"ADHD services"

I had sound reasons to suspect I had undiagnosed ADHD and thought there would be lengthy waits for a NHS diagnosis so I opted to pay a reputable private provider for an ADHD assessment. My GP informed me they wouldn't recognise a private diagnosis so I asked for a referral to FV MH services. They agreed to refer but my referral was refused due to a national shortage of medication. I asked my surgery to complain against this as my medication wasn’t in short supply and I'd never had any issue obtaining it. I never heard anything back.

The medication has made a huge difference to my life, I am now on a stable dose and I have no side effects. However, I pay a substantial amount of money each month for a private service. I earn a good wage but between my son and myself, I pay around £300 per month. This is not easy to manage and it does impact me financially. I therefore asked my private provider if they would agree to shared care. They approached my GP to request this, advising they would still undertake the reviews but asking if my surgery would issue the prescriptions.

Their request was sent. My GP replied to ADHD refusing, stating that they do not enter Shared Care Agreements. GPs are not trained in the management of ADHD or in its prescribing and do not make independent decisions to prescribe ADHD medications. The responsibility for a prescription lies entirely with the prescriber and so they were not comfortable entering any agreements with private providers.

I responded, making a formal complaint to my surgery. I explained I was aware that GPs do not have to accept shared care, but given this is recommended by NICE guidelines, why were they not looking to achieve this recommendation?

I asked what their rationale was for treating a registered doctor with the GMC differently simply because they work in private practice compared with the NHS?

I pointed out that the shared care request was not a request for a GP to make an independent decision to prescribe, that this decision had already been made by a suitably qualified specialist, the dose had been titrated and stabilised by the specialist and would be reviewed by the specialist. Therefore why couldn't my GP continue the medication for ongoing ADHD care?

I believe the criteria for accessing NHS FV MH ADHD assessments services is ageist. If I were a child or young person, I would be able to access services yet I am denied solely based on my age.

I stated that I had heard that GP surgeries were refusing shared care agreements with private providers for financial reasons and asked if this was the reason.

I received a reply where I was informed that they do provide ADHD medications who are under a shared care with NHS psychiatry. They advised they are an NHS contractor with specific roles they carry out on behalf of NHS FV and it isn't their role to make up for the inadequacy or lack of specialist services. 

They advise that NICE guidelines are for England and there was no requirement to follow them in Scotland. They reiterated they do not feel it safe or suitable to take on shared care with private providers because they should have access to the specialist and this isn't possible with private providers because their relationship is based on the patients ability to pay.

They believe NHS FV MH focus their limited resources on managing those people who have severe and enduring mental illness such as depression, schizophrenia or bipolar disorder. They do not currently have the capacity to take on additional adults. They state they have represented the needs of their patients in regards to the lack of provision of ADHD assessment. They advise there are no other NHS providers they can refer me to as an alternative.

This has left me feeling deflated, angry, sad and really stigmatised by the NHS. It seems to me like my GP is only interested in the financial contract, not what's best for me, and is using my potential inability to pay privately in the future as an excuse to refuse shared care. I feel like I'm being judged on what might happen in the future. If that was really their concern, then they prescribe on the proviso it would stop if I stopped paying for reviews!

I also take umbrage at their belittling of those who have ADHD implying its somehow a lesser condition that doesn't deserve funding. The GMC's professional standards state GPs should make the care of the patient their first concern.

As for FV mental health services, I believe their refusal to accept my referral has nothing to do with a medication shortage and everything to do with there being no adult referral pathway in place. In my view, it's age discrimination! I think the lack of funding from FV is clearly the number one factor in my GPs decision and FV seem to be happy to mislead their patients on the real reasons they can't access services.

Is this NHS FV's idea of patient centred care?