GP refusing to treat adult ADHD

[WhereTheNorthwindGoes]

I'm asking this question on behalf of a friend. Would be very interested in hearing from GPs or health professionals.

Basically she is an adult who has long suspected she had ADHD. She went to a private psychiatrist to finally get a diagnosis. The psychiatrist prescribed Vynase which she was to give to her GP.

Her GP has refused to prescribe it or treat her ADHD. She cannot go to another practice as she lives rurally and this is the only GP that serves her area.

She queried this with the practice manager. She has received a phone call from the admin staff - not the GP - confirming they will not treat her ADHD. She hasn't been deregistered.

What she wants to know:

1. Is it normal to refuse to treat privately diagnosed patients? I am guessing the drug being controlled has something to do with it?
   
   
2. Is it normal for the admin staff - not the GP who could explain why and offer alternative solutions - to make this call to the patient, with access to medical records?
   
   She is in Northern Ireland, if it makes a difference.
   
   Many thanks

[ThisIsStartingToBoreMe]

Yes to both questions I'm afraid.

Why doesn't she just get a private prescription from her clinician and use that?

[catgotyourbrain]

Dh did as your friend did and the GP then referred him into the mental health service so they could prescribe the scheduled drugs. GPs have to have consent to prescribe them. I would escalate up.

FWIW anyone reading what we did: find out which NHS clinic would likely assess you. Look up the practitioners there. Look up their private practice (most do private clinics). Beek that person to assess privately. Then you will have seen the same person you would have if you had sadly had to wait 3 years for assessment.

Phrases to bandy about: the undiagnosed ADHD is affecting your job prospects severlely, relationships severely. If you have a conviction this may swing it too (many, many prisoners have ADHD or undiagnosed ADHD)

[catgotyourbrain]

Thisisstartingtobore me because she'd have to get a private prescription monthly - £££££

[Wombat64]

My GP won't prescribe either. Would need to be reassessed by the local cmht. Not doing that, as they will be overstretched.

It's all a lottery.

[ThisIsStartingToBoreMe]

@catgotyourbrain

Thisisstartingtobore me because she'd have to get a private prescription monthly - £££££

So? How much is it anyway?

[chinateapot]

Yes normal. No doctor should prescribe something outside their competence. The GP is unlikely to have enough experience managing ADHD to safely prescribe this - it’s something that would usually be managed in secondary care. It would be reasonable to ask for a referral into NHS services for ADHD but sadly that’s likely to take a really long time

[4PawsGood]

“ThisIsStartingToBoreMe

catgotyourbrain
Thisisstartingtobore me because she'd have to get a private prescription monthly - £££££

So? How much is it anyway?”

Googling would suggest about £300 a month.

[CrashBank]

Having just been through this myself, unfortunately, the GP can refuse a shared care arrangement and insist on a diagnosis through the NHS service (6 year waiting list in my part of the UK).

If your friends psych is willing to continue prescribing privately then she’s looking at ongoing costs of £25-£40 per prescription, and £70-£120 for the Vyvanse from a pharmacy. The supermarket pharmacies (Tesco, Asda) are far cheaper than the private or chain pharmacies; I was quoted £220 for 1 month of 20mg Vyvanse by the pharmacy at the end of my road, and ended up paying £68 in a Tesco pharmacy. It’s well worth ringing around and getting prices from a few places.

[KOKOagainandagain]

DS2 was observed by a specialist NHS nurse at the request of comm paed and provisionally diagnosed ADHD with a recommendation of meds. I thought he was too young for meds are that this would confuse the ASD that he was being investigated for. They seemed to think it was either/or.

At 14 his GP refused to give medication as he was not officially diagnosed and referred him to CAMHs. I waited 6 months with no progress and then went private (PUK). His consultant did private prescriptions until dose was stable and then wrote to GP to take over prescribing. Which they did.

Not all GPs will. You need a private provider with shared care agreement and escalate up if necessary.

[LemonRoses]

Get a private prescription and buy online - its quite cheap.

[Lou324]

Hi sorry I know this post was a few months ago but did your ever get this sorted as I am in the same situation but for bipolar.

[Kitkat151]

Yes completely normal... she should get a private prescription

[leavesthataregreen]

@LemonRoses

Get a private prescription and buy online - its quite cheap.

How do you know a reputable source?

[Warmduscher]

@Kitkat151

Yes completely normal... she should get a private prescription

What about adults with ADHD who can’t afford hundreds of pounds a month on a private prescription? Is this another case of poor people getting a worse service than rich people?

[Kitkat151]

@Warmduscher they would need a referral to an nhs service then there would be an agreement in place for the GP to be able to take over the prescribing from secondary health services. As OPs friend had accessed private healthcare in order to get a diagnosis I assumed they would be able to afford the prescription..... so I’m sorry if this isn’t the case.

