GPs don’t have to enter shared care agreements with private ADHD prescribers, says LMC

An LMC has advised GP practices that they can decline to enter shared care agreements with private ADHD prescribers, citing lack of capacity or clinical grounds.

Kernow LMC is in the process of publishing a position statement in connection with ADHD prescribing and reminded practices in Cornwall that there is no contractual requirement to enter a shared care agreement with any organisation.

GPs around the country recently told Pulse that poor shared care arrangements were generating more workload as practices are expected to take on prescribing and monitoring, with ADHD being a particular issue.

In all, 46% of GPs responding to a Pulse survey said they were doing more work as a result of patients opting for private healthcare.

Kernow LMC committee member Dr Jonathan Hollow said that knowledge of ADHD and requests for referrals have ‘skyrocketed partly due to awareness campaigns and social media’.

In a newsletter, he said: ‘The local waiting times became so long that NHS right to choose (NHS-RTC) requests through private providers exploded and we became inundated with printed off forms and occasionally aggressive letters.

‘We are now at the point where many of those NHS-RTC patients are “stable” and looking for shared care agreements with their practices.

‘There is no contractual requirement to enter into shared care with anyone and it is up to the individual GP or practice to decide. You can decline on capacity or clinical grounds.’

BMA guidance published in August pointed out that most shared care arrangements are commissioned by NHS commissioners and may not be funded for patients seeking private treatment.

It said: ‘If this is not funded by local commissioners, the prescriptions and investigations should remain the responsibility of the private provider.

‘All shared care arrangements are voluntary, so even where agreements are in place, practices can decline shared care requests on clinical and capacity grounds.

‘The responsibility for the patient’s care and ongoing prescribing then remains the responsibility of the private provider.’

NHS England guidance cited by the BMA said that when decisions are made to transfer clinical and prescribing responsibility for a patient between care settings, it is of ‘the utmost importance’ that the GP feels ‘clinically competent’ to prescribe the necessary medicines.

It added: ‘If the GP considers him- or herself unable to take on this responsibility, then this should be discussed between the relevant parties so that additional information or support can be made available, or alternative arrangements made.

‘When drawing up shared care agreements, or where there is a lack of clarity about prescribing responsibilities, it may be necessary for local discussion to take place between hospitals, commissioners, the Area Prescribing Committee, and the relevant LMCs as a prelude to establishing agreement with individual GPs.

‘GPs would only be obliged to provide treatment consistent with current contract requirements.’

Recently, Pulse revealed that LMCs have told GP practices they can decline patient requests for routine aftercare in the first two years after private bariatric surgery undertaken abroad.

During the LMCs annual conference in May, local GP leaders called for practices to be remunerated appropriately for requests from private healthcare or insurance providers relating to their patients.

A Pulse investigation last year found private health services were thriving as a result of long NHS waiting lists with demand for self-pay healthcare rocketing.