GPs are facing an increased workload relating to new ADHD diagnoses, which have gone up by one fifth alongside a nearly-as-high rise in related drugs prescribing.
In the latest quarter – April to June 2022 – there was a 6.8% increase in prescriptions for CNS stimulants and drugs used for ADHD, compared with January to March, according to NHS Business Services Authority data.
It is an 18.7% rise from the same period in the previous year with a total of 2.23 million items dispensed from July 2021 to June 2022.
The upward trend in the prescribing of ADHD drugs since 2017/18 corresponds with an increase in the number of identified patients in the category, which jumped almost 20% in the latest figures compared with the same quarter last year.
A Pulse survey recently found that two-thirds of GPs were having to provide specialist mental health support beyond their capacity as waiting times for some services, including ADHD assessments exceeding 18 months.
GPs have also told Pulse they have being asked to prescribe and monitor people on drugs initiated by private services that they do not have a great deal of experience with.
In its guidance in 2017, NICE pointed out that ADHD is often missed in women and girls because they do not tend to have symptoms implying hyperactivity but also there needed to more awareness of patients at risk of ADHD who may have been overlooked.
Professor Azeem Majeed, professor of primary care and public health at Imperial College London, said GPs had seen a large increase in the number of people diagnosed with ADHD in the last few decades and although traditionally it was seen as a condition diagnosed in early life, many adults are now also being diagnosed with ADHD.
‘NHS waiting lists for ADHD assessment are very long, sometimes years, and so many people with symptoms of possible ADHD are turning to private clinics for a diagnosis,’ he said.
‘This in turn is putting more pressure on GPs as the private clinics often don’t offer the same level of support as NHS clinics.
‘It’s yet another part of the NHS where commissioners won’t fund adequate services for diagnosis or management.’
Dr Selvaseelan Selvarajah, a GP partner with Bromley by Bow Health in Tower Hamlets, said the figures definitely chimed with what they were seeing in their practice.
‘We have seen a rapid increase in patients coming to us with suspected ADHD concerns, so referrals to psychiatrists have gone up.
‘As there is a long delay for NHS ADHD clinics, many are going to private psychiatrists. These patients are coming back to us for medications started by the psychiatrists and we are having to continue those medications and regularly monitor the patients as well. This has added to the workload in primary care.’
READERS' COMMENTS [1]
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That is curious. As a GP, and not qualified or experienced in assessing, monitoring, or prescribing ADHD drugs. I do not prescribe them, but Secondary care clinics who prescribe them usually want GPs to supply the repeat prescriptions: which is sort of OK on a shared-care basis until :
1) patient reaches 18, and has to leave Pwediatric department, and they are not handed over with the shared-care agreement to an adult consultant;
2) the consultant leaves, without arrangement for them to be taken over by another consultant;
3) patinet moves house, and GP, and forgets that they need to arrange handover to new consutlant, and expects new GP to do it contrary to rules and GMC guidance;
4) private clinic non-medically-qualified person tries to persuade, contrary to GMC and NMC guidance, a GP without required specialist experience, to take full responsiobility for supervising the practising of a specialist medical role by an unqualified private practitioner (nightmare vicarious liability scenario!)
5) foreign patient arrives expecting new GP to continue a prescription initiated by a non-specialist, with no shared-care monitoring arrangement with anyone of a patient who has never had pre-initiation basic screening and diagnosis properly performed, and fails the screening on several counts of significant contraindications whicht he prescriber never recognised – even worse vicarious medico-legal liability scenario.
basically best avoided even with extra-long bargepoles, as you are bound to be forced into a lose-lose situation with the GMC guidance very soon, whatever you do.