Exclusive GPs should withdraw care for children with ADHD due to ‘capacity issues’, and as a way of pressuring the ICB into commissioning a specialist service, a group of LMCs has recommended.
North and South Essex LMCs chief executive Dr Brian Balmer told Pulse that practices are not currently paid to provide this care, and that these ‘complex patients’ should be cared for by specialists rather than GPs.
In a recent letter to all GP practices in Mid and South Essex, the LMCs recommended that GPs should refuse to accept new patients and give current patients three months’ notice of the decision to withdraw care.
It also mentioned issues with ‘capacity’ in general practice currently, which mean that practices cannot ‘ensure the provision of a high quality service’.
Dr Balmer told Pulse: ‘Practices are not currently paid and there is no shared care protocol agreed. Withdrawal is based on capacity issues, and the need for these complex patients to be cared for by specialists.’
This new recommendation follows similar advice to Essex GPs in November when the LMCs said practices should stop care for patients on adult ADHD pathways as part of collective action.
Other LMCs across the country, including Suffolk and Dorset, recommended similar but less drastic action, telling practices they can refuse to sign new shared care requests for ADHD.
The letter to Essex GPs on Tuesday, seen by Pulse, said the issue of children’s ADHD care is a ‘difficult issue’ which was discussed ‘at length’ by the LMCs last week.
It continued: ‘The LMCs recommend that practices in Mid and South Essex withdraw provision of ADHD services to children, therefore refusing to accept new patients and giving patients three months’ notice of this decision.’
Dr Balmer told practices they ‘must inform’ both current patients and the ICB, and he also recognised that ‘this may cause short term difficulties in the relationship between some patients and their families’ and the practices.
He emphasised that the ‘final decision is for individual practices’, but the LMC made a case for withdrawing services, suggesting that provision of ADHD care to children risks compromising core GP care.
The letter said: ‘The safety of patients is paramount, and the current capacity in general practice will not ensure the provision of a high quality service without reducing the care given under the GMS contract.
‘The total withdrawal from this service may lead to a more streamlined service commissioned over the entirety of the ICS thereby offering a level of activity which will encourage consistency and effectiveness.’
According to Dr Balmer, the position of the LMCs is that any children’s ADHD service should be ‘properly commissioned by the ICB and not disseminated across general practice’, in order to ensure ‘the best possible care’.
Dr Balmer also said that the LMCs would take this position regardless of the BMA’s ongoing collective action.
ICB director of primary care William Guy said in response: ‘NHS Mid and South Essex is working with the LMC, primary care and other providers to ensure local people have uninterrupted access to ADHD medications.’
Researchers recently warned that GPs face patchy shared care agreements for ADHD care among adults, and that some do not feel sufficiently supported to prescribe for the condition.
Lets hope all GPs actually join in. The do gooders are going to the ones to the let the whole profession down as usual sadly.
No place for bleeding hearts when GP is under so much pressure.
Well done Essex LMC
To be honest I don’t think medicolegally or clinically we should be providing ANY shared care full stop. The standard for legal duty of care for medical treatment is outlined in the leading case Montgomery vs Lanarkshire Health Board.
https://www.themdu.com/guidance-and-advice/guides/montgomery-and-informed-consent
To meet that duty of care the doctor providing treatment must make sure the patient has informed consent to that treatment; ie material risk/benefits and reasonable alternatives. AS prescribing doctor we take medicolegal responsibility for providing that medication. Unless we have specific experience or training in providing that medication/care we can’t provide informed consent. To be frank we generally don’t even have that informed consent discussion with the patient; we get the letter we follow instructions. I’m not sure any shared care we do, when we prescribe medications we are not personally familiar with, are we able to meet the standard of informed consent to meet our medicolegal liability. The less confidence we have in the specialist who diagnosed and prescribed, most particularly when private providers are involved ie less standardised standard of care, the less confident we will feel that we are professionally and medicolegally meeting our obligations. All shared care is arguably problematic and should be handed back to secondary care. Pharmacists with prescribing qualifications could be given specific training by the specialists to do this shared care and it should not be part of our work. it’s a dodgy business and should never have been started. It’s been mission creep ever since.