GPs should be incentivised to take on more ADHD care, taskforce recommends
The Government should incentivise GP practices to take on some aspects of care for ADHD, an independent taskforce has recommended.
In its second and final report, the taskforce, commissioned by NHS England last year, also called for GPs to take a greater leadership role on ADHD.
Among several recommendations, the taskforce said the new GP contract should include funding for training and enable GPs and the primary care workforce to undertake ‘routine generalist work such as post-diagnostic support and NICE recommended health checks’.
GPs should have the opportunity to train in more specialist areas of ADHD care, including assessment, treatment and prescribing, the taskforce concluded.
This could be done through ring-fenced funding for ADHD to support locally commissioned services or through the new neighbourhood provider contracts, the report added.
Better links are needed with secondary care with stepped pathways in place as they are for other common chronic conditions such as diabetes and depression.
It follows an interim report published earlier this year, which set out the need for change recommending that general practice should take a greater role in management of ADHD.
Currently, the report warned, ADHD assessment and treatment in England – as recommended by NICE – are only ‘provided by highly specialised, secondary care clinicians (super-specialists)’ or via ‘private providers that are not regulated’.
The ‘inability to access NHS services’ has led to a ‘significant growth’ in the use of private services, resulting in ‘two-tier access to services, diagnosis and treatment’.
While shared care protocols for ADHD have been available for many years, these have become more problematic in recent years with many arrangements no longer in place, the latest and final report said.
It said: ‘Although overall there are greater efficiencies for the NHS in primary versus secondary care and those with ADHD often state a preference for GP care, primary care does not currently play a major role in ADHD care.
‘Barriers include insufficient time to meet quality standards, a lack of relevant training on ADHD (although brief digital ADHD training for primary care does appear to be effective), lack of capacity and remuneration, concerns about the quality of ADHD diagnosis from some providers, and a lack of direct support and link up with specialist psychiatry services.’
But it added that all GPs need to be able to recognise ADHD and ensure clinically appropriate referral and do initial screening ‘as they would do for any other health condition’. Given how common ADHD is, there is an ‘urgent need’ for GP training, it recommended.
GPs who take on some aspects of ADHD care including shared care ‘should receive additional funding through locally commissioned services’.
And, as with other common chronic conditions, GPs should have access to secondary services for specialist advice and support when needed ‘in a timely manner’.
The taskforce also said the Government should introduce ‘more transparent and clear regulation’ of ADHD service providers as well as ‘auditable quality control for commissioners’.
In addition, there is an ‘urgent need’ for the NHS and Department of Health and Social Care to work with NICE to ‘explicitly define what is meant by an appropriately ADHD qualified healthcare professional’.
The taskforce found that currently, in England the demand for ADHD services, even with narrowly defined ADHD diagnosis, ‘greatly exceeds service capacity’.
A single patient record on the NHS App is a priority for ADHD care, to avoid duplicated work and support follow up, the taskforce said.
In response to the report, the RCGP said that many ADHD patients require more support than is currently available – and that if GPs are ‘expected to fill this gap’, there must be time to develop the appropriate expertise necessary, and this must be supported by dedicated funding.
RCGP chair Professor Kamila Hawthorne said: ‘GPs are seeing growing numbers of patients seeking help for symptoms that may relate to ADHD, and we know that delays in care can be distressing for individuals and families.
‘Patients with ADHD often have complex health needs, so we agree with the Taskforce that better coordination and improved pathways across the health and care system will be vital to improving ADHD care.
‘Whilst the identification of potential ADHD is covered by the GP curriculum, this is an area of medicine that requires a holistic approach with specialist support in diagnosis, management, and prescribing. This needs a more integrated approach, particularly where patients may have more than one diagnosis.’
‘At present, the system does not consistently provide the integrated approach needed to deliver this safely – the move to neighbourhood health services could support this change, but would need to be adequately resourced.’
Professor Anita Thapar, chair of the independent ADHD taskforce, said: ‘This report reflects a real shared commitment to improving understanding, support, and outcomes for people living with ADHD.
‘ADHD impacts are wider than health alone, and the taskforce’s recommendations will need action across government and society, not just within the NHS, if we are to make changes.’
Last month Pulse revealed that one ICB ‘redirected’ ADHD prescribing, after nearly 50 practices in one area withdrew from shared care agreements as part of collective action.
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READERS' COMMENTS [16]
Please note, only GPs are permitted to add comments to articles
Demonstrable performance enhancements with a drug does not automatically mean that patient has an illness.
