ADHD must be diagnosed, and medication initiated and stabilised by a specialist. Ongoing prescribing within primary care should only be undertaken as part of a shared care agreement once the patient has been stabilised.
Hampshire and Isle of Wight ICB have contracted local service providers for ADHD diagnosis and medication initiation and stabilising:
- PHL for adults
- CAMHS for children
Patients have the 'Right to Choose' other NHS ADHD service providers. Some of these services may only be commissioned to offer diagnosis and not provide medication initiation and stabilising.
Other private providers are available who do not hold any NHS contracts and may or may not offer medication initiation or stabilising. Private providers are not subject to NHS scrutiny in terms of Clinical Governance and are covered by NHS indemnity schemes.
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Provider
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Credible Diagnosis
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Initiating & Stabilising Medication
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Shared Care in Place
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NHS (HIOW Contracted)
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Yes
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Yes
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Yes
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Right to Choose
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Yes
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Sometimes
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Sometimes
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Other Private Providers
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Uncertain
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Uncertain
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Uncertain
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Patients should be made aware that we will only support ongoing prescribing for HIOW contracted services, or for Right to Choose services where the initiating and stabilisation steps have been completed and a shared care agreement entered that mirrors the HIOW shared care guideline. The HIOW shared care places the responsibility of monitoring the patient by the specialist, not by primary care. Right to Choose providers must agree to this requirement.
In all cases, if the patient fails to attend for review with their specialist/discharged from their care, or does not attend for monitoring, their medication may be stopped.
We recommend that our patients confirm the answers to the following questions with the provider before making their choice:
· Does the provider hold a Right to Choose contract with the NHS?
· Does the provider initiate and titrate medication?
· Does the provider arrange necessary tests or referrals to initiate, titrate and monitor medication (e.g. blood tests, ECGs, height/weight, blood pressure, hospital specialist referrals, mood and behaviour monitoring)?
· Does the provider offer an annual medication review?
· Does the provider offer a shared care agreement with general practice which mirrors that published by NHS Hampshire and Isle of Wight? See here: Shared Care :: NHS Hampshire and Isle of Wight