[Doorhandleghost]

GPs have a personal liability for prescribing if it goes wrong, they can decline to prescribe if they wish. As we have a long and established relationship my GP was reluctant but willing to prescribe when I’d been through private MH services because NHS services were too slow, but asked the private psych for lots of extra info to get to a place where he was happy with it. The psych also made it clear that my GP might not want to pick it up and I might need to pay for ongoing private prescriptions/care if I wanted to pursue the treatment plan they recommended. Private healthcare isn’t a fast track into NHS care like people might think it is.

[Warmduscher]

[quote Kitkat151]@Warmduscher they would need a referral to an nhs service then there would be an agreement in place for the GP to be able to take over the prescribing from secondary health services. As OPs friend had accessed private healthcare in order to get a diagnosis I assumed they would be able to afford the prescription..... so I’m sorry if this isn’t the case.[/quote]
We lent our adult DD the money for a private psych assessment as she had spent ten years trying to access some support for she now knows was undiagnosed ADHD and she was at the end of her tether.

Unfortunately it wasn’t made clear that it was entirely the decision of the GP whether they would be willing to enter a shared care agreement with the psychiatrist and she is now battling to get them to agree to one.

On medication, DD has been able to hold down a part-time job for the first time in two years, she is sleeping better and her mood has stabilised. The meds are costing £180 a month and her wage only covers some of it after other living expenses so once again she’s reliant on us, her parents, to make up the difference.

That’s not great in terms of her becoming financially independent and supporting herself in the future, something the government and some people on here always berate young people for.

[Pigeontown]

The medications for ADHD and some other neuro conditions are Controlled Substances - that's because they can be used as recreational/addict drugs. They can only be prescribed in small amounts (usually one month at a time) and by a consultant. When you collect the pharmacist has to make special checks. So your GP can't prescribe.
You need to be 'under' a consultant
If you are diagnosed then you need to ask your GP to refer you into your Neurodiversity service OR assessment and treatment service (some places don't have an adhd service). Think of it like getting a hospital appointment. Same process. It will be run by the mental health Trust in your area. You can Google this. Sometimes it's easier to just find the service info and give to your GP. They don't always know and often have to look it up themselves. If you are diagnosed just send that with your note. They can't deny treatment. Complain if they do.
The mental health consultant psychiatrist then picks it up. It does take a while as waiting times are long and severe shortages. You can get private to start prescription but it does cost a bit. Medication isn't expensive as such but appointments are.
Once the NHS consultant start prescribing generally it eventually gets handed back to GP for repeats(more tricky with private they still then need to hand to GP to hand to consultant at NHS so same!). But if you need to change dose etc then back to consultant each time. Getting right dose is a pitta.
Gp are only gatekeepers in a sense. They refer for specialist issues. E.g they would do same for epilepsy, cancer, heart, immune conditions and so on.

[Warmduscher]

Medication isn't expensive as such but appointments are.

£180 a month probably isn’t a huge amount for someone in a reasonably paid full time job, but it’s not an amount my DD can afford without support from us.

[Kitkat151]

@Warmduscher is your DD still on NHS waiting list to be seen for assess,met? .....Hoping it doesn’t take too much longer and then at least she will have access to nhs prescriptions

[Warmduscher]

[quote Kitkat151]@Warmduscher is your DD still on NHS waiting list to be seen for assess,met? .....Hoping it doesn’t take too much longer and then at least she will have access to nhs prescriptions[/quote]
Thank you @Kitkat151.

She was on the waiting list for way too long and it got to the point where we were very concerned for her mental health, so we paid for the private assessment.

Because she is now on such a low income she is elegible for funding for ADHD coaching, ironically. She wouldn’t even have known about that without the private psych telling her about it - we’d certainly never heard about it before. She would love to be at a point where she no longer needs medication so ADHD coaching would be a good step towards that.

[Pigeontown]

@Warmduscher a months elvanse or concerta is only about 30 or 40 privately. The rest must be the consultations. The prices are online.

[Warmduscher]

[quote Pigeontown]@Warmduscher a months elvanse or concerta is only about 30 or 40 privately. The rest must be the consultations. The prices are online.[/quote]
Thanks for that - she paid over £100 for the Elvanse. The rest was the other two meds. She pays separately for the consultation.

[Pigeontown]

They add to that then as the actual cost is a lot lower for both of them. If you just get a private prescription and get it dispensed you'll pay less. But I'm guess the private clinic won't do that.

[Warmduscher]

@Pigeontown

They add to that then as the actual cost is a lot lower for both of them. If you just get a private prescription and get it dispensed you'll pay less. But I'm guess the private clinic won't do that.

That’s exactly what she did do - the psychiatrist sent her a private prescription and she took it to the pharmacy in her town. They charged her £180 for all three meds.

But thanks for the heads up - I’ll tell her to do some research into where to get it cheaper.