Are most GP's stopping shared care for ADHD?

[Milmoe]

I am thinking about seeking a private ADHD diagnosis so that I can get some help. I am almost certain I have this condition and I want to get help before I completely waste any potential that I have. I did ask my GP about it some time ago but they were quite dismissive.

I have heard about people being able to pay for a private diagnosis then they are able to get shared care via their GP's for their medication long term. However I am also hearing now that lots of GP's are now doing a blanket refusal on shared care for ADHD and are even ending shared care agreements that have stood for years.

I can barely afford the diagnosis and would not be able to pay £100's monthly for my medication so if there is no chance of shared care via my GP then their would be little point in seeking a diagnosis except for perhaps being able to access some in work modifications.

I just feel so hopeless, the medication for ADHD seems like my last hope of a normal life but it seems I will never be able to actually access it even if I was diagnosed.

I havent suggested any scenario actually, you keep confusing me

I dont know how it works for adults but for children we have terrible problems with accessing medication in a timely way because its not via the GP, CAMHS often dont have a psychiatrist working with them, dont have appointments, cancel appointments, it causes massive delay. I can see that occuring if the need is to keep going through the dedicated service.

Well I meant that the original consultant did the first prescriptions in both cases and now the GP does that.

Not talking about private, but I still dont see the difference between a specialist department (ENT, neurology) prescribing/diagnosis, then GP picking up my regular ongoing medication. I dont have reviews or check ups either with the original consultants or the GP, but if I needed a review the GP may do this I assume, Im not sure. So an NHS ADHD departement, why is it not the same as any other condition?

I can see this having huge repercussions in people being able to get their meds, we have it bad with children at the moment in any case.

You shouldn’t be. We don’t. If they have been prescribed a hard to get drug there will be problems but even with that our psych switches to the break down of the dose so they might take several pills instead of one for the same amount. My daughter switched brand for an easier to get one too. Had no issues at all for some time.Our NHS psych said the problems with the main hard to get one was alleviating too.

No I haven’t confused you this time. You have to keep on top of it. No point contacting whichever service you’re under the day before you run out. We also used to ring the pharmacy to check it was there in order to avoid a wasted trip and will revert to that when it goes back to the consultant. If they didn’t have the med we were after the psych switched to a different unit amount very quickly. Everything is done electronically.

Issue with shard care are cost and more importantly first line medication is a controlled drug that needs careful monitoring by person who diagnosed adhd. The dose needs titrated by weekly then monthly appointments then there's constant weight monitoring, bp monitoring regularly (GP literally just write the prescription they are given they dont do this) so unless the GP knows this monitoring is def happening (which can't be guaranteed with private provider) then they won't do shared care as they are ultimately responsible for the prescriptions they write

Some treatments, presumably like the one from ENT, the specialist can say ‘take this don’t need to see you again’ but others like ADHD it’s not safe to . It’s just the way it is unfortunately.

If you require support in work, you do not need a diagnosis to get the support. Your employer has a legal responsibility to put reasonable adjustments in place regardless of whether you have a diagnosis.

We do keep on top of it, but very difficult when a medication revew is booked, review cancelled, rescheduled, medication not prescribed and renewed because the review hasnt taken place, or more common the medication is having a negative effect/side effects and need urgent review before changing to something else and you just cant get an appointment, or child moved in an emergency to another NHS trust area and only has 2 weeks left of meds and you cant get a represcription, the list is endless of why there are problems here

I might ask for a review to be honest of one of them, Im on quite a strong drug for epilepsy although I dont have epilepsy, its never been reviewed. 3 years now.

Mine hasn’t. Took it on last month. It saves us £95 pcm to be able to access DDs medication via an NHS prescription, which is really all they are involved with, but many of the GPs have known her since she was a baby and supported with the co-morbid issues, so perhaps this is why?

But ADHD med reviews are only once a year. Surely any urgent issues would have showed up during the titration process before then. Prior to shared care we contacted the PA of the NhS psych if there were any problems with actually getting meds and he changed the prescription slightly so that they were there for pick up from our pharmacy( which is next to the GP surgery the next day. Considering how snowed under nhs adhd psychs are I really don’t get why they are better placed to do this than the GP.

Ditto with daughter however that didn’t stop her GP from ending her nhs diagnosed shared care.

They're not once a year for children, and children grow, their weight changes (down and up because of the effect on appetite), regular reviews are needed. Children also often stop taking, go missing for long periods of time, mix up other substances which mean that more medical oversight is needed.

Some of our children are extremely stable, others are not and need regular reviews, changing from time to time to different regimes, times of the day, slower release or back to the original, mixing with other medications.

Often camhs are saying 'we're waiting for our psychiatrist to start' and that wait can be ages. Meanwhile there is a part time duty psychiatrist that doesnt have any availability.

There are going to be cuts and it does seem adult ADHD services are in line to be cut

Of course it can be guaranteed it's happening with private providers, the nhs uses most of them for Right to Choose! Private providers who are registered nhs providers follow NICE guidelines and patients who are paying those private providers have to submit regular obs, so there's a full record which is passed over to the GP regularly.

Exactly this.

I was diagnosed privately as my NHS GP wouldn’t even refer me to a waiting list for assessment as “they’ll just give you amphetamines and we don’t really advise that” (seriously!) so my employer paid for me to be assessed privately. My private psychiatrist wrote to my NHS GP practice and they agreed to shared care. I now have an annual review with my private psychiatrist (including me sending him evidence of my blood pressure etc) and he sends a copy of his report to my NHS GP practice. Privately my ADHD meds costs approx £140/month so I’m very relieved to have shared care. Paying privately for my psychiatrist is so expensive (it isn’t covered by my insurance) but it’s a lot more manageable than having to also pay for a private prescription for meds as well.

This is GP surgeries increasingly stopping shared care which is separate. I’ve seen nothing that has said adult adhd survives are to be cut.