- Document type
- Patient information
- Place
- Hertfordshire and West Essex ICB
- Output type
- Clinical Pathways
ADHD
Frequently Asked Questions:
Attention
Deficit Hyperactivity Disorder (ADHD) For Primary Care- MARCH 2025
The
number of patients in Hertfordshire and West Essex seeking ADHD services has
significantly increased and continues to do so. This has resulted in longer waits to access both diagnosis and treatment
where there is an identified medical need.
This
document aims to answer some of the commonly asked questions from GPs, service
users and carers with regards to ADHD.
What is being done about long waits after
referral to an ADHD service?
For adults, measures intended to ensure those patients most
in need are prioritised have been put in place. Those who can self-manage are
supported to do so.
A list of resources for waiting well has been provided at
the end of this document.
In South & West Hertfordshire,
a service for children and young people on medication requiring long term
monitoring and follow up had been set up, aiming to increase capacity in the
CAMHs teams.
A longer-term community-based model for services is being
developed in Hertfordshire, with the aim of providing a seamless pathway for
children and adults with ADHD (and/or autism in children).
What can we do if we are concerned about the
mental health or the behaviour of a patient awaiting an ADHD diagnosis?
Adults:
Individuals may need help with their mental health in
addition to symptoms of ADHD. In an emergency, they should call 999/visit the
Emergency Department.
To speak to someone about mental health use NHS Direct on
111 option 2. In Hertfordshire, this line can be used for all ages. In West
Essex, the crisis phone line is for
people aged 18 and over. Anyone under the age of 18 or family members of anyone
under the age of 18 in crisis, should call North East London NHS Foundation
Trust’s Emotional Wellbeing and Mental Health Service on 0300 555 1201.
If the query is not urgent- refer via HPFT SPA/West Essex
referral system.
If the patient has been referred and requires help whilst
waiting, contact the team they are under direct. Details and a directory of
mental health support services is at the end of this document.
Children and young adults:
Hertfordshire- HPFT CAMHS SPA on 0800 6444
101 (24/7)
West Essex- North East London
NHS Foundation Trust’s Southend, Essex and Thurrock Children’s and Adolescent
Mental Health Services (SET CAMHS)
0800 953 0222
SET-CAMHS.referrals@nelft.nhs.uk
What are the legal and ethical considerations
when referring to an ADHD service?
Referring only to providers with the appropriate
NHS contracts is not just a recommendation - it is a legal requirement under
the national RTC framework. It ensures:
• Fair access to healthcare services.
• Transparency in the choice available to patients.
• Compliance with legal standards required by NHS
England.
When does the Right to choose and Patient Choice
apply?
Patients can exercise their right to choose
when:
•
They receive an NHS
referral for their initial or first appointment.
•
A GP, dentist, or
optometrist has made the referral.
•
The service is led by a
consultant (for both physical and mental health) or by a mental health
professional (for mental health services only).
•
The provider is
commissioned by the NHS in England to provide the service needed.
•
Not under the care of
secondary mental health services.
Patients can only access NHS care under Right to
Choose and Patient Choice if the GP refers. Patients self-referring to a private provider cannot then switch to
being seen on the NHS unless the GP makes the formal referral.
Is a direct contract between NHS HWE ICB and the
provider necessary?
No, the right to choose is valid for any
provider with an NHS commissioning contract in England, independent of whether
the local Integrated Care Board (ICB) directly contracts with that provider to
provide the relevant service. Providers must offer services in accordance with
the NHS commissioned terms.
Which providers can a patient choose from?
Patients are free to select any appropriate
qualified provider across England if the provider is commissioned by the NHS in
England to provide the service needed. This includes NHS organisations as well
as private and independent providers.
What is the difference between Right to Choose
and a Patient choice accredited provider for ADHD?
Under the umbrella term "Patient Choice”, the "Right to
Choose” provides patients the option to select their NHS provider if the GP
deems a referral to be clinically appropriate. In addition to traditional
NHS mental health services, private health organisations who hold an NHS
contract anywhere in the UK may also be contracted by the local NHS for
patients to use. Under "Right to Choose” these private health organisations who
hold an NHS contract elsewhere can be chosen by the patient even if their NHS
contract is not with the local ICB.