The way long term medication is prescribed in the uk – specialist recommendation combined with fear of discrimination allegations – means GPs are at the forefront of rapidly disseminating the latest medical trends unless they become expert enough to offer an argument why they might decline.
Gabapentinoids, trans hormones and wider ADHD prescribing are all examples where GP essentially has had to go along with single toolbox expert opinions.
There has been no explicit societal debate of the wider rollout of performance enhancing medication, and under the guise of a medical blessing anything seems possible.
As Mitchell and Webb said ‘Are we the baddies?’
Another sneaky way of solving a funding and workforce crisis by getting GPs to take one the work
Just say No unless the price and governance is right !
The trendy labelling and medicalisation of psychological variants is ruinous to an already dysfunctional NHS. We simply don’t have the capacity nor resources to pander to these first world luxury diagnoses.
Given the tickbox self diagnosis, the “spectrum” (i.e. we ALL tick a few boxes), the financial incentive for being labelled (PIP etc), the handy reason to never work, the appalling excuse for violent crime (“it’s me ADHD, m’lud”), and the mass prescribing of dubious expensive amphetamines, the NHS needs to get a grip of this runaway train.
But no. Just dump it on the GPs and scapegoat THEM when expectant patients are left disappointed.
Why do these taskforces never come out to say this is something that GP’s should never be involved with?. It is somebody else’s problem to sort out and do not expect General Practice to pick up the dump on them.
The definition of ADHD is not fully defined. The demarcation between normal and abnormal behaviour is up for debate. Almost all of us concentrate better when taking certain types of stimulant medication , but by precisely how much is a treatment success and how much is simply a predictable herd medication effect has not been fully defined. How long someone should stay on medication has not been fully defined. Until all this is thrashed out and guideines underpinned by good quality evidence, this diagnosis should remain within the secondary care arena.
Parents get ADHD diagnosis on demand locally, it’s nothing to do with kid.
Most seem to be bored, not enough exercise, not enough stimulation, bored rather than unwell.
All day sitting in school, all evening sitting in front of the TV or games console, no wonder they play up.
Would anyone really want to take this on? Whatever they offer?
25% extra time in exams is another nice secondary gain
Off-topic but Hitler was dishing amphetamines out to his troops by the bucket-load, regardless of their place on the neurodivergent spectrum
A quick search on the authors comprising this independent taskforce shows that out of the 11, only one appears to have a very remote research based link to primary care, and does not appear to be a GP themselves.
LT, Well let’s hope we’re not turning these little tykes into little Nazis..
@stbfa
I wasn’t suggesting an association!
Just providing some historical context – the drugs were widely credited with the success of the Blitzkrieg
Just an illustration that anyone will (initially) feel good and be more productive
Liam, my comment was supposed to be humorous 😁 – obviously I failed 🤦.
But now “the success of the Blitz” – I wouldn’t put it that way myself – tip: if you find yourself in a hole…stop digging 😉😁
“The British Royal Air Force (RAF) approved the use of amphetamine sulphate, branded as Benzedrine, for Bomber Command operations to promote wakefulness and well-being. The US military also adopted amphetamines, with an estimated 72 million tablets purchased for Britain’s armed forces during the war.”.
Interesting Dave
I had a couple of patients who were involved in WW2 bombing operations and they were both alive till their late 90s – both sadly gone now in the last couple of years so too late to ask them about this
One told me he was briefed for an assignment with these words – “look chaps we are expecting heavy casualties – but it’s like a rugby tackle – if you go in half-hearted you’ve even more chance of being hurt”
adds some perspective to a lot of the nonsense we are dealing with on a daily basis
No thanks.
I have no desire to be responsible for offering adjustments to dose and type of stimulant for every tom dick and harry still failing in school due to non-disease factors or following an anti-work anti-social existence.
The continued reviews, changed and titrations just being an excuse for can kicking and not engaging with the realities of life.
All while coming at opportunity cost of other appointments for illness. Except its not instead, its as well as, especially with 24/7 online queries for all drugs.
Right now a meds query takes 3-12 months for secondary providers to review. We’re being mandated to respond in 24 F’ing hours. Thats handing patients the option of demanding a review hundreds of times a year vs the current once or twice by ADHD clinics.
p.s. They are framing this as a business case for the NHS dumping it on GPs surgeries.
Therefore, regardless of mealy-mouth GMC wording on shared care not being based on convenience – obviously unless its for secondary care or government convenience I assume (see also history of GMC comments gender drug prescribing to show how entirely clueless these pencil pushers are):
As businesses providing services to the NHS, the business decision of practices should be clear on being forced leads on treatment of ADHD: TTFO