Care minister defends GP practices’ right to decline ADHD shared care arrangements 

The primary care minister has defended GPs’ right to decline ADHD shared care arrangements from specialist doctors. 

Answering a question from MP Kim Leadbeater on GP practices following NICE guidelines on ADHD care, Stephen Kinnock affirmed their right to decline requests on clinical or capacity grounds. 

It comes as GPs have warned of rising workload related to ADHD prescribing initiated in the private sector, and as prescribing of ADHD medication continues to rise year on year.

Ms Leadbeter asked ‘what discussions (the secretary of state) has had with NHS England on ensuring that GP practices follow the NICE guideline entitled Attention deficit hyperactivity disorder: diagnosis and management … on Shared Care Agreements in cases where a patient has received a diagnosis from a qualified provider.’ 

Mr Kinnock referred to GMC prescribing guidance which says shared care decisions should not be based on ‘convenience or the cost of the medicine and associated monitoring or follow-up’. 

He said: ‘The GMC has made it clear that GPs cannot be compelled to enter into a shared care agreement.  

GP practices may decline such requests on clinical or capacity grounds. 

If a shared care arrangement cannot be put in place after the treatment has been initiated, the responsibility for continued prescribing falls upon the specialist clinician. 

The NICE guidance referred to by Ms Leadbeater on ADHD medication care arrangements says: ‘after dose stabilisation, prescribing and monitoring should be carried out under Shared Care Protocol arrangements with primary care.  

‘The exact balance between primary and secondary care will vary depending on the circumstances of the person with ADHD and the available primary and secondary care services.’ 

BMA guidance reminds GPs shared care is a non-core voluntary activity that can be declined by the GP practice for any reason including: 

• Inadequate capacity within the practice 

• Inadequate competency about the specialist medication, despite training 

• Lack of assurance to provide the ongoing specialist support required for shared care. 

In June, an ADHD taskforce commissioned by NHS England recommended that general practice takes a greater role in management of the condition, similar to diabetes care. 

The first report from the taskforce recommended a shift to ‘accessible, regulated and generalist models of care in the community, including primary care and other sectors outside the NHS’. 

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’. 

But GPs have warned of increasing workload of ADHD prescribing as more patients access private healthcare for diagnosis.

Last year, a survey found significant regional variation in shared care arrangements for ADHD prescribing.

While 90% of surveyed commissioners said that at least some shared care protocols were in place in their region, only 79% of healthcare professionals agreed.