‘Independent providers are part of ADHD solution but GPs need clearer pathways’
The upcoming review into ADHD and autism is a pivotal moment in reassessing the role general practice plays in the system, says former GP and clinical director of the Independent Healthcare Providers Network Dr Howard Freeman
As GPs, we are used to managing uncertainty. But few areas of our clinical practice have felt as complex, fast-moving – even fraught – in recent years as the growth in demand for ADHD and autism assessments.
We are seeing more patients presenting with concerns, whilst NHS waiting times now routinely stretch over multiple years.
This swift pace of change has encouraged the health secretary to commission an independent review into mental health conditions, ADHD and autism, of which an interim report was recently published, recognising ‘real increases in distress in some groups, improved recognition of previously unmet need, changing expectations about support, and systems that frequently rely on formal diagnosis as the primary route to assistance’.
With that review due to conclude in the coming months, there is, therefore, a significant window of opportunity to ensure that current system pressures are better understood – and the issues addressed coherently.
The independent sector will have a significant role to play, with providers having stepped in at scale to bring patients greater choice and swifter access to specialist support in recent years, as well as significant innovation through virtual models of care.
Recent analysis from the Independent Healthcare Providers Network (IHPN) estimates that more than half of all NHS ADHD assessments and roughly a third of all NHS autism assessments delivered today are delivered by the independent sector.
But despite this contribution, the wider healthcare system has been insufficiently prepared to handle the pace of change – both the growth in demand and this diversification of provision.
In the middle of it all, GPs are left having to support vulnerable, unsure patients and families from a thicket of conflicting messages.
Current issues raised around shared care protocols are a case in point. Whilst shared care supports continuity, operational barriers and information gaps undermine confidence.
A recent study, examining shared care in Northern England, found that medications prescribed for ADHD had the highest out-of-date monitoring data.
Moreover, when accepting share care, prescribing costs accrue to GP budgets – something which has not been addressed, despite the growth in patient demand and formal diagnoses.
It is entirely reasonable for GPs to seek reassurances meanwhile about service quality. All providers of NHS Right to Choose (RTC) services must hold a ‘qualifying contract’ with an ICB and must deliver NICE-compliant care. Many providers have meanwhile adopted additional, voluntary frameworks, such as the UKAAN Adult ADHD Assessment Quality Assurance Standard, but there are gaps in the current regulatory regime.
As the ADHD Taskforce recently recommended, updating NICE guidelines so there is clarity over the ‘appropriately qualified healthcare professional’ able to diagnose would be welcome. In addition, the Government should consider further regulatory reform to ensure that all elements of ADHD and autism assessment and treatment pathways are subject to CQC oversight.
Boosting clarity here would provide greater confidence for GPs, but most importantly of all, it would mean fewer patients left in limbo – as they are too often at present.
What’s needed in the policy debate is less polarisation and greater alignment. Independent providers are a key part of the system today – and can be a key part of the solution to ‘escalating’ waiting times.
IHPN (and our members) support NHS England’s work to develop mandatory tariff pricing across NHS neurodevelopmental services – but this work must go hand-in-hand with the development of clear service specifications that all NHS commissioners should use.
With the Government looking to implement the recommendations of the ADHD Taskforce report and with the independent review into mental health conditions, ADHD and autism, commissioned by the Health Secretary, due to report in the coming months, there is a significant window of opportunity emerging to ensure these issues are addressed coherently.
Whilst ambiguity remains in many facets of our understanding of neurodevelopmental conditions, the cost of failure to provide timely and effective support is clear.
Unidentified and unsupported ADHD and autism is associated with significant downstream impacts: worse academic and employment opportunities, financial difficulties, higher likelihood of contact with the criminal justice system and increased mortality. The ADHD Taskforce suggests the avoidable costs to the wider economy may be as high as £17bn. This necessitates ensuring there is sufficient access to specialist assessments and ongoing care.
General practice has an important role to play in providing timely and appropriate support. However, it needs additional resources to do this and policymakers must address these areas of ambiguity. Ensuring there is improved alignment and coordination will be key to addressing waiting times and reducing the anxiety and anguish that is the experience of far too many patients at present.
Dr Howard Freeman is a former GP and current clinical director of the Independent Healthcare Providers Network
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READERS' COMMENTS [9]
Please note, only GPs are permitted to add comments to articles
Non-NHS providers are NOT “Independent”, and should never be allowed to become part of any pathway or solution for diagnosis nor management, because they are NOT Independent.
They are not paid to provide an unbiased and ‘independent’ assessment – they are paid to provide the diagnosis the patient wishes, and they do so, usually regardless of whther it is correct or not, because they want patients’ money.
They should be excluded by provision of a properly unbiased NHS service ASAP. Continued failure to do this is harming patients with incorrect diagnoses and over-drugging with dangerous drugs during a period of high brain development.
‘General practice has an important role to play in providing timely and appropriate support’ – do we though, really? I’d argue that the growth in numbers seeking a diagnosis has turned this into an unmanageable burden and neurodiversity need not come under a GPs remit. We could go back to referring children with developmental delay, severe signs of autism to CDCs and the behavioural presentations of ADHD/ autism could be managed directly by links from schools with appropriate assessment services. More pragmatism is needed as the numbers are getting to the level where the whole system is swamped and cannot cope. I don’t add any value to a parent who calls me up telling me about their son’s inattention and poor behaviour. Doesn’t need a GP to be involved, ergo we shouldn’t be.
When do we ever see any quality control data of theseassessments and range of other diagnoses found in these patients by both NHS and particularly the ‘Independent Providers’ ie how many patients don’t have ADHD/autism but other clinical diagnosis
As a former GP and father I have experienced contracted mental health providers as useless. Assessments were an administrative nightmare, non drug treatments a joke and drug monitoring void of any signs of a meaningful review
Independent providers are NOT part of ADHD solution.
There – fixed that for you Howard. Free of charge.
Siloing ADHD/ASC provision is making the system worse for patients and is wasting money that should be put back into an intergrated local care whichj can sepnd the money on non medical support as an option.
I agree with David Church that “independent” providers tend to give the patients what they want. I have only ever seen ONE assessment which did NOT diagnose the patient with ADHD. The assessments are totally focused on teasing out traits of ADHD and do not seem to take a wider holistic view nor consider other possible diagnoses or formulations of the patient’s difficulties. I also agree with “Hello my name is” – as a GP I add no value to the assessment process. I think people should be able to self-refer, as they do to other mental health services. The problem arises when they come back wanting prescriptions, and these are for CD. We have no capacity for this work. What are we supposed to stop doing to make space for it?
Perhaps Wes Streeting (gaslighter in chief) will stop crowing about patients choosing to self refer to ‘specialist’ AQPs on the basis of a host of nebulous suspicions as they currently in effect do with right to choose in ADHD/autism.
what exactly is the ”unmanageable burden”. Annual BP check and a blood test form. so long as the patient has been seen by a GMC registered specialist what is the issue?? You don’t want to or cant do the assessment and yet don’t want anyone else to do so either!! NHS provision for these individuals is appalling which is why families go private. The condition affects families and patients daily life with effects on employment etc. and ” family doctors ” are blocking help.