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GPs feeling pressurised to prescribe unlicensed medication for ADHD, warn LMC leaders

GPs are feeling pressurised to prescribe unlicensed medication for adolescents with Attention Deficit Hyperactivity Disorder (ADHD) because of gaps in provision, LMC leaders have warned.

In Manchester, LMC leaders said most GPs have refused to do this, leading some sufferers to buy amphetamines on the street, while in Devon, practices have been asked to undertake audits to identify adolescent patients with ADHD who may be left without treatment.

GPs say this is part of a wider problem where they are left to care for 17-year-old patients with chronic conditions who are discharged by paediatric services without a transfer to adult services. But they said the problem is particularly acute with ADHD, as the medications are not licensed for use in adults.

Manchester LMC secretary Dr John Hughes said that no service for this age group had been commissioned in the city, leaving GPs in an uncomfortable position.

‘A small number of GPs are prescribing this medication, but significant numbers will not because it is unlicensed. For those that do it's a precarious medico-legal position.

‘It's an amber drug and should be under a shared care arrangement with psychiatrists' supervision. For pure ADHD there is no service to refer them to, so GPs find themselves acting outside GMC guidance and managing conditions which they don't have expertise in.

‘Some of these patients have been purchasing amphetamines on the streets. Adults with ADHD have a higher rate of offending and tend to end up in custody,' he added.

Dr Hughes said he felt there was a national problem for a lot of chronic conditions in children. ‘Very often paediatrics is a regional, tertiary service and there's not a lot of joined up thinking with adult services.'

Following pressure from the LMC and a local MP, Manchester Mental Health and Social Care Trust has agreed to look into commissioning a service for young adults with ADHD, he said.

Devon LMC is also concerned about a lack of shared care guidelines for this group, and about a gap in services, and has asked practices to undertake an audit to identify 17-year-olds with ADHD as "a matter of urgency."

Dr Sunil Angris, a GP in Stoke on Trent with an interest in mental health, told Pulse: ‘There's a problem in changeover from CAMHS to adult mental health services where people fall between two stools. That makes continuity of care and a smooth transition difficult. You sometimes get it in diabetes too.

‘Paediatric services should not be discharging back to the care of the GP. When I had this situation a few years ago I refused to prescribe ADHD medication because it was off licence, and wrote a letter to CAMHS saying it was unacceptable to discharge someone without follow up or transfer to specialist care.

‘GPs should not feel pressured to prescribe medication which is specialist only or unlicensed. That pressure probably comes from the patient or their parents.'

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