England’s GP leaders have voted in favour of bringing in an enhanced service for an ADHD annual health check.
Delegates at this year’s annual LMC conference also overwhelmingly voted in favour of ‘urgent’ action from NHS England to remedy years of chronic and ‘shameful’ underfunding for ADHD services.
And they called on NHS England to set up proper medication shared-care arrangements.
But GPs narrowly rejected calls for an NHS England central list of private providers that patients could access through NHS Right to Choose.
Leeds LMC’s Dr Lucy Clement, who proposed the motion, told the conference of her personal experience of being diagnosed with ADHD four years ago.
The condition is the ‘diabetes of psychiatry’ because it is just as prevalent and with consequences that include reduced life expectancy and increased risk of other long-term conditions, she noted.
But she added that ‘not a single penny of NHS money’ has ever been ringfenced for ADHD and no NHS England directorate was taking responsibility.
‘Our NHS ADHD services are in crisis, some reporting 20-year waits to be seen. Is it any wonder in England where there is a legal right to choose your providers, the private sector has completely capitalised on the situation.
‘The reality is they are providing much-needed NHS capacity but it has become a complete nightmare to track who is doing what and how well, with general practice being asked to enter shared care and prescribe controlled drugs with an untrackable array of companies,’ she argued.
Dr Clement demanded a direct enhanced service payment ‘like we have for severe mental illness and learning disability and is in the pipeline for autism, to perform ADHD annual health checks that would also properly fund workload for shared care’.
It is unrealistic, she said, for specialist services to keep hold of patients, so GPs needed to be proactive and negotiate a DES to enable better care.
GPs voted 63% in favour of the proposed DES and 97% of those attending the conference voted for NHS England to take urgent measures to address funding for ADHD services.
Others speaking at the conference also had personal experience of ADHD, including Dr Annie Farrell from Liverpool LMC, who said her child was diagnosed with the condition but was being well managed on the NHS. She referred to the current situation with the proliferation of private providers as a ‘wild west’.
But she raised concerns that the motion – particularly the parts calling for a central list of qualified private providers – simply ‘props up’ an unsatisfactory system and ‘let’s NHS England off the hook’.
Dr Laurence Heywood from Devon LMC said he used to see one or two cases every six months or so but that now happened twice a week.
Long delays in diagnosis were particularly difficult for children and prevented early intervention and support, he added.
‘Parents and families are left to struggle and cope for years and years.’
But Dr James McNally from Berkshire LMC called on the conference to reject a DES for ADHD, saying while everyone could agree the health service needed additional resources, GP colleagues were expected to enter into ‘sham’ shared-care arrangements that went against NICE and MHRA guidance.
GPs at the conference also voted 89% in favour of accredited career pathways in ADHD for interested GPs with ‘nationally funded mechanisms to enable training and subsequent skills to be utilised’.
Motion in full
That conference, in recognition of the increased awareness and identification of ADHD, expected prevalence rates, significant secondary complications and impact on an individual, the NHS, the wider system, and society as a whole; we demand:
(i) the prompt establishment of an NHS England Any Qualified Provider (AQP) list of neurodevelopmental services, including private providers available through NHS Right-to- Choose – NOT PASSED
(ii) an England-wide self-referral mechanism to a single-point-of-access offering screening and triage to deem “clinical appropriateness” and care-navigation to inform and enable patient choice – PASSED
(iii) that urgent measures are taken by NHS England to remedy the fact that NHS ADHD Services across all ages in have been chronically underfunded for years – PASSED
(iv) a direct enhanced service to cover the implementation of an ADHD annual health check, that would also properly fund the workload for ADHD medication shared-care agreements – PASSED
(v) accredited career pathways in ADHD for interested GPs and other primary-care HCPs, with nationally funded mechanisms to enable the training and subsequent skills to be utilised. – PASSED
“ADHD is the “diabetes of psychiatry””
Hyperbole?
Adult ADHD is essentially self diagnosed. Every fidgety patient, having googled their symptoms, suggests to the GP that they might have the condition, they tick the right boxes on a form, are then referred to a clinic which ALWAYS confirms diagnosis in a 15 minute appointment, followed by discharge and recommendation of medication, presumably for life, with no meaningful follow up.
If you asked 100 people if they had any of the symptoms (poor concentration, disorganised, fatigue etc) nearly 100% could be considered for diagnosis. If we are waving everyone through already, then this is a potential bottomless pit, with genuine cases drowned out by trendy wannabe “I’ve got ADHD doncha know” Tik-Tok narcissists, pushing waiting lists into infinity whilst denuding stocks of expensive drugs desperately needed by the genuine few are gobbled up by the phoney many.
We need to tighten up diagnosis fast. Labelling every single person who has poor concentration with a psychiatric illness does no good for them nor society.
Well said David. I don’t think anyone’s really thought through the implications of a diagnosis that more-or-less everybody fits, and which leads to a significant input of clinical time and prescription funding.