GPs asked to pull out of ADHD shared-care agreements as part of collective action

LMC leaders are asking GPs to stop prescribing ADHD medication for patients who have been diagnosed elsewhere as part of collective action.

In several areas, Pulse has learned that GPs have stopped entering new shared-care agreements for ADHD, however some LMCs wish to go further and have asked GPs to also stop agreements for existing patients.

And at least one trust has already highlighted the impact of GPs pulling away from providing care to adults with ADHD.

In Essex, GPs have been advised by LMCs to stop care for patients on adult ADHD pathways in order ‘to focus capacity on core services’.

A letter to practices recommends they inform Mid and South Essex ICB that they will be ‘withdrawing care to adult ADHD patients currently under their care in three months and to no longer accept new patients’.

The letter said: ‘This is a rapidly growing issue with multiple providers offering opinions and diagnoses of variable credibility to vulnerable patients.

‘The associated workload is significant and LMC members recommend that this care be provided by properly commissioned specialist services.’

It called a recent offer for a shared care payment of £50 per patient per year ‘derisory’.

‘Attempting to provide care at such rates is a threat to the sustainability of general practice,’ it continued.

Dr Brian Balmer, Essex LMCs chief executive, told Pulse that they were also recommending GPs do this within Suffolk and North East Essex ICB. It remains ‘an active issue and discussions are ongoing’, he said.

Suffolk LMC says it advised that practices taking collective action should ‘stop accepting prescribing responsibility for ADHD medications under new shared care agreements on the NHS’, ahead of a new locally enhanced service (LES) coming into force.

‘Suffolk LMC have declined, on behalf of all practices in Suffolk and irrespective of their position on collective action, the option of continuing shared care’ in this area, it said.

According to the LMC, ADHD will not be part of a new shared-care LES, although NHS Suffolk and North East Essex ICB denied the LES plans altogether when asked by Pulse.

A spokesperson added: ‘The ICB is working to ensure local people have uninterrupted access to ADHD medications. We are working with primary and secondary care colleagues to achieve this.’

In Dorset, practices taking part in collective action have agreed to decline new shared care requests for ADHD as part of wider collective action.

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, who provide mental health services and disability care across the region, have said they were seeing an impact on collective action in terms of return of shared care, specifically for ADHD.

An update, presented to Newcastle and North Tyneside LMC, said it ‘was impacting on the ability to take on new assessments, specifically with the ADHD pathway’.

The trust continued to support GPs taking part in collective action, it was reported at the LMC meeting.

In board papers published in September, the trust said there were currently 12,000 patients on the adult ADHD waiting list increasing month by month with a current average wait of seven years.

LMC leaders argue that without special financial arrangements ADHD shared care is unfunded work for GPs.

Dr Adam Janjua, chief executive of Lancashire and Cumbria LMCs said: ‘These shared care agreements are nothing but a request for GPs to take on the workload of secondary care for free.’

‘There is absolutely no funding for shared care ADHD and as such practices are being asked to take on extra workload that is completely unfunded.’

He said it was up to the commissioners to hold hospitals to account for their inefficient use of outpatient clinics.

‘If there is a backlog it’s due to poor management and very poor planning from the people that should and must do better.’ 

However, some GPs have been reluctant to withdraw from arrangements amid concern for patients.

Nottingham GP partner Dr Irfan Malik told Pulse his practice is ‘reluctant to start shared care’ for private ADHD services, but they have ‘carried on with’ existing shared care agreements, adding that withdrawing these would impact patients.

He said: ‘There would be an impact, because they’d have to liaise back with the specialist, and set up what happens in the shared care with the specialist.

‘It would be a disruption for the patient, the specialist, and for us as well, because we would have to notify those people that we’re not doing that. But we haven’t gone down that route.’

Pulse has contacted relevant trusts and ICBs for comment.