Paediatric ADHD Medication

Our surgery has opted out of prescribing ADHD medications under Shared Care Agreements (SCA) for paediatric patients due to unfamiliarity and uncertainty of this medication in this patient population which may then result in poor patient outcomes and care.  Patients have been lost to follow up to adult care in the past, so once the patient turns 18 years old then we may consider a Shared Care Agreement (SCA).

We believe it is too specialised for our care and would prefer the initiating specialist to continue prescribing and continue responsibility and care for the patient due to our patient safety concerns.

Therefore, we are unable to agree future prescribing of paediatric ADHD medication at this current moment.

Our local Integrated Care Board (ICB) has been informed of our decision.

28 Day Prescribing

Our practice policy is that we prescribe 28-day prescriptions to all patients. In some exceptional circumstances we may consider prescribing 7-day prescriptions, as outlined by Coventry Warwickshire Integrated Care Board (CWICB):

Coventry & Warwickshire ICB recommends that most repeat prescriptions be written for 28-days’ supply. This is to avoid medication waste and ensure stability of the medication supply chain. However, there are situations where differing intervals are more suitable:

Fewer than 28 days:

On rare occasions, prescriptions for 7-days may be more suitable where risks are perceived, or medication is frequently changing. This should be an agreement with the patient/representative, pharmacy and the GP.

The following considerations will be taken into account if prescriber agrees to 7-day prescribing:

·         Drugs liable to abuse.

·         Vulnerable patients who are likely to get confused and/or over-dose.

·         Terminally ill patients receiving palliative care support.

·         Dressings for short-term use or where likely to change.

·         When required / PRN medication.

·         Medications that are recommended for short term use only, e.g., hypnotics, benzodiazepines.

·         Newly prescribed medication when a shorter period is appropriate to assess response / titrating dosages etc.

·         An assessment of suicide risk in patients with a past medical history of overdosing should be undertaken and medication prescribed in a suitable quantity and with appropriate support.

Greater than 28 days:

·         Oral contraceptives and HRT (supplied in 3-month packs)

·         Medication that is supplied in special containers.

Monitored Dosage Systems (MDS):

Where the pharmacy is supplying medication in monitored dosage systems (MDS), a 28-day prescription should be issued and 4 weeks of MDS will be supplied at a time.

The community pharmacist should carry out a Disability Discrimination Act (DDA) assessment with a patient who is requesting an MDS or dosette box. If the assessment identifies that it is appropriate for the patient to receive an MDS, the pharmacy is required to do this at no additional charge. If the patient does not meet the criteria for requiring an MDS but would still like one, the pharmacy is able to charge the patient for this service.

https://www.covwarkformulary.nhs.uk/docs/chapter18/CG017-Monitored%20Dose%20System%20guidance.pdf

Our Local Pharmaceutical Committee (Ardens LPC) has issued the following advice as well with regards to MDS/7-day prescriptions:

It is at the pharmacy’s discretion as to whether they supply MDS – this is ONLY where they meet Equality Act and useful for the patient – which is a very small number of cases and do not qualify if they have a carer either formal or informal.

7 days prescriptions are applicable (MDS or not) if patient cannot safely have more than 7 days at a time – otherwise the pharmacy should provide 28 days at a time, whether that is original pack or other format. Sometimes patients do get confused if given multiple packs and so if concern they may on occasion need 7-days prescription and collected weekly.

Note pharmacies are not funded to provide MDS nor deliveries. If the patient ‘needs’ MDS but do not meet Equality Act then the pharmacy can charge the patient.

When going on holiday:

The maximum prescription duration allowed by the NHS for supplies for an extended holiday is THREE months.

Patients should check UK government advice on travelling with medicines and specific rules for the country that they are travelling to. There is a useful factsheet available here: https://travelhealthpro.org.uk/factsheet/43/medicines-and-travel.

Shared Care Agreements with Private Providers

Shared Care Agreements are written agreements between specialist services and general practitioners and allow care, specifically prescribing, to be safely shared between them.

BMA guidance, Advice & Support, “shared care” with private providers:

Sometimes the care of a patient is shared between two doctors, usually a GP and a specialist, and there is a formalised written ‘shared care agreement’ setting out the position of each, to   which both parties have willingly agreed. Where these arrangements are in place, GP providers can arrange the prescriptions and appropriate investigations, and the results are fully dealt with by clinicians with the necessary competence under the shared care arrangement. There is NHS guidance available about this.

Share Care is not recommended with private providers due to the NHS constitution principle of keeping a clear separation between private and NHS care.  Shared Care is currently set up as an NHS service, and entering into a shared care arrangement may have implications around governance and quality assurance as well as promoting health inequalities.  Shared care may be appropriate where contracted private providers are providing commissioned NHS services and where appropriate shared care arrangements are in place.

All shared care arrangements are voluntary, so even where agreements are in place, practices can decline shared care requests on clinical and capacity grounds.  The responsibility for the patients care and ongoing prescribing then remains the responsibility of the private provider.

As a practice we are following the BMA guidance, around private ADHD shared care agreements.  Presently we are not commissioned for most private ADHD services and therefore, not required to sign up for all private shared care agreements offering ADHD care.

We understand that this is frustrating, but until we are authorised by the Integrated Care Board Contracting Team, Coventry & Warwickshire who have reviewed the providers NHS contract there are limited prescribing ADHD providers we can refer to.

Privacy notice for sharing your data outside the practice

As a result of improvements in information technology and appropriate information governance standards, it is becoming possible to share your GP records across Coventry & Warwickshire Health & Social Care electronically using the practice clinical system. We will only share this information with your explicit consent, when seeing a health worker so that you are able to allow doctors, nurses and other health and social care services in other health organisations to view the information held on your GP records. Therefore, enabling health organisations to provide an appropriate health service required to meet the patients’ needs.

The following are examples of the types of organisations that we are likely to share information with:

  • NHS and specialist hospitals, Trusts
  • Independent Contractors such as dentists, opticians, pharmacists
  • Private and Voluntary Sector Providers
  • Ambulance Trusts
  • Clinical Commissioning Groups and Primary Care Networks
  • Social Care Services and Local Authorities

Any patient can choose to withdraw their consent to their data being used in this way. When the Surgery is about to participate in any new data-sharing scheme we will make patients aware by displaying prominent notices in the Surgery and on our website. These schemes are only for direct care so you (or your carer) will be present when the information is accessed and will be asked for consent again, before your records are opened.

A patient can object to their personal information being shared with other health care providers and can withhold consent but if this limits the treatment that you can receive then the doctor will explain this to you at the time.