GPs say they need better guidance and prompt access to specialist advice to deal with the problems caused by shortages of ADHD medicines.
It follows a directive in September not to start any new patients on ADHD medicines due to a national shortage with GPs also being asked to identify and contact all patients currently prescribed the medicines to ensure they have supplies to last.
A national patient safety alert said there were ‘supply disruptions’ of various strengths of methylphenidate, lisdexamfetamine and guanfacinedue to a combination of manufacturing issues and increased global demand.
The shortages, which are likely to continue until the end of the year are making things very difficult for practices and patients because of shared care arrangements and the complex logistics involved in switching, GPs said.
Dr Emma Nash, a GP partner in Hampshire, told Pulse a lot of GPs are now pushing patients back to secondary care because they don’t have the capacity to change medications.
‘It’s not a simple change – it involves switching to two different preparations usually, and you have to work out the various components in them – especially as they’re branded.’
The ICB has sent out some helpful information on switching and drug shortages but lack of resource to do it is a real problem, she adds.
‘We’ve declined to take on any more shared care agreements until the supply issue is resolved.
‘We haven’t been given guidance on whether it’s likely to destabilise patients and whether additional follow-up is needed, and this is also driving GPs to refer back to secondary care as we aren’t skilled in management of ADHD and medicines adjustment,’ she said.
Dr Nash said patients were of course very worried but GPs were being seen obstructive for not prescribing even though NICE agrees that shared care is required.
‘The variability in providers doesn’t help – some won’t prescribe, others do. Ultimately, if patients can’t get their meds, the GP practice is the one that takes the brunt. I can see staff being shouted at demanding meds are changed.’
Patients who are on guanfacine must not stop their medication abruptly as it can cause rebound tachycardia and hypertension, she noted.
‘These patients need identifying early – with searches – and referring back to secondary care immediately, before we get to the “what now” situation,’ she said.
The issue was raised last week in the Welsh Senedd with the Government urged to provide an update on what it was doing to address the shortages which was causing ‘distress’ to patients.
Welsh health minister Eluned Morgan explained the UK Department of Health and Social Care had added all ADHD medications to the list of medicines which cannot be export to secure UK supplies.
Dr Selvaseelan Selvarajah, a GP in Tower Hamlets in East London said many patients were going private given the long NHS ADHD clinic delays.
‘But, given the shortage of ADHD meds, we are unable to issue new scripts for patients recently diagnosed.
‘We are also struggling to switch to suitable alternatives and the lack of uniform shared care agreements with private psychiatrists make this challenging.
‘It is really important for patients and GPs to have prompt access to specialist advice.’
A Department of Health and Social Care spokesperson said: ‘We are aware of supply issues affecting medicines used for the management of ADHD due to increased global demand, and we have issued communications to the NHS to advise healthcare professionals on management of patients during this time.
‘We continue to work closely with the respective manufacturers to resolve the issues as soon as possible and to ensure patients have continuous access to ADHD medicines in the UK.’
Fortunately, all patients on these drugs in Wales are under care of a Secondary Care Responsible Prescriber, so GPs can just tell patients to contact their Specialist and tell them to write to us once the patient is stabilised on their new medication to ask if we are willing to take on shared care again !
Actually, it looks like an opportunity to regularise those where Specialist is not forthcoming with appropriate communications.
Many years ago when discipline and respect existed we did not prescribe as much. Now, the medicalizing of lazy parenting which has not worked has caused more problems. The ADHD is over diagnosed.