To support Patient Choice and enable quality governance, arrangements
are being put in place for providers (public, independent or third sector
organisations) to qualify for and secure NHS Standard Contracts for the
provision of elective services where the legal rights to choice apply. This is the "Patient Choice Standard
Framework Scheme”.
Under the Patient Choice Standard Framework (Patient Choice
Scheme for short) the accreditation framework aims to set standards of service,
prescribing, shared care and long term follow up from a recommended list of
around 5 providers. The specification for the "Patient Choice” providers has
been set out in HWEICB, and standards are high. They would be expected to carry
out physical health reviews, annual reviews, shared care of medication,
awareness and signposting on for co-existing mental health or autism conditions
and GP support in a timely manner. The HWEICB ADHD "Patient Choice” scheme is under
development and will take at least several months to be fully functional.
In the interim, in Hertfordshire & West Essex, there is
choice to receive care via the "Right to Choose”, or local NHS referral (if
they meet the criteria). In the future
there will also be the "Patient Choice” provider (once provider is registered
on the ICB framework) whom the patient can chose to go to.
Why may there be a problem if a patient asks to be referred
to their chosen ADHD service under their right to choose in HWE?
Currently the option of right to choose for HWEICB ADHD
patients is complicated because the provider chosen may not meet the standards
local service adheres to. They may not be able to provide medication. They may
not be able to provide long term GP support and long term follow up. If and
when a patient decides to switch back to local ADHD services having been
diagnosed elsewhere, they need to join the local waiting list. This means a gap
in medication and shared care and support.
Is there a list of Right to Choose providers
the ICB recommends?
The ICB does not have the ability to vet every possible
provider, and the risk is the patient choice leads them to a care pathway that cannot
be fulfilled.
When the accredited "Patient Choice” providers are in place
the ICB can recommend them in confidence.
What if my patient asks me to refer under Right
to Choose to another provider?
The decision to make a referral is the GP’s responsibility
and separate from Right to Choose. Right to Choose is a patient’s right to
decide where that referral is to. A Right to Choose provider can be a private
organisation, but they must hold an NHS contract. Patients may not self-refer to a Right to
Choose provider on the NHS: if a patient self refers to a private Right to
Choose provider that treatment will be considered a private consultation.
The right to choose
provider may request that the GP engages in shared care once the patient has
been titrated and stabilised on medication. However, if they are not an accredited patient choice provider the ICB
cannot be assured of the governance and has no quality assurance of the service
provision.
With all referrals:
- The
GP will need to be satisfied that a referral is medically
appropriate/needed through a consultation.
·
The GP knows what service will be provided by
the RTC provider i.e. diagnosis and/or ongoing medication supply, shared care
and support. If this is not provided by
the Right to Choose provider, the GP should explain to the patient they may
then have to be referred again locally to access ongoing medication initiation,
titration, shared care and support. They
may not access this quickly, as they will join a local waiting list and there
is a risk to a gap in service. Should the patient not wish to take medication,
or consider long term follow up then the risk is not as significant to them.
The quality of the diagnostic service is unknown and therefore may not meet
local standards.
·
When the Patient Choice Accredited Providers
are in place, they will all be expected to provide a medication initiation,
titration and shared care service as well as GP support and long term follow
up. Thus mitigating the risk of a gap in
service and ensuring an equitable service to local providers.
Will RTC cover the cost of medication?
Possibly not, the patient must be treated in
accordance with the agreed terms and pathway as specified in the original
contract holding ICB (host ICB) contract.
If a patient had an assessment previously and
has not been diagnosed, but wants a second opinion, can they use Right to Choose?
Regardless of the reason for the referral, it is
the referrer (GP) who determines if the referral is clinically appropriate.
Second referrals after a previous NHS-referred diagnosis, would need to be
prompted by additional evidence or symptoms that were not previously
considered.
Patients can only
access NHS care under right to choose AND Patient Choice if the GP refers and
deems it clinically appropriate to do so. Patients self-referring to a private provider cannot switch to being
seen on the NHS unless the GP makes the formal referral.
Right to choose
does not apply to patients who have self-referred.
What if a patient wants to be referred to a
provider that I believe is not in their best interests?
The NHS England » Patient choice guidance states that the referrer is
not required to make a referral to a provider or team if they do not believe
this would be clinically appropriate.
Can I share care with a Right to Choose
provider?
