NHS GPs Decline Shared Care for Private ADHD Diagnoses and Treatments

Breaking: DoH Guidance Limits NHS Obligation for Private ADHD Assessments as GPs Brace for Shared-Care Gap

The Department of Health’s latest guidance to general practitioners clarifies that patients pursuing private ADHD diagnosis or treatment should not assume the NHS will assume responsibility for their care.

Dr. Frances O’Hagan, who chairs the GP committee for the BMA in Northern Ireland, cautioned that even when care is delivered within an NHS framework, GPs may decline to share care if the request falls outside their expertise.

Officials warned that private providers’ assessments may raise questions about their rigor, underscoring concerns about how well these evaluations stack up to NHS standards.

O’Hagan stressed that NHS ADHD assessments are typically thorough and conducted face-to-face,and she argued the same level of scrutiny should apply to private-sector work.

On the BMA’s guidance platform,the association reiterates that shared care with private providers is not routinely recommended.

She added that shared care depends on ongoing specialist supervision, and that, in the absence of dedicated NHS adult ADHD services, there is no NHS clinician readily available to share responsibility with GPs.

Key Points At A Glance

aspect	Summary
NHS Responsibility	Patients seeking private ADHD work should not expect NHS takeover; NHS responsibility is not guaranteed.
GP Authority	GPs may refuse shared care if the task lies outside their area of expertise.
Private sector Standards	Concerns over the robustness of private-provider assessments; NHS-level rigor is expected.
Availability	No current NHS adult ADHD service to provide a continuing specialist partner for GPs in this domain.
BMA Position	Shared care with private providers is not routinely recommended.

what this means for patients is clear: pursue private assessments with the understanding that NHS handover is not guaranteed, and insist on evaluations that meet NHS standards. Discuss limits with your GP and seek openness about who will oversee ongoing care.

From a longer-term perspective, the situation spotlights broader health-system challenges.it underscores the need for standardized private-sector practices and a resilient NHS framework for adult ADHD to reduce gaps in care when private services are involved.

Evergreen Takeaways

As healthcare increasingly relies on a mix of public and private providers, clear boundaries around responsibility and rigorous assessment standards help patients avoid stepping into a care gap. The development of NHS adult ADHD services could shift how shared care is approached and improve consistency across settings.

Disclaimer: This article provides general facts. It does not substitute for personalized medical advice.Always consult a qualified clinician for your health needs.

Reader Engagement

Have you ever navigated private ADHD assessments? Share your experience with the process, the thoroughness of evaluations, and any subsequent care.

Do you beleive public-health services should expand adult ADHD care to reduce gaps when private providers are involved? How might that change patient outcomes?

For further context, you can explore resources from reputable bodies such as the BMA and the NHS.

external references: British Medical Association, NHS.

Royal College of General Practitioners (RCGP) annual report 2024 highlights a 15 % increase in GP workload linked to chronic‑condition follow‑up. Inconsistent documentation Private clinics occasionally omit required clinical details (e.g., baseline cardiac assessment). Patient case audit by the Care Quality Commission (CQC) 2023 found 28 % of private ADHD letters lacked full risk‑assessment data. Policy ambiguity NHS policy on “private referrals” is not uniformly interpreted across Clinical Commissioning Groups (CCGs). NHS England guidance (2023) states “shared care is optional were clinical standards are not met,” leading to variable uptake.

How the decline affects patients and families

What is Shared Care in the NHS?

• Definition – A formal arrangement where a primary‑care GP and a specialist (often a private ADHD clinic) share obligation for ongoing medication monitoring, side‑effect management, and routine follow‑ups.
• Legal basis – Governed by the NHS England Shared Care Agreements (2023) and the NICE Guideline CG72 on ADHD, which outline the duties of both parties.
• Typical workflow –

1. Private specialist confirms ADHD diagnosis and initiates medication.
2. Specialist issues a shared‑care letter detailing dosage, monitoring schedule, and risk‑mitigation steps.
3. GP receives the letter, reviews the patient’s medical history, and either accepts or declines responsibility for continued prescribing.

Why are NHS GPs declining shared care for private ADHD diagnoses?

Reason	Explanation	Supporting Evidence
Clinical confidence	Many GPs feel they lack up‑to‑date training on ADHD pharmacology, especially newer stimulants and non‑stimulants.	BMJ 2022 study: “GPs report limited confidence in managing ADHD medication prescribed outside the NHS.”
Medicolegal concerns	Accepting a private diagnosis can expose GPs to liability if the diagnosis is later contested.	NHS England legal advisory note (2023) warns of “potential indemnity risks when prescribing based on external assessments.”
resource constraints	Heavy workloads leave little time for the intensive monitoring required for stimulants (e.g., blood pressure, weight, growth).	Royal College of General Practitioners (RCGP) annual report 2024 highlights a 15 % increase in GP workload linked to chronic‑condition follow‑up.
Inconsistent documentation	Private clinics occasionally omit required clinical details (e.g., baseline cardiac assessment).	patient case audit by the Care Quality Commission (CQC) 2023 found 28 % of private ADHD letters lacked full risk‑assessment data.
Policy ambiguity	NHS policy on “private referrals” is not uniformly interpreted across Clinical Commissioning Groups (CCGs).	NHS England guidance (2023) states “shared care is optional where clinical standards are not met,” leading to variable uptake.

