ADHD Medication Prescribing Policy

This policy outlines the procedures for initiating, monitoring, and prescribing ADHD medications to ensure safe and effective management of patients, adherence to clinical guidelines, and proper communication with specialists and patients.

• Initiation and Monitoring by Specialist:
• ADHD medication must be initiated and monitored by a specialist.
• Once a patient has been stable on a dose for 6 months following the last titration, prescribing may be considered for transfer to primary care under a shared care agreement (SCA).
• Patients who have not been stable for 6 months will receive a notification (e.g., via text) explaining that prescribing cannot commence until the stability period is met.

• Shared Care Agreement (SCA):
• Transfer of Prescribing: Doctors will be notified via task when letters regarding SCAs are received. It is the responsibility of the patient’s GP to decide if they are happy to take over prescribing under the terms of the SCA.
• Requirement for SCA: If no SCA is in place, prescribing will not be transferred to primary care.
• If the GP has any concerns after accepting shared care or if any dose titration is required, we reserve the right to refer the patient back to the specialist for prescribing the medication at any time.
• Communication with Patients:
• Patients will be sent a letter explaining the SCA and its implications.
• Patients must sign and return the letter to confirm understanding before prescribing responsibilities can be transferred.

• Private Patients:
• Patients receiving private care must meet the same stability criteria as NHS patients (6 months of stability) before prescribing can be transferred.
• Patients must continue seeing their private specialist annually, as per SCA requirements. If a patient cannot afford private specialist care, they may be referred to the NHS, but they must continue private reviews until an NHS appointment is available.
• If there has been no physical monitoring or specialist review in the last year, the SCA is considered broken, and prescribing will cease.

• Annual Recall and Physical Monitoring:
• ADHD review dates will be added based on the last review date with the consultant. The process for annual recall is currently under development.
• Physical monitoring must be completed as required. Notes indicating the due date for monitoring must be added to the patient’s prescription.

• Medication Shortages:
• Prescribe generic formulations when possible during medication shortages.
• If patients are unable to obtain medication after trying a few pharmacy, they should be contact their specialist.
• Avoid switching formulations (e.g., from Concerta to Medikinet) as differences in dosing and bioavailability may compromise safety and effectiveness. Current guidance does not recommend such switches unless it has gone through a specialist.
• Exercise caution and ensure accuracy when prescribing alternative brands or medications to minimize errors.

Roles and Responsibilities

• Specialists:
• Initiate and monitor ADHD medication.
• Provide clear communication and documentation, including SCAs, to primary care.

• GPs and Primary Care Providers:
• Review and decide on acceptance of prescribing under SCAs.
• Ensure annual recall and physical monitoring are conducted and documented.
• Communicate with patients regarding the requirements and implications of SCAs.

• Patients:
• Understand and comply with the requirements of SCAs, including regular specialist reviews and physical monitoring.
• Notify the GP if they encounter issues obtaining medication or fulfilling monitoring requirements.

Patients must receive clear instructions regarding the requirements for prescribing, including the need for SCAs, physical monitoring, and annual specialist reviews.

Notifications (e.g. text messages or letters) should be sent to patients when prescribing cannot proceed or if additional actions are required.

All prescribing and monitoring processes will be audited periodically to ensure compliance with this policy and adherence to clinical guidelines.