Shared Care Protocols for ADHD

Posted on February 13th, 2025

Statement on: Shared Care Protocols for ADHD.

The Practice has taken the difficult decision to now reject any new requests for Shared Care Protocols for ADHD medications, in line with the BMA Collective Action (https://www.bma.org.uk/our-campaigns/gp-campaigns/contracts/guidance-for-gp-collective-action/gp-partners-collective-action-9-actions-you-can-take  ) . Any agreements we have already accepted prior to 17/1/2025 date will continue as normal. This will be both for NHS and private services.

What is affected: All new requests for shared care for ADHD medications such as stimulants.
What is not affected: Any currently existing plans we have accepted, shared care for other medications not related to ADHD are unaffected.

Why are we doing this now:

We previously accepted ADHD shared care even through the early days of BMA collective action (which allowed practices to serve notice on voluntary services) however we have had to reconsider our approach and now refuse further new shared care requests for the following reasons:

– Lack of specialist support i.e. who we “share” the care with. Such services have intolerable waiting list times for new patients on the NHS and are virtually impossible to access in crisis by patients and GPs (both NHS and private). It is hoped that by refusing further workload transfers (which are unfunded and voluntary i.e. work accepted by the GP with no additional resource), it strengthens the case for those specialist services to improve and seek additional resources to meet patient need.

– Increasing numbers of patients, ADHD now makes up a significant proportion of the total number of shared care medications we have as a practice, and that number is rising rapidly with an increase in complexity of cases that GPs are not best placed to manage.

– For NHS and under 16-year-olds specifically, the local service (Ryegate) discharges patients when they become adults, however the adult service (SAANS) does not accept them onto any transition agreement so shared care automatically breaks at this point and the GP is left holding a prescription without a specialist and a 5-8 year wait into the adult services.

What is the practice doing to support ADHD patients?

We continue to support patients who we have already agreed a shared care protocol with to supply medications.   This agreement continues unless it ends for clinical reasons.  For patients midway or just starting the assessment process, perhaps as part of a referral from a GP, we know this is not what you want to hear.  Ultimate responsibility for prescribing these medications rests with the specialist who will be able to prescribe those medications and provide ongoing follow up.

We have written to local services to push for better specialist support for this. If the situation improves and it becomes possible for us to safely take on this work, we will consider this.

What can we (the patient or family do)

Contact your specialist provider if you do not already have a shared care protocol in place to advise the GP won’t accept one so you can plan follow up through that service. And particularly for NHS patients, write to your service and the ICB to ask that such services are properly funded and resourced that they can manage the monitoring and follow up of patients themselves.