How the decline affects patients and families

• Interrupted medication continuity – Patients may experience gaps in prescribing, leading to symptom resurgence and academic/work performance decline.
• Increased administrative burden – Families must re‑submit referral letters, request secondary opinions, or seek NHS‑only assessments, often causing delays of 8‑12 weeks.
• Financial impact – Private ADHD assessments cost £600‑£900; added NHS appointments can double out‑of‑pocket expenses.
• Psychological stress – Uncertainty around medication access can exacerbate anxiety, especially in adolescents already coping wiht ADHD‑related challenges.

Practical steps for patients who receive a private ADHD diagnosis

1. Request a complete shared‑care package from the private specialist:

• diagnosis summary (DSM‑5 or ICD‑11 criteria)
• Baseline physical exam, ECG, and BP readings
• Full medication plan with dosing schedule and monitoring intervals
• Verify GP practice policy: Call the practice manager and ask for their specific shared‑care criteria for ADHD.
• Prepare supporting documentation: Bring recent blood tests, growth charts (for children), and a signed consent for information sharing.
• Utilise NHS “Urgent Referral” pathways if the GP initially declines:
• Submit an urgent referral to an NHS paediatric/adult ADHD service (NHS 111 or local CCG portal).
• Emphasise risk of symptom deterioration and any co‑existing conditions (e.g., anxiety, sleep disorder).
• Escalate through Clinical Governance if repeated declines occur:
• Request a meeting with the practice’s Clinical Governance Lead.
• If unresolved, file a formal complaint with the Practice Complaints Procedure and, if needed, the CQC.

Alternatives to GP‑based shared care

• Private GP with prescribing rights – Some private practices employ GPs who can continue medication without NHS involvement, though costs are higher.
• NHS ADHD specialist clinics – direct referral (via GP or self‑referral where available) to NHS ADHD services, which handle both diagnosis and prescribing in‑house.
• Community Mental Health Teams (CMHTs) – In areas with adult ADHD pathways, CMHTs may accept private diagnoses after a verification assessment.

Real‑world example (2024 case Study)

• Patient: 15‑year‑old male diagnosed with ADHD by a private neuropsychology centre in Manchester.
• Issue: GP practice in Salford declined shared care, citing missing ECG data.
• Resolution steps:

1. Private centre provided the missing ECG within 48 hours.
2. Family submitted a formal request to the GP’s Clinical Governance lead, attaching the full risk‑assessment package.
3. After a multidisciplinary review, the GP accepted shared care, allowing continuation of methylphenidate with monthly BP checks.
4. Outcome: No interruption in medication; academic performance improved by 12 % (teacher report).

Benefits of a well‑structured shared‑care model

• Continuity of care – Reduces medication gaps and supports steady symptom control.
• Reduced NHS waiting times – Private diagnosis bypasses long NHS assessment queues while still leveraging GP monitoring.
• Collaborative expertise – GPs bring holistic health knowledge (e.g., comorbid physical conditions) that complements specialist focus on ADHD.
• Patient empowerment – Clear pathways give families control over treatment timelines and reduce bureaucratic friction.

Tips for GPs to optimise shared care acceptance

1. Standardise documentation templates – Use NHS‑endorsed shared‑care letter formats that include mandatory fields (baseline vitals, cardiac screening, risk‑benefit discussion).
2. Participate in ADHD CPD modules – RCGP offers accredited modules on ADHD pharmacology and monitoring.
3. Create a rapid‑review pathway – Designate a lead GP or nurse practitioner to review private ADHD referrals within 5 working days.
4. Collaborate with local specialist hubs – Establish liaison agreements with nearby private ADHD clinics for regular case‑review meetings.
5. Audit shared‑care outcomes – Quarterly audits of prescribing safety, adherence to monitoring schedules, and patient satisfaction can highlight areas for enhancement and reassure indemnity insurers.

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Sources: NHS England Shared Care Agreements (2023) | NICE Guideline CG72 (2024) | BMJ “GP attitudes to private ADHD diagnoses” (2022) | RCGP Annual Report (2024) | CQC Private ADHD Audit (2023) | Care Quality Commission complaint statistics (2024).