Attention Deficit Hyperactivity Disorder (ADHD) Shared Care Policy

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1. Eligibility for Shared Care Agreement

• The practice will accept a shared care agreement for patients with a pre-existing ADHD diagnosis, either from the UK or abroad, provided that the diagnosis has been made by a consultant psychiatrist with experience in ADHD.
• The patient must be established on their ADHD medication for usually at least 3-6 months prior to initiating a shared care agreement.

2. Exclusions

• Bridging care will not be provided. This means the practice will not continue prescriptions for ADHD medication that has been purchased online or obtained without a proper prescription from a qualified healthcare provider, as outlined above

3. Role of the Consultant Psychiatrist

• The consultant psychiatrist will remain responsible for the ongoing diagnosis, management, and treatment of the patient’s ADHD.
• The patient should have open access to the psychiatrist, either by in-person visits or telemedicine consultations, for any concerns or adjustments regarding their ADHD treatment. The consultant remains ultimately responsible for the care.
• Formulation changes (e.g., switching medications or altering the form of the medication) must be corroborated by the consultant psychiatrist before any changes are made by the GP practice.

4. Health Monitoring

• The GP practice will conduct 6-monthly health checks, which will include monitoring of the patient’s blood pressure, heart Rate, height, and weight.
• If changes to the formulation are necessary, for example if a medication is unavailable from the pharmacy in 60mg tablets, we will consider prescribing an equivalent dosing regimen such as 3x20mg tablets on a case-by-case basis, but the consultant psychiatrist should be made aware of this and ideally approve this beforehand. 
• The GP practice cannot issue generic or alternative brands without prior approval of the responsible psychiatrist, because ADHD medication is brand specific

5. Medication Adjustments

• The GP practice may consider reducing the dose of ADHD medication if the patient prefers a lower dose. Again, any such changes ideally will be made in consultation with the consultant psychiatrist and communicating this will be the responsibility of the patient.  
• Any drug changes necessary due to side effects or poor effect/benefit must be made by the consultant.  

6. Annual Check-In with Consultant Psychiatrist

• As part of the shared care agreement the practice insists on an annual check-in with the consultant psychiatrist to ensure that their treatment remains appropriate.
• If an annual review is not possible this needs to be brought to the attention of a GP at the practice who will consider the circumstances and may refer the patient to local providers for ongoing care. However, if the patient has open access to the consultant psychiatrist (e.g. through telemedicine), the shared care arrangement will continue without disruption.

7. Responsibilities of the GP Practice

• Once the patient is stable on their ADHD medication, the GP practice will take over the prescribing of ADHD medications, according to the instructions provided by the consultant psychiatrist.
• The GP practice will also ensure the patient receives biannual health checks as part of their shared care agreement.
• The GP practice will ensure that the ADHD treatment plan, including medication doses and monitoring requirements, is followed as outlined by the consultant psychiatrist.

8. Referral to Other Providers

• If it is determined that the patient requires additional care or monitoring beyond what can be provided within the shared care agreement, the GP practice may refer the patient to local providers for continuation of care, ensuring they maintain access to their consultant psychiatrist.

Conclusion

This policy outlines the shared care responsibilities between the GP practice and consultant psychiatrists. It ensures that ADHD treatment is well coordinated, and that the patient receives comprehensive care. The consultant psychiatrist remains the primary authority for the diagnosis and ongoing management of ADHD, while the GP practice supports the patient by providing health checks, medication management, and necessary follow-ups.