Attention Deficit Hyperactivity Disorder (ADHD) assessment – Referrals and Medication

 

As a practice we are committed to supporting patients with neurodevelopmental diagnoses, both children and adults.

 

This information is for those patients who are concerned or suspect that they may have ADHD and would like to be referred for an ADHD assessment.

 

Attention Deficit Hyperactivity Disorder (ADHD) can affect many aspects of a person’s life. However, diagnosis is complex and GPs are not able to make a diagnosis of ADHD, a referral is needed to an ADHD specialist. If an ADHD diagnosis is subsequently made by the specialist, they may choose to offer medications to help manage the symptoms. These medications are potentially dangerous and therefore require careful monitoring.

 

This guide will explain how the referral process works, how referrals are initiated and what you can expect if you are diagnosed. This information is based on national and local guidance, specifically NICE guidance.

 

ADHD referrals for Children:

The person who needs to initiate the referral will depend on the education age of the child:

Pre-School – The referral needs to be discussed with the Childs Health Visitor or Early Years Setting – they can be contacted by calling: 0300 247 0025

School Age – The referral is undertaken by the school

Home Schooled Children – the referral is undertaken by the GP. Patients who request a referral for ADHD diagnosis can be referred through the NHS pathway, the NHS Right to Choose pathway or to a private provider.  Patients must choose a preferred provider and completed any necessary pre-assessment forms before they book a GP appointment to discuss a referral.

 

Supporting evidence will be required regardless of who is initiating the referral.

 

ADHD referrals for those aged 18-25:

Patients who request a referral for ADHD diagnosis can be referred through the NHS pathway, the NHS Right to Choose pathway or to a private provider.

 

Patients must choose a preferred provider and complete any necessary pre-assessment forms before they book a GP appointment to discuss a referral.

 

Adults aged over 25 years:

Due to the unprecedented demand for ADHD diagnosis and treatment nationally and locally across all age groups, strict referral criteria are in place across the Frimley ICB. 

 

To be referred under the NHS to a Right to Choose provider, adults aged 25 years and older must meet criteria 1, 2 & 3, and one criterion from 4.  Evidence of eligibility must be provided in writing.  If the below criteria are met, patients must choose a preferred provider and complete any necessary pre-assessment forms before they book a GP appointment to discuss a referral.

 

1.    Over the age of 25 years

2.    The client is registered with a GP within Frimley ICB.

3.    The client does not have a contraindication to ADHD Medication / treatment (physical health reason such as a contraindicated condition OR condition already investigated e.g. cardiovascular problems that would contradict ADHD treatment at times of referral, high blood pressure regulated, or cardiologist has been consulted).

4.    The client can provide written evidence from a suitable authority that they meet one of the criteria below:

A.   SAFEGUARDING: The client or child in their care is open to a safeguarding team and an assessment and/or treatment has been identified as a need. (Referrer should consider sharing any information relevant to a RTC provider. There will be situations where a local commissioned service may be more suitable if coordination of risks is required. Holistic assessment may be required in some cases.)

B.   LEGAL PROCEEDING: Clients open to Criminal Justice Liaison and Diversion/street triage/link/probation and an assessment and/or treatment has been identified as a need. This does not include family law. This does not include medicolegal assessments. (This would potentially include prison leavers.) Referrer should consider sharing any information relevant to a RTC provider.

C.   LONG TERM CONDITION: Client has a long term physical health condition e.g. diabetes, epilepsy, menopause and they are struggling to manage the care plan. An assessment and/or treatment has been identified as a need.

D.   EDUCATION: The patient is enrolled in an academic / vocational course and difficulties associated with neurodivergent traits (such as focus, submitting work, communication) have led to risk of failing/non-completion/exclusion. The student support service (or SEND) has provided evidence that reasonable

E.   adjustments have been implemented consistently for a term and diagnosis is required to access further support (e.g. medication/funded adjustments available with a confirmed diagnosis). Adjustments should be offered without formal diagnosis; we will not review adjustments that have been made. We recognise that these are person-specific and out of our medical remit.

F.    EMPLOYMENT: There is a pattern of repeated loss of employment due to symptoms or client is at risk of losing current employment due to symptoms despite implementation of reasonable adjustments AND a diagnostic assessment is considered essential to access or maintain employment.

