ADHD in Adults – Information
This document covers the practice policy regarding specialist referral and ongoing care under shared care agreements, SCAs for adult patients registered with ECMC who request referral for symptoms likely to represent ADHD.
ADHD is defined as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning. The definition requires that symptoms:
- Start before 12 years of age.
- Occur in two or more settings, such as at home and school or work.
- Have been present for at least 6 months.
- Interfere with, or reduce the quality of social, academic or occupational functioning.
- Do not occur exclusively during the course of a psychotic disorder and are not better explained by another mental disorder.
Inattention is manifested by wandering off task, difficulty with persistence, difficulty sustaining focus, and with organization.
Hyperactivity:
1. In a child is manifest by excessive motor activity when it is not appropriate (such as running around), or by excessive fidgeting, tapping, or talkativeness.
2. In an adult is manifest by extreme restlessness or wearing others out with their activity.
Impulsivity refers to hasty actions that occur in the moment without forethought and that have high potential for harm to the individual. Impulsive behaviour may manifest as social intrusiveness (for example, interrupting others excessively) and/or making important decisions without considering the long-term implications.
If ADHD is suspected :
- Patients should request an assessment appointment.
- The presence or absence of features of ADHD would be noted.
- The psychological, social, educational or occupational impact of symptoms would be explored.
- For patients with persistent features of ADHD across more than one domain which has been present since childhood and is currently adversely affecting functioning a referral for assessment by a mental health specialist trained in the diagnosis and treatment of ADHD should be offered.
Referral Options :
- Refer to 3 Boroughs ADHD assessment service
- Refer to a Right to Choose provider via NHS identified by patient
- Refer to a private provider at patients request
Stimulant Medication Provision :
It is practice policy that following appropriate specialist assessment and diagnosis, if stimulant medical therapy is chosen and is started by a specialist and shown to be well tolerated and effective and appropriate monitoring arrangements are in place which must include at least include an annual review we will accept Shared Care Agreements SCAs for NHS 3 Boroughs and Right to Choose providers.
However we do not accept SCAs from private providers because ongoing shared care can not be assured.
When patients are referred they should be provided with a copy of the letter to patients being referred for an ADHD assessment informing them regards the above policy.
Shared Care Agreements:
1 When we receive a shared care agreement SCA from the 3 Boroughs service it shall be actioned as it has been pre-agreed within Southwest London ICB and assured as a complete ADHD service.
2 When we receive a SCA request from a Right To Choose provider then this shall be forwarded to a named clinical pharmacist who will follow the practice check list to ensure that the complete ADHD service is provided to enable care to be shared.
3 When we receive a SCA request from a private provide they shall be informed that we will not accept.
If you have an existing diagnosis and are receiving stimulant medicines currently please note this SCA acceptance protocol applies to patients joining the practice who may already have had alternate arrangements with previous practices. A shared care agreement is between an individual practice and a specialist provider and not between General Practice and specialist provider. If your existing SCA is with a private provider or a R to C provider who does not provide ongoing care and reviews we will not be able to accept and prescribe.