ADHD / Autism

Over the last few years, we have seen increased patients wanting an assessment for ADHD or Autism.  Services are experiencing potentially long waiting times due to the demands on their services.

If after a GP assessment, a patient requires a referral for assessment of ADHD or Autism, there are 2 main choices:

1. An NHS assessment using our local provider, or
2. Elect for a ‘Right to Choose’ referral (see separate section).

OPTION 1: NHS assessment using our local provider

The current local NHS referral pathway, put in place by our local ICB (Humber and North Yorkshire Health and Care Partnership), has 2 pathways to access an assessment. If you meet certain criteria (as per below), you may be referred directly for an assessment at ‘The Retreat’ (who run the Tuke Centre in York) for assessment by the GP.  Please note, these criteria are very strict.  If accepted, there remains long waiting times for assessment.   

Referral Criteria for local direct referral (a lack of diagnosis affects the following):

• Affects court decision, employment (family breakdown, custody hearing, armed forces),
• Adjustments needed to access health care (hospital operations / procedures),
• Immediate urgent impact on care (loss of housing, employment tribunal, financial loss)

For patients not meeting the set criteria for direct referral (see above), it requires patients to complete a self-assessment tool online (The ‘Do IT Profiler’), to assess eligibility. Patients will receive online practical advice, and you will be given the option of remaining on a waiting list, which is managed by the ICB.

OPTION 2: Right to Choose referral

See separate tab for this.

NEXT STEPS

Please read the following tabs below to decide what referral pathway you want:

• Right to Choose
• Shared care prescribing for ADHD medication (if wanting an ADHD assessment)

Once you have decided which referral pathway you would like to explore, please send an eConsult to the practice so we can assess your case further. Within this econsult, you need to provide details on the reasons for your suspected diagnosis, the impact it is having, what you hope to achieve and which referral pathway you would like to follow.

GP practices are not able to provide evidence for Disabled Student DSA applications. If you are waiting for assessment through this route, the Do-It Profiler will provide a standard letter, signed by an ICB GP, which patients can then pass to the University.

We are aware that NHS services for ADHD/Autism assessment, diagnosis and treatment are limited, with extensive waiting times. An increasing number of patients are therefore choosing to access private providers, sometimes under the NHS ‘Right to Choose’ rules. 

Our ICB has recently updated their advice on making Right to Choose referrals. The Do-IT Profiler no longer must be completed for these.  We can confirm that if the provider has a contract with NHS England for the required service, then you can go ahead and arrange an appointment, or we can refer you, when this is clinically appropriate. No prior commissioner approval is required, provided the service is led by a named consultant or named healthcare professional. 

The right to choose pathway will fund an assessment.  Some private organisations may also offer prescribing under an NHS right to choose (see below for information).

For the avoidance of doubt please read the following:

1. Investigations / health checks / monitoring

We are not able to perform any investigations, physical health checks or initiation monitoring on behalf of a private provider (whether or not you were referred under the ‘Right to Choose’), as this is their responsibility, even if they operate a remote access tele-health service. 

• Shared care prescribing – see separate section for details

If medication is recommended for treatment of ADHD, the drugs will need to be started by the specialist with initial prescriptions issued by them.  Some private clinics (under Right to choose may be able to offer this but not all).  The practice will then decide if they are able to agree to a ‘shared care prescribing’ contract with the private provider.

NEXT STEPS:

If you choose to have ‘right to choose’ referral, you will need to organise this yourself. We are not legally allowed to recommend specific companies. You will need to consider what sort of service /assessment that company offers.

Once chosen, you will need to go on their website/ contact the company to find out what their referral process is. Some will accept self-referral, some need the practice to complete a referral form.

We will still need information regarding the reasons for a referral and symptoms, so we can assess this further. Some companies require you to complete scoring questionnaires – these will need sending to the practice as well. 

If you need us to refer, please send an econsult with all the required information / scoring questionnaires.

WAITING TIMES FOR RIGHT TO CHOOSE

Waiting times for private patients are usually shorter than NHS patients (under right to choose).

The private providers will have waiting times and recently we have seen these are starting to rapidly increase as demand outstrips capacity.

Once you are referred to one provider, we will not then switch to another private provider.

Medication for ADHD can only be initiated by a specialist and must continue to be supervised long term by a specialist. Most of the medications used are legally classified as Controlled Drugs, which means that only a 28-day prescription can be issued at a time.

Please be aware that the practice will not be able to do any shared care prescribing with a private provider. If medication is recommended, you would need to be referred to the NHS provider to review and advise if they able to support the decision. If a patient has already been started and stabilised on the medication, we can usually obtain shared care prescribing with the NHS relatively quickly.  Unfortunately, if no medication has been started, there are significant waits for an assessment to be done.

In order for the Retreat to share care with us on the NHS, you must provide us with all of the following:

1. Your original ADHD diagnostic report.
2. A full medication and prescribing history from your current specialist.
3. The most recent clinic letter from your last review with them, with details of your most up-to-date physical monitoring.

Once we have received this, we can refer for a medication review at The Retreat.  Depending on the source of your diagnosis, it is possible that The Retreat would not recognise this and would not agree to take over prescribing on the NHS. If all the necessary information is received by The Retreat, then they will sign a shared care agreement, and return this back to us for agreement.

Once we have received this, we will be able to take over the prescribing of your medication on a monthly prescription.

The current waiting times for a medication review at the Retreat for NHS patients are in excess of 1 year. To continue prescribing your medication if you keep up-to-date with the required physical monitoring and reviews.

Autism assessments are carried out through a dedicated team at Harrogate District Hospital.  ADHD assessments are carried out by a different team, based at CAMHS (part of TEWV NHS Trust). There are self-referral processes for both assessments, which would then be triaged by the relevant service. 

There are lengthy waits for these appointments. 32 months is quoted at the time of writing this (Sept 23) on the HDFT website for an autism assessment. 

• Children’s Autism self-referrals can be made here: Children’s Autism Assessment Service – Harrogate and District NHS Foundation Trust (hdft.nhs.uk)
• Children’s ADHD self-referrals can be made here: Self referral form for Specialist CAMHS referral

Some parents may choose to approach private providers for assessment, diagnosis and management of Autism and ADHD. The Practice operates the same policy for children and adults, as outlined above. We are unable to provide investigations, physical health checks or ongoing monitoring on behalf of the provider, this is their responsibility, even if they operate a remote access tele-health service. 

As with adults, medication for children with ADHD can only be initiated by a specialist and must continue to be supervised long term by a specialist. Most of the medications used are legally classified as Controlled Drugs, which means that only a 28-day prescription can be issued at a time.

Once a child is stable on medication (for at least 3 months), we will usually enter a ‘Shared Care’ arrangement with the NHS team at CAMHs (or HDFT), so that we take over the prescribing. The child will remain under the care of the specialist and will be required to attend regular review appointments. 

We will not enter into a shared care agreement with a private provider, so if you choose to fund the initiation of medication in the private sector, you will be required to do so long term.