 

ADDITIONAL PROVISION TO ENSURE CONTINUITY OF CARE

The following should also be considered when deciding on referral to Right to Choose providers:

G.   CONTINUITY OF CARE: Client has an existing and evidenced (child or adult) diagnosis approved by an NHS service (based on NICE compliance) AND

                                          i.    meet criteria outlined above OR

                                        ii.    there is objective evidence of past behaviour that indicates significant risk of meeting criteria above if medication stopped (e.g. loss of job; discontinued education, imprisonment).

 

If a patient aged 25 and over does not fit the above criteria, they can ask to be referred to a private provider of their choice.

 

NHS Pathway:

Referrals through the NHS Mindworks team are available but are subject to a wait list.

 

NHS Right to Choose:

Under NHS England’s Right to Choose legislation patients can exercise their right to see any appropriate health service provider.  This provider can be anywhere in England. Please click here to view the list of Right to Choose providers.

 

Please only book an appointment with a GP to request a referral after a Right to Choose provider has been chosen and their pre-assessment forms have been completed by the patient. GP referrals to Right to Choose providers will consist of a standard letter only.  Any other forms requested by the provider will not be completed by Lightwater Surgery.

 

If a diagnosis is determined and medication is recommended, clinical responsibility for prescribing and monitoring of the patient and their medication remains with the Provider, unless a Shared Care Agreement can be formed between the consultant and the GP.

 

Please note there is no obligation nor mandatory requirement for a GP to enter into any Shared Care Agreement. 

 

Private Providers:

You may choose to be referred to a Private Provider for your ADHD assessment due to the long waiting times for an NHS appointment, or simply out of preference.

 

Please only book an appointment with a GP to request a referral after a provider has been chosen.

 

If a diagnosis is determined and medication is recommended, clinical responsibility for prescribing and monitoring of the patient and their medication remains with the Private Provider, unless a Shared Care Agreement can be formed between the consultant and the GP.

 

Please note there is no obligation nor mandatory requirement for a GP to enter into any Shared Care Agreement. 

 

Medication Prescriptions and Shared Care Agreements:

 

If the Provider confirms a diagnosis of ADHD, they may initiate treatment and may offer medication; initially this will need to be obtained directly from the specialist consultant. Once they are confident the patient is stabilised on their medication, they may feel it is appropriate for the patient to obtain their medication from the GP Surgery. 

 

In order for us to prescribe this type of medication, the consultant will need to send a completed, standardised, Frimley ICB Shared Care Agreement to your GP. This is an agreement between a Consultant and a GP which stipulates any monitoring needed to continue to prescribe the ADHD medication safely. 

 

Please note, the GP is only able to continue prescribing and monitoring a patient if an up-to-date Shared Care Agreement is in place.  Annual reviews with the consultant must be attended as a condition of a Shared Care Agreement.

 

Please note there is no obligation nor mandatory requirement for a GP to enter into any Shared Care Agreement. 

 

Signposting Information on ADHD:

ADHD UK: A charity offering free advice and information on ADHD and Right to Choose referrals

ADHD Foundation: The UK’s leading neurodiversity charity, offering services for those who live with ADHD, Autism, Dyslexia, DCD, Dyscalculia, OCD, Tourette’s Syndrome and more

Mind: ADHD and mental health

Attention deficit hyperactivity disorder (ADHD) - Living with - NHS

 

Getting support for Children & Young People

Mindworks Surrey

Mindworks Surrey supports children and young people across Surrey with emotional wellbeing, mental health, and neurodevelopmental needs.

For children who attend a State School and where their needs are not urgent or crisis:

Mindworks has expanded support in state schools across Surrey.

·         Speak to your school (teacher or SENCO).

·         School staff can help you access Mindworks without a referral.

If a child is not in School or is Home Educated and where their needs are not urgent or crisis:

A professional (GP, social worker, or teacher) can request support for neurodevelopmental needs via: neurodevworkrequests@sabp.nhs.uk

If the child attends an Independent School
Parents can request a consultation directly for neurodevelopmental needs via:
neurodevworkrequests@sabp.nhs.uk

If You’re Concerned About a Child’s Mental Health

A health or social care professional can make a request for support at:
mindworks-surrey.org/professionals/request-support-child-or-young-person

For Urgent or Crisis Help
If you’re worried about yourself, your child, or someone else:
Mindworks 24/7 Crisis Line (Free): 0800 915 4644

Out-of-Hours Parent & Carer Helpline
For advice on supporting children or young people with attention, activity, or behaviour challenges:
0300 222 5755
Open: 5pm–11pm, every day, all year round
Speak to friendly advisers for calming strategies and practical support.

Find Out More
www.mindworks-surrey.org