Herts and West Essex ICB do not support shared care between
private and NHS prescribers. If the private provider is a right to choose
provider, we currently advise exercising caution as we cannot be assured of the
governance or quality assurance of the service provided. Herts and West Essex
ICB will support shared care with the RTC providers accredited as part of the patient
choice accreditation exercise once this is completed as the ICB has stipulated
in the service specification the key standards and governance required for safe
prescribing.
What if my patient sees a provider privately
and wishes me to continue prescribing?
We would advise if a patient is prescribed a medication
under a private specialist, that would usually require monitoring under a
shared care protocol on the NHS, then they should remain under the care of the
private prescriber. Herts and West Essex ICB do not support shared care between
private and NHS prescribers, and we recommend that shared care agreements may
only be formed between NHS doctors providing an NHS service.
Locally, we have a guidance statement on the transfer of
private care into NHS, which can be found at the following link
This is in line with the BMA
guidance which can be found here.
https://www.bma.org.uk/advice-and-support/gp-practices/managing-workload/general-practice-responsibility-in-responding-to-private-healthcare
What happens if my patient is transferred from
another country on ADHD medication/ from another part of UK on medication?
If a patient is diagnosed in the NHS and the treating team
is within a commutable distance for the patient then they should continue to be
monitored under a shared care protocol with their existing team until they are
seen by the new local service.
If this is not the case, then the GP will need to decide as
to whether they feel able to take on the prescribing and monitoring of the
patient until they are seen by the local service. We advise that this is only
considered if the patient is stabilised on the medication. The GP should only prescribe
the medication if they feel it is clinically safe to do so. Further advice can
be sought from HPFT SPA on 0800 6444 101 or the Primary Care
Medicines Optimisation Team (PMOT) if needed.
Further guidance of monitoring ADHD medication can be found
here Recommendations
| Attention deficit hyperactivity disorder: diagnosis and management | Guidance
| NICE.
If a patient has moved to the local area from
another country and is on a medication regimen not commonly
used in this country and would like a GP to continue to prescribe these
medications the GP should seek urgent advice from local consultant via the SPA
on 0800 6444 101. A decision on whether to continue the medication or not
should be on a case-by-case basis. The HPFT ADHD team will aim to prioritise
such cases.
If the GP is considering prescribing for this patient, they
need to be satisfied that the medication prescribed for ADHD is in accordance
with NICE and local prescribing guidance and continues to be clinically
effective. The monitoring of the medication may need to take place in primary
care in such cases until they are transferred to the local service. Further guidance of monitoring ADHD medication can be
found here: Recommendations
| Attention deficit hyperactivity disorder: diagnosis and management | Guidance
| NICE.
Do I have to agree to share care with a NHS
provider?
The Hertfordshire
and West Essex (HWE) ICB Principles for Shared Care document states that
‘transfer of clinical responsibility to primary care should only be
considered where the person’s clinical condition is stable or predictable. The
initial secondary care prescribing period should be enough for adverse effects
associated with initiation of the drug to occur; to allow stabilisation of the
patient’s condition if sick; to allow stabilisation and achievement of a
suitable therapeutic dose; and to allow time for communication and acceptance
of shared care at this point with the patient’s GP. This will usually be 12
weeks unless otherwise stated within the agreed individual shared
care protocol.
For some medications the stabilisation period could be as short as 4 weeks, if
stated in the protocol.’
Practices are under no
obligation to accept shared care where there are concerns relating to clinical
aspects of the shared care request, for example, the patient has not been
stabilised on therapy. GPs accepting
shared care should also be satisfied that treatment falls in line with locally
agreed decisions or national guidelines, and they feel clinically competent to
prescribe.
Requests to share care
should be considered and accepted or declined on an individual per patient per
drug basis. The GMC states ‘If you are
uncertain about your competence to take responsibility for the patient’s
continuing care, you should ask for further information or advice from the
clinician who is sharing care responsibilities or from another experienced
colleague. If you are still not satisfied, you should explain this to the other
clinician, and to the patient, and make appropriate arrangements for their
continuing care.’
What can I do if I need help for my patient
with ADHD that is not due a review by the specialist?
