Private/NHS Titration query

[Verbena17]

Adult DC has just been diagnosed with ADHD.
Assessed privately through an ADHD assessment company (all above board) who have just announced they’ll going to be taking on NHS assessments.

So, we’ve just had DC’s report through & all the details about medication titration, how it works if DC chooses to try it, cost for 12 weeks (nearly £500).

But now I’m thinking that seems mighty unfair that their NHS clients surely won’t need to pay for titration.

I understand we chose to pay the £300 for the private assessment but surely charging private patients for titration now they’re going to be doing NHS work seems strange.

Anyone ever swapped to an NHS psychiatrist after private assessment in order to not have to pay for titration and if yes, how do we do this?

As I understand it, if you get your diagnosis privately you would need to establish a Shared Care Agreement with your GP. You can approach them, but not all GPs are willing or able to enter into these agreements if the diagnosis wasn't through the NHS.

When I first spoke to my GP about getting a diagnosis, they told me this and essentially said if I went private I would be on the hook for paying for my medication, which is why I went down the Right To Choose route instead.

What’s the Right to Choose route?
Could DC just go to their GP and ask about being referred to an NHS psychiatrist who could then medicate….either get DC back onto antidepressants or ADHD meds?

My DD was assessed privately.

She then was prescribed and titrated privately.

She then was able to get her GP to do a shared care agreement.

I'm not sure "swopping" to an NHS psychiatrist is a thing.

She ran into problems 5 years later when she changed GP and the new one would not of shared care.
As the old psychiatrist had left the private outfit she got diagnosed with she had to have a "rebooking" appointment with a new one.

Each psychiatrist is personally responsible for the drugs they prescribe, and they are generally reluctant to take over patients without having seen them.

@Octavia64 but DC was assessed through their online service and it was with a mental health nurse, not a psychiatrist, so the prescribing psychiatrist wouldn’t have seen DC anyway 🤔.

It seems very strange that it’s not possible to switch back to the NHS, when the assessing private company will be assessing NHS patients anyway.

You can ask to be referred to an NHS psychiatrist but expect a long wait. You can’t just switch between the two as it’s like queue jumping

Yeah tbh it wouldn't feel very fair if people who paid for a private diagnosis then got to jump the queue into NHS prescriptions- there's a long enough wait for titration on the NHS as it is (I have been told that after my assessment in Jan, assuming I get a diagnosis, I can expect a further 7-9 month wait for titration to start).

Of course in an ideal world there'd be enough medication for everyone who needed it, but the reality is there isn't.

Right To Choose is your right to choose which provider does your NHS assessment- I chose Psychiatry UK. You could do this, but your DC would have to start from the beginning to get an assessment this way- I have been on the waitlist for a year, and as I say my assessment is in Jan. I believe there are other providers now who are quicker, but you'd have to investigate this.

Nightsong has it. It's basically considered queue jumping.

I'd pay for the private titration, the private prescription and let your GP know that is what you are doing and you'd like to eventually move to a shared care agreement.

Thanks everyone - what a nightmare!
We have bupa health care but annoyingly, this year, DH’s company removed the ASD/ADHD assessment part without us realising.

Then I found CareADHD, the chair of which is Professor Tim Kendall - who actually wrote the NICE guidelines for ADHD assessment and now we find ourselves here. We promised DC we would pay for a private assessment and didn’t know about the titration issue before getting the diagnosis report back this week.

So with a Shared Care Agreement, does that mean you don’t have pay for private prescriptions?

It does seem a bit naughty however, that the private company did not inform us when we booked literally a week before their social media announcement, that they were going to be doing NHS referrals.

A shared care agreement means that the nhs gp will share care with the private psych.

So they will prescribe on the nhs but if you need a meds review or re-titration for whatever reason it goes back to the private company.

Of course they wouldn't inform you, they'd rather have your money.

Even if they had, an NHS referral has a much longer waitlist than a private assessment. Would you have waited?

But there will be a NHS waiting list for referrals? You seem to be assuming that you'd be seen straight away under the NHS which wouldn't have been the case.

You get assessed privately, you have to titrate privately also. And after that your NHS GP may accept a shared care agreement or they may not. Plenty don't. You need to be prepared to pay for meds and future psychiatrist appts privately when you go down the private assessment route. Did you not research any of this first?

Yes that’s true - we would have had a much longer wait.

I did research it first yes, although I didn’t completely understand the titration part I guess.

However, I also assumed that the private adhd assessment system would be just like the private MRI/s an system - where you can pay to have a private scan or consultation etc and then (as they say in their own words) switch back into the NHS system with no probs.

We had a nightmare with DD. The GP refused to prescribe the medication the private physiatrist did, and would also not accept the private report and diagnosis. It cost a fortune and was a complete waste of time

Ok thanks @Octavia64 . That’s very helpful.

Me and DH are actually hoping DC chooses to try Escitalopram first instead of adhd meds. Until spring this year, DC had been taking Citalopram for years but weaned themself off. Just before this adhd assessment they said they might consider trying Escitalopram as it’s supposed to be really good for anxiety, which DC has due to their adhd.

It’s ridiculous- I’m so sorry to hear that happened.

The problem is not all NHS authorities do 'shared care'. My DS was assessed privately and we are having to pay for a private GP to prescribe his meds and then pay again for the private prescriptions. It's hugely frustrating as the person who diagnosed him privately also works within the NHS half the week, but the diagnosis still isn't accepted....

I might be misunderstanding but has your DC seen anyone face to face?

An online assessment by a mental health nurse is not the same as a psychiatrist making a diagnosis. In my experience the RMO (responsible medical officer) is the one who will prescribe as it is not within the nurses remit.

I appreciate you may have seen an RMN who has prescribing responsibilities but it is unusual not to have been overseen by a psychiatrist or met face to face before a prescription or medication is discussed.

Just be mindful with regards to shared care agreements for those areas that do them, lots of GPs are currently “working to rule” and not doing any new shared care agreements for all sorts - diabetes, dermatology, rheumatology etc. and that’s NHS (hospital) to GP! Not even private. Our rheum and derm services are about to completely fall over because of it, we can’t bear the brunt of the work the gp is no longer (quite rightly) doing.
not sure how long it will last though!

The private assessment clinic is Care ADHD and currently their assessments (that are all carried out in line with NICE guidelines for ADHD & written by the chair of the company, Professor Tim Kendall), are all done online via Teams.
As well as being NICE compliant, they are registered with the CQC.
The official questionnaires are all completed prior to the formal assessment and a second person who knows the person well, also has to complete 2 questionnaires.

Whilst the mental health nurse is fully trained to carry out the ADHD assessment, I assume the prescribing is not.