While traditionally more common in young children, in recent years there has been a significant increase in diagnoses of Attention Deficit Hyperactivity Disorder (ADHD) in adults.
This has put pressure on the NHS patient pathway, with the volume of demand leading some trusts having to close waiting lists. This has, in turn, led many patients to seek diagnosis and treatment from private providers, who can offer assessments much faster.
However, an issue has arisen in those privately diagnosed patients seeking to then revert back to the NHS for medication and treatment, due to the high costs of obtaining this from a private provider.
GPs are then left with a choice; rely on the ADHD diagnosis from the private provider and prescribe medication under a ‘shared care’ arrangement, effectively allowing the patient to bypass the NHS waitlist, or refuse to do so and insist the patient receives an NHS diagnosis before receiving medication with NHS funding.
Assessment and diagnosis
According to the National Institute for Clinical Excellence (NICE), an ADHD diagnosis should only be reached following a full clinical and psychosocial assessment, including obtaining a full developmental and psychiatric history, as well as observer reports and assessments of the patient’s mental state.
Responsibilities and risks
It is entirely up to an individual GP whether they enter into a shared care arrangement and adopt a private provider’s ADHD diagnosis. Whilst the private healthcare sector should not be used by patients as a tool to bypass NHS waiting lists or expedite NHS treatment, patients have understandably become frustrated with the NHS system which is struggling to cope with the surge in demand.
Guidance from GPC England (England’s general practitioners committee) and published by the British Medical Association (BMA) – ‘General practice responsibility in responding to private healthcare’ – highlights that complying with a private healthcare provider’s request for tests or investigations “is outside the scope of NHS primary medical services”. However, if the GP deems the proposed investigations as “clinically appropriate”, the GP may proceed to arrange these if they feel that they are “competent to both interpret them and manage the care of the patient accordingly”. The Guidance also refers to NHS guidance which states that private and NHS care should be kept as clearly separate as possible and NHS resources should never be used to subsidise the use of private care. The separation should be “as clear a separation as possible of funding, legal status, liability and accountability between NHS care and any private care that a patient receives”.
Should a GP agree to a shared care arrangement, they must ensure the diagnosis was made by a healthcare professional with training and expertise in diagnosing ADHD. The GP is ultimately responsible for the prescriptions they write and must ensure that the medication is appropriate, necessary and safe for the individual patient. The GP could be subject to potential legal liability, should the diagnosis be incorrect or the medication inappropriate.
Comment
ADHD diagnoses reached by reliable private practitioners in compliance with NICE guidelines may well assist in alleviating pressure on NHS waiting lists, helping to reduce the backlog. GPs may wish to enter into shared care arrangements on this basis, should they feel comfortable doing so. However, GPs and other NHS bodies and practitioners should be mindful that not all diagnoses will be correct or reliable and that it is their prerogative to refuse to prescribe medication should they have any doubts over the ADHD diagnosis.
When the lines between private and NHS treatment are blurred, difficulties may arise. The GP is ultimately responsible for any injury or negative side effects a patient may experience from incorrect or inappropriate medication which they have prescribed.
Amber Anderson is a senior associate at Kennedys.
