ADHD Shared Care & Prescribing

ADHD Medicines – Prescribing & Shared Care Policy

1. Purpose

This policy sets out LL Medical Care Ltd’s position (“the Practice”) on prescribing medicines for Attention‑Deficit/Hyperactivity Disorder (ADHD) and participation in Shared Care Agreements (SCAs). The policy aims to ensure safe, lawful, and clinically governed prescribing and to provide clear information to patients, carers, external providers, and staff.

2. Scope

This policy applies to: – All requests for ADHD medicine prescriptions (e.g., methylphenidate, lisdexamfetamine, dexamfetamine, atomoxetine, guanfacine).
– All requests to initiate, continue, or transfer prescribing and/or monitoring under an NHS SCA.
– All staff involved in clinical care, prescriptions, referrals, and correspondence.

3. Definitions

ADHD medicines: Licensed pharmacological treatments for ADHD.
Shared Care Agreement (SCA): An NHS arrangement where an NHS specialist initiates treatment and provides ongoing oversight, and a GP may agree to continue prescribing/monitoring according to an agreed protocol. Participation by a GP practice is voluntary and contingent on safety, capacity, and governance.
Private provider: Any clinician or organisation providing assessment or treatment outside NHS‑commissioned services.

4. Practice Position (Stance)

  1. No acceptance of ADHD SCAs: The Practice does not currently accept Shared Care Agreements for ADHD medicines.
  2. No NHS prescriptions for privately initiated care: The Practice will not issue NHS prescriptions for ADHD medicines that have been initiated or managed by a private provider. Prescribing and monitoring remain the responsibility of the private provider.
  3. No “bridging” prescriptions: The Practice will not provide bridging prescriptions for ADHD medicines while patients await NHS assessment or transfer from private care.
  4. Monitoring/tests requested by private providers: The Practice will not undertake baseline investigations or routine monitoring solely at the request of a private provider. Where an NHS clinician identifies a separate NHS clinical indication, investigations may be arranged through usual NHS pathways.
  5. Existing/legacy arrangements: If any historical ADHD SCAs exist, they will be individually reviewed for safety and governance. The default position is to transfer prescribing back to the NHS specialist unless an explicit, time‑limited exception is authorised by the Partners.
  6. Future changes: This position will be reviewed periodically. If the Practice later elects to participate in ADHD SCAs, updated criteria and processes will be published.

5. What the Practice Will Do

  • NHS referral: Where clinically appropriate and not already in place, the Practice will facilitate referral to an NHS‑commissioned ADHD service for assessment/ongoing care.
  • General health care: Provide routine NHS primary care for other health needs and ensure safeguarding and risk management in line with NHS standards.
  • Safety advice: Offer advice on urgent symptoms and signpost to NHS 111, urgent care, or emergency services where required.
  • Communication: Provide clear written responses to requests relating to ADHD medicines, referencing this policy.

6. What the Practice Will Not Do

  • Issue NHS prescriptions for ADHD medicines without an accepted NHS SCA and without active NHS specialist oversight (the Practice is not accepting SCAs at this time).
  • Convert private prescriptions to NHS prescriptions for ADHD medicines.
  • Undertake routine monitoring (e.g., blood pressure/heart rate/ECG/weight/height blood tests) solely to support private treatment.
  • Guarantee acceptance of any future SCA; participation is discretionary and subject to governance, capacity, and commissioning arrangements.

7. Responsibilities

  • Partners: Approve the policy; decide on any exceptional, time‑limited departures from the stance; oversee governance and risk.
  • Practice Manager: Implement the policy; ensure staff are trained; coordinate patient and provider communications; maintain a log of requests and outcomes.
  • Prescribers (GPs/ANPs/Pharmacists): Adhere to this policy; decline inappropriate prescribing; document advice and safety signposting.
  • Administrative staff: Use standard responses and pathways; route clinical queries to the appropriate clinician; record and file correspondence.
  • Patients/Carers: Use NHS referral pathways; maintain arrangements with private providers if choosing private care; follow safety guidance.

8. Processes & Pathways

8.1 Requests from Patients

  1. Private care: Inform the patient that the Practice cannot issue NHS prescriptions for ADHD medicines or undertake monitoring for private care. Provide this policy link and safety signposting.
  2. NHS referral needed: If not already referred, offer an NHS referral and advise on expected commissioning timelines and any information required (school reports, previous assessments, etc.).

8.2 Requests from Private Providers

  • Respond with the Practice stance: no shared care acceptance; no conversion to NHS prescriptions; no routine monitoring undertaken for private care. Signpost the provider to continue prescribing/monitoring privately.

8.3 Requests from NHS Services

  • Where an NHS service requests SCA participation, the Practice will respond with the current stance (not accepting ADHD SCAs). The NHS service remains responsible for continuing prescriptions and monitoring.

8.4 Safety/Risk Escalation

  • If a clinician identifies immediate risk (e.g., severe adverse effects), manage according to clinical urgency: urgent assessment, NHS 111/ED, or ambulance. Document actions taken and inform the responsible specialist service where relevant.

9. Equality, Diversity & Inclusion

The Practice is committed to equitable access and non‑discriminatory care. Decisions under this policy are based on clinical governance, safety, and commissioning factors, not on protected characteristics. If you require reasonable adjustments (e.g., communication support), please inform the Practice.

10. Complaints & Feedback

Concerns about this policy or its application can be raised through the Practice complaints process. Complaints will be investigated in line with NHS regulations and local procedures.

11. Information for Patients Under Private ADHD Care

  • Prescriptions and monitoring are provided by your private clinician.
  • If you wish to transition to NHS care, request an NHS referral via the Practice. Acceptance and timeframes depend on local commissioning and service capacity.
  • The Practice cannot provide interim (“bridging”) NHS prescriptions for ADHD medicines.

12. Document Control

  • Version: 1.0
  • Next review: September 2026 (earlier if national or local guidance/commissioning changes)