ADHD (adult)

Overview

Clinical Knowledge Summaries has guidelines for the diagnosis and management of ADHD.  The guidelines cover diagnosis and management of attention deficit hyperactivity disorder (ADHD) in children over 3 years, young people and adults. It aims to improve the diagnosis of ADHD as well as the quality of care and support for people with ADHD.

AWP are commissioned to provide ADHD services for adults in BNSSG. Age range for the service is 18 years and over. Please note that average waiting time for AWP referrals is around 5 years. (2024)

AWP ADHD service is a specialist team of doctors, psychologists and nurses who work exclusively with adults who have ADHD. The service is available to all BNSSG patients and receives referrals from many health professionals in the south west and beyond.

AWP ADHD service can reassess and continue treatment of people who have a diagnosis of ADHD from childhood, and they also assess adults who have never had a diagnosis made.

Clinical Partners are commissioned to provide ADHD/Autism services for CYP/adults in BNSSG, from 1^st December 2024.  Age range for the service is 18 years and over. They have delivered services under Right to Choose in BNSSG for some time and going forward, the service offer will include ADHD titration and medication across CYP and Adults. Referrals can be made via https://www.clinical-partners.co.uk/nhs-services/right-to-choose or GP referral form to rtc@clinical-partners.co.uk Clinical Partners will also take referrals from SENCO’s

Right to choose. Other providers known to BNSSG ICB, to date, that have a contract with another ICB in England and therefore, can offer Adult ADHD services under Right to Choose (patient choice) are:

• ADHD 360 
• The Centre for ADHD Research & Excellence (CARE ADHD