to ask what shared care regarding ADHD actually means?

[ADHDnewbie]

Very confused at the moment!
DD 13 years old is about to start Concerta XL
The private clinic is closing down soon due to retirement so whilst our GP has agreed shared care once he is stable ( approx 6 months time ) does this mean I now need to find another private DR / clinic to oversee the medication just to get the GP to write the prescription?

Shared care means the care is shared.

The GP will not be happy to prescribe if you are not having regular checkups by a specialist.

What if the dose stops working for your child?

What of there is a shortage and you need an alternative?

What if you notice side effects once your child has been taking the medication after a few months? GP can't adjust the dose. And any decent GP would not prescribe if you aren't under follow up.

You’re not on one dose of meds l for your entire life, as your daughter grows/hormones change/life changes occur she’ll probably move up or down dosages so need to see psychiatrist yearly if not twice yearly. At some point she maybe stop taking concerta and switch to a different medication completely.

Also medication isn’t a silver bullet you need coaching/therapy to go hand in hand with it.

I understand all this but the GP mentioned nothing of the sort - she said once she had been stable for 6 months then she would be happy to take over as long as the dose was consistent.
She knew the psychiatrist was retiring and didn’t say I would need to find another.
Luckily the trials will all be done through the private psychiatrist anyway as she’s not retiring until next summer but I wonder how easy it will be now next year to find a consultant to oversee DD just to give the go ahead to the GP

Under the shared care arrangements we had the consultant prescribed the dose then the gp issued monthly prescriptions, gp couldn't change the dose. Dd had monthly sessions with the specialist nurse who worked with the consultant. Everything was nhs though, through camhs. The gp couldn't alter dose or meds only the specialist team so you will need a specialist, state or private. Can't you get an nhs referral? Does your dc meet the criteria in which case you should be able to get something in place

I'm surprised you could find a private consultant for under 18, we couldn't find any when my dd was a teen, thankfully we got camhs help after about 6 weeks (took a lot of calls) she was self harming so urgent. I tried private hospitals and clinics, none took children, said only camhs prescribed.

It’s because she was diagnosed privately so that’s the psychiatrist currently overseeing her start of medication.

CAHMS to assess her completely from the start will be about a 3 / 4 year waiting list!

Or can they take it on just for medication issues when medication is already in place?

It's not 'shared care' if GP were to be doing this without consultant overview - there would be no-one sharing the care and it's outside of the re-mit of a GP

You'll need to find a new private psychiatrist to take over when your current one retires - private providers are beginning to limit taking on new cases because of the high demand/backlog so maybe you'll need to start looking soon/now

As your DC is only 13 it's a good idea to get them on the waiting list so that there is an end point to paying for their treatment

Sorry the waiting list in my last para is the CAMHS waiting list

I was told that they might take my child on as an out patient rather than re-diagnose for the consultations however I am still waiting on the list (expect to be seen next year)

I’ll try and get through to CAHMS to ask their advise - I was on hold for over an hour yesterday

Thank you for all your advice

Definitely - my costs are now the private consultant appts c£150 ish twice a year - paying for the meds was brutal on top so at least that's only for 6 months

My child was referred via school about 3 years ago and I used that form to arrange my private appt - then they used their questionnaires

If you're phoning CAMHS about going on their waiting list - not all CAMHS will take self-referrals so probably save some time by going via your GP

My DD was seen by a private psychiatrist.

He then adjusted the meds and she saw him for about 6 months, her GP took on shared care so her prescriptions were NHS.

She stopped seeing him after about a year and the GP was prepared to take over. The private practice has now closed down and she is still being prescribed her meds by the GP.

Octavia64 - I have PMd you

Shared care is med reviews with private clinicians but the nhs prescribes via the GP.

The GP is acting against all guidelines, and your daughter is getting poor care.

I think there is a timing issue here. As others have said, a specialist needs to take responsibility and this can be either private or NHS.

However, personally, I would be tempted to ask the GP's opinion, but not for several months until GP prescribing is routine. Some GPs may advise you to find another private provider, but others will refer to the NHS.

The specialist doesn't need to be a Psychiatrist - some nurses are also specialist practitioners and many offer meds reviews online if clients are able to do their own observations.

Finally, you could ask your retiring Psychiatrist. They maybe able to signpost to other local services.

Many GPs won't share care if the diagnosis wasn't made by a psychiatrist

Many GPs won't share care if the diagnosis wasn't made by a psychiatrist

Do you mind if I ask a bit more about the reasons for that? is it because they are concerned the diagnosis doesn't meet DSM-5 or a simple GP not trusting a non-medical practitioner?

In practice, most of the better private services have an MDT approach and although the service is Psychiatrist led, the reality is that most meds reviews are done by other clinicians. I should add that I work closely with a service that offers shared care and have not come across Nurse Practitioners being a reason for saying no. (but I accept it may happen).

Is she on the NHS list for diagnosis? That would be easiest (but could be a very long wait). Then you share between the GP and the NHS consultant in the future.

Diagnosis needs to be done by a doctor. Otherwise it's not differential.

But that isn't NICE guidance?

Medicolegal responsibility lies with the prescriber and there is lots of concern about the accuracy of non-medical diagnoses, and how much responsibility the diagnoser can take, whether they have fully considered other co-morbidities etc.