking for?

It was only approved by NICE late last year and it is very closely guarded at the moment due to cost compared to other treatments.

I didn’t go looking for this medication and hadn’t even heard of it until it was prescribed. So no queue jumping or trying to game the system. I really wanted to just come away with a proper diagnosis.

*ThirstyMeeples *

I agree. DD works in a pharmacy and the number of normal weight woman who have been prescribed weight loss meds is unreal - they pay£150 per prescription and there is no way a GP would prescribe these, there aren’t monitored. Makes me wonder what pharmacists think about these prescriptions.

I'm a GP so maybe I can answer this. It's about risk. When we enter SCA, we rely on the specialist being immediately available to deal with results that are abnormal or to help with dose adjustments etc. We are not allowed to prescribe certain medications off our own backs. In the NHS for example, if 1 rheumatologist is on holiday, they have a team that provides them cover.
In private scenarios, we cannot send results to a consultant and expect a response quickly (as often the consultant does NHS work too and isn't available) There's much less likely to be cross cover and the consultant can retire/ leave the country/ drop ded which would leave us with no back up at all and practicing very unsafely.
The patient can also run out of money and decide they're not going to see a secondary care doctor again (again leaving us responsible and really damaging the dr/patient relationship by putting pressure on the GP to prescribe)
So the vast vast majority of GPs decline shared care with private providers as the back up just isn't there and these are usually meds that are beyond our comfort zone (hence why a patient has seen a specialist in the 1st place)
The whole system sucks currently so I get the frustration but it's not a safe way to practice.

I'm going to guess this is ADHD meds.
It's always that.

@StormingNorman what do you mean “too new”? Is it not in the BNF? Does the BNF say specialist only, or have other restrictions? General question, you don’t have to give personal info.

To take the example of melatonin. It’s cheap as chips and available over the counter in many countries in Europe. Yet here it’s highly guarded. I don’t have an answer for this, but the ire is mis-directed IMO.

And what about when the consultant is prescribing in line with NICE guidelines for your local trust and it isn’t morally contentious? The reason the GP gives is price. Equally, they have tried and failed to diagnose and treat over a period of years.

I will be asking my GP to refer me to an NHS consultant but what a waste of money for the NHS to pay for an appointment when I’ve already paid for one. And what a waste of a space on a multi-year waiting list.

I don’t know how ICBs work, but at the end of the day GPs are independent practitioners and you can’t force them to treat you the way you want if they’re practising within their limits.

In my case a number of GPs didn’t know what was wrong and at last count I had seven very similar diagnoses because every time my symptoms changed they added another diagnosis to the list. And I always asked “is this an instead of” but it was always an “as well as”.

That was why I went private (not even private really - Benenden) to get a diagnosis. GPs literally had no idea what was going on and nothing they tried was working.

But I’m now in the same situation as you. The consultant made a diagnosis, recommended a treatment which has literally changed my life and I’ve been told my GP is unlikely to repeat the prescription because it’s too new and too expensive. £230 per month. So my only option will be to pay out of pocket. Which I am fortunate to be able to do, but frankly, why should I?

I have read the thread, op has clarified that's the case. Have you read the thread?