Purpose

The purpose of this policy is to outline The Glen Medical Practice policy for the prescription of medications for the treatment of attention deficit hyperactivity disorder (ADHD) in both adults and children.

This will allow the surgery, prescribers associated with the surgery and our patients to be clear on the surgery’s policy on the prescription of these medications.  This will maintain high standards of patient safety and quality and avoid distress.

Scope 

This policy applies to all staff members involved in patient-care and decision making regarding the prescription of medications for ADHD.  This includes NHS Lanarkshire staff providing prescribing services on behalf of the practice.  This information is available to patients for information and transparency purposes.

Definitions

Shared care agreements are agreements that exist between a patients GP, their specialist team and a patient, to facilitate the prescription of specialist medications which require monitoring.  These include (but are not exclusive to) medications for gender care, ADHD medications, disease modifying anti-rheumatic drugs (DMARD’s) and immunosuppressant medications.  In the NHS, protocols exist both to ensure these shared care agreements are safe and provide adequate resource to your general practice for the work involved.

Private Providers are any healthcare organisations or individuals who operate for profit and not part of our public health care system (the NHS).

ADHD is a lifelong neurodevelopmental condition which should only be diagnosed as part of a comprehensive neurodevelopmental and mental-health assessment by a specialist team.

ADHD Medications are medications used to treat the symptoms of ADHD.  Many are controlled medications and all require specialist monitoring to be prescribed safely.

Why is this policy needed?

Quality of Care and Patient Safety

There has been a significant increase in ADHD diagnoses for patients at the Practice with an increase in requests to share care from private providers.  This has led to an increase in patient safety concerns, examples of poor practice and potential for patient harm. We therefore cannot presume that private providers can undertake a shared care agreement safely.

Equity in Health-Care

All patients at the Practice should have equal access to health-care independent of ability to pay or influence of private-profit motive.

Implications for Other Patients

Our Practice has a responsibility to ensure it meets the needs of all patients on the practice list.  As demand continues to rise, doing so within the budget allocated to us is increasingly difficult.  There is no mechanism by which private providers can resource The Murray Surgery for their part of the shared care agreement.

NHS Lanarkshire Guidance

The Glen Medical Practice observes the NHS Lanarkshire ADHD prescribing guideline and is of the opinion that following this guideline promotes best evidence-based care and patient safety.

Policy Statement

1. The Glen Medical Practice does not engage in shared-care agreements with private providers for any reason.  This includes any requests to share care for ADHD.  This decision is based on our commitment to uphold the values of equity, access and quality of care for all patients.  We believe that sharing care with private providers may lead to inconsistencies with care delivery, potential conflicts of interest, increased access to care based on ability to pay and risks to patient safety.
2. The Glen Medical Practice does not participate in the recording of physical observations, medical efficacy and adverse events for the sole purpose of ADHD medication monitoring.  This is performed by NHS mental health services.
3. The Glen Medical Practice will only prescribe ADHD medication on advice of an NHS specialist service.
4. The Glen Medical Practice will not prescribe ADHD medication unless the monitoring guidelines in the document “ADHD – Prescribing Guideline for the Treatment of ADHD in Children, Young People and Adults” are followed by the NHS specialist service and their patient.

References

Principles for Shared Care Prescribing

ADHD – Prescribing Guideline for the Treatment of ADHD in Children, Young People and Adults