ICB redirects ADHD shared care prescribing following GP collective action

Exclusive An ICB has ‘redirected’ ADHD prescribing, after nearly 50 practices in one area withdrew from shared care agreements as part of collective action.

The decision, which comes as a direct result of action, has ‘undoubtedly’ reduced workload, according to local GP leaders.

Practices in Suffolk stopped prescribing ADHD medication ‘on account of pressures’, explaining to patients that GPs do not have to prescribe shared care medications ‘if they feel unable to do so’, or if they are ‘not able to do this in a safe manner’, as it is not part of their contract and ‘has always been a core part of the specialist role’.

Suffolk LMC had indicated handing back ADHD medications ‘en bloc’ as one of the actions its local practices could take as part of collective action – which was paused nationally but continued locally aimed at ICBs.

Papers shared with the local ICB show that the action has ‘disrupted neurodevelopmental services’, with 47 GP practices exiting by the Autumn.

The LMC said that the ‘balance of factors’ that lie behind this decision will be different for each practice, but core factors include the need to ‘prioritise’ core general practice services; increasing practical difficulties of sourcing alternative medications; frustration at referral bureaucracy and concerns about a lack of clinical leadership at national level regarding ADHD; as well as a ‘historical absence’ of funding for such medications locally.

It added: ‘It may also be noted that GP practices in Suffolk continue to provide oversight and clinical responsibility for thousands of medications per GP per month and that a system whereby secondary care providers can efficiently prescribe to their patients in the community is long overdue. It is frustrating that it has taken this action to precipitate such a system.’

According to the Suffolk and North East Essex (SNEE) ICB papers, emergency prescribing via GP federations and provider Care ADHD has been introduced as a result of the action, but ‘challenges remain’, including medication gaps and long waits – up to three years for ADHD and two and a half years for adult autism.

The documents added: ‘Service delivery is now fragmented, with GP federations supporting NHS-diagnosed patients and Care ADHD assisting non-complex, “stranded” adults.

‘Rising demand, driven by public awareness, post-pandemic effects, and social media, has highlighted gaps in referral criteria, school diagnostic requirements, and local authority placements.’

Suffolk LMC’s medical director Dr Peter Smye told Pulse that the action has reduced workload for practices as well as reduced liability concerns.

He said: ‘ADHD is very complicated in the way that it’s set up – you’ve got Right to Choose Providers, private providers, NHS local providers and all of them have slightly different shared care arrangements.

‘And quite a lot of the time the governance, and secondary care providers sticking to the governance, just doesn’t happen.

‘And that has been the biggest advantage – that we have in fact exposed that and relieved practices of what was a liability in the end.

‘There’s a whole bunch of work that’s gone which I think practices are very happy about. And it has undoubtedly reduced workload.’

A spokesperson for the ICB said: ‘SNEE ICB has redirected practice-based shared care ADHD funding to Suffolk GP federation (in Suffolk) and GP primary choice (in NE Essex) to enable continuity of prescribing for adults and children under the NHS secondary care of Norfolk and Suffolk FT and Essex Partnership University FT for a 12-month period, with the option to extend for a further 12 months. 

‘The ICB is commissioning a range of patient choice providers for diagnosis and treatment, including prescribing pathways. We anticipate that this will be operational by January 2026.’

GP collective action was paused nationally in April following the 2024/25 contract agreement but it continued at a local level aimed at ICBs.

Practices have taken action serving notice on any underfunded services, which has produced a financial impact in some areas, including Humber and Yorkshire, where both local ICBs said they had to provide an extra £1.6m to mitigate against practices servicing notice on locally-commissioned services.

GP collective action in Kent led to an agreement from the ICB to fund new locally-commissioned services, including for CVD and ADHD, and in Somerset it highlighted several gaps in services, leading to an additional £2m investment from the local ICB.

Next month, GP leaders will vote on using undated contract resignations as part of new ‘collective or industrial action’ due to the Government’s delay in negotiating a new substantive GMS contract.