Attention Deficit Hyperactivity Disorder (ADHD) Policy

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What is Attention Deficit Hyperactivity Disorder (ADHD)?

ADHD is a neurodevelopmental problem that can affect children and adults. 

Attention Deficit Hyperactivity Disorder (ADHD) can affect many aspects of a person’s life. However, diagnosis is complex and cannot be made by a GP.  It requires a specialist, usually a consultant psychiatrist to do this. Once a diagnosis has been made medication may be offered to help.

These medications are potentially dangerous and must be monitored carefully. The specialist is responsible for prescribing the medication, adjusting doses as needed and arranging regular reviews---the frequency of which is dependent on the age of the patient. 

Over recent years there has been increasing public awareness of the disorder and as a result and increase in demand for assessment, diagnosis and treatment. Oak Tree Health Centre want to reassure our patients that we are committed to supporting our patients with this diagnosis as much as possible but wanted to explain the local situation.

Adult Services

Oxford Health NHS Foundation Trust is the service commission by our local ICB to provide and adult diagnostic and treatment service. Unfortunately, due to overwhelming demand they paused taking any new referrals in February 2024 as their waiting list was in excess of three years. 

Paediatric Services

Oxford Health NHS Foundation Trust is commissioned to offer a local service through the Child and Adolescent Mental Health Service (CAMHs). The referral should be made by the child’s schoolteacher or SENCO services. The estimated current waiting time is approximately six years. This pathway offers a holistic assessment for your child to determine any possible diagnoses, start any medication, titrate the medication appropriately and undertake regular and appropriate post diagnostic reviews. 

Best Practice for Diagnosis and Treatment

The specialist service sees and assesses the patient, reaches a diagnosis and offers further appropriate treatment. This may often be in the form of medication. As mentioned above these medications must be monitored carefully and appropriately. A patient should have regular post diagnostic reviews to assess the effects of the medication, their mental and their physical health. The local services above are commissioned to provide all of this. One stable it may be possible for the GP to take on the prescribing and some of the monitoring for these patients. This is done under a local shared care agreement (SCA), made between the GP and the locally commissioned service. The responsibility of prescribing remains with the specialist. The SCA has been developed carefully with the local services and the local GPs and provides the GP with prompt access to a specialist should any problems or concerns arise.

What might Happen 

Due the lengthy waits some patients and families have, understandably, opted to seek diagnosis using the NHS Right to Choose or a private pathway. 

As an NHS patient you can use your right to choose and ask to be referred to an alternative provider who has an existing NHS contract to provide NHS services elsewhere in the country.

More information can be found here: Right to Choose - ADHD UK

The Right to Choose provider may only offer an assessment and diagnostic service. This may only be done remotely rather than face to face. The patient may then just be discharged back to GP without any ongoing care. Alternatively, they may attempt to enter into a SCA with the GP. This SCA has not been ratified locally or agreed with the GP.  

You should be aware that we do not enter into any shared care agreement with private providers and will not be able to take over prescribing initiated in the private sector. Any medication advised by a private provider needs to be obtained through the private service and monitored by them. This will incur additional costs to your treatment.

Oak Tree Health Centre Policy 

If you have chosen to pursue a private referral you are responsible for sourcing your specialist and arranging the appointment. We can provide a medical summary detailing your relevant current and past medical problems and treatments. Please get in touch with our administrative team to request this.

If you have decided to exercise your NHS Right to Choose option, please research which provider you want to use (Right to Choose - ADHD UK). Ensure that you have downloaded and completed any paperwork that they require and hand this in at reception for a scanning onto your record. You will then need to complete a GP contact form to discuss the referral and ensure that you meet the NHS threshold for referral. (this is often assessed by questionnaires available for each right to choose provider) Once you have spoken to your GP a referral can be made, 

We will not accept unilaterally imposed SCAs from any Private Provider or NHS Right to Choose provider.  If there is no appropriate SCA in place both patients and GPs are left vulnerable. GPs should not and cannot accept additional medico-legal risks because the NHS has been unable to provide appropriate secondary care services. Patients should not be left without the care and treatment they may need due to a lack of funding or commissioning of appropriate services.  

We do understand the impact of this disorder and are saddened that we are unable to support our patients with timely and appropriate referral. We have discussed this at length and looked at the needs of our entire population but feel we cannot take on any more unfunded work.

As such we will no longer be entering into any SCA with NHS Right to Choose services. Any treatment advised by such a service must be prescribed and monitored by them as part of their NHS service provision.