Children and
young adults
A
resource pack has been created for parents or guardians with details of
services available for them to access, this can be found here – The Hertfordshire Local
Offer. Please share this animation with your
parents/carers: (33) Your guide to ADHD and autism support in
Hertfordshire on the Local Offer website - YouTube
You
may also signpost the family to the Neurodiversity Support Hub Advice line on 01727 833963. The neurodiversity support hub is an advice service offering
support, signposting and guidance about a whole range of things relating to
ADHD and Autism. The phones are answered by a team of parents and carers of
neurodivergent children and young people and the child doesn't need a diagnosis
to use this service. Further support can also be found on the
Healthier Together website : https://hwehealthiertogether.nhs.uk/download_file/view/1264/4154
If your child needs an urgent
review or you if you believe the child’s behaviour is deteriorating
significantly and there is a risk to themselves or their family, we suggest
that you contact the CAMHS SPA on 0800 6444 101 (24/7). To discuss
the case with someone who will be able to help.
Adults
GPs can contact the local community mental health team at
HPFT via SPA on the 18+ referral form and ask for medication review, patient
review or advice and guidance. In the future the same service will be provided
by the Patient Choice providers. This is also part of the shared care agreement
for those on medication. For those not known to HPFT, not on medication or transferring
from another provider the waits will be determined by risk and prioritised. It
may be HPFT as a specialist service provider will signpost those without
psychosocial complexity to a self help resource.
Adults who are seeing a private specialist need to be
reviewed by them. If they can not continue to fund this they can be referred if
appropriate to HPFT or a RTC NHS provider. Their wait will be determined by
risk and may be long.
If they have been discharged to the GP and are not on
medication they are entitled to mental health support and services as per any
local resident.
If they deteriorate in terms of ADHD sequale or require
medication initiation they need to be referred to an NHS service.
It may be a signpost to an ADHD self help resource or
charity is appropriate for those with non complex ADHD queries- list provided
below.
if they are exhibiting serious mental health or autism or
eating disorder or addiction or psychosocial co-morbidity they should be
referred to HPFT via SPA, and consider referring to addiction and housing and
other services as well if applicable.
If they are experiencing crisis the usual mental health
crisis route and and advice applies. For mild or moderate mental health
co-morbidity they can access the commissioned and third sector local services.
See below for more detail.
Patient Information and Resources
There are a number of useful websites and reading resources
available. See a selection below.
- ADDiSS (ADHD
information services) National Attention Deficit Disorder Information and
Support Service. People-friendly information and resources for parents,
teachers, sufferers and professionals.
Phone line also available 020 8952 2800 www.addiss.co.uk
- AADD-UK site for
and by adults with ADHD
- AADD-UK also has a
list of support groups across the UK
https://aadduk.org/help-support/support-groups/
- ADDers - Promotes
awareness of ADHD and provide information with as much free practical help
to sufferers, both adults and children, and their families www.adders.org
- Royal College of
Psychiatrists - information leaflet - ADHD in Adults
https://www.rcpsych.ac.uk/mental-health/problems-disorders/adhd-in-adults
- ADHD UK
- ADHD Foundation
The Neurodiversity Charity https://www.adhdfoundation.org.uk/
- CBT for ADHD or
Coach: BABCP registered CBT therapist list
https://www.bacp.co.uk/search/Therapists
- ADHDadultUK – a UK
based adult ADHD charity, providing online resources including video
guides, a podcast, online magazine
- The Open
University ‘Understanding ADHD’ free online course https://www.open.edu/openlearn/health-sports-psychology/understanding-adhd/content-section-0?active-tab=description-tab
- How to ADHD – a
website and YouTube channel dedicated to helping people with ADHD live and
work effectively
·
ADD-vance - a Hertfordshire based charity
that supports families affected by ADHD, Autism or a related condition and the
professionals who support them. www.add-vance.org
·
Royal College of Psychiatrists -
information leaflet - ADHD in Adults
https://www.rcpsych.ac.uk/mental-health/problems-disorders/adhd-in-adults •
ADHD UK https://adhduk.co.uk/
·
CBT for ADHD or Coach : BABCP registered
CBT therapist list available on: https://www.bacp.co.uk/search/Therapists ADHD
Self-help book
Self-help books
- Russel A. Barkley
'Taking Charge of Adult ADHD' (Guilford Press 2010) and Mary V.
Solanto 'Cognitive - Behavioural Therapy for Adult ADHD'
- Gabor Maté
‘Scattered Minds: The Origins and Healing of Attention Deficit Disorder’
2019. Written by a Canadian physician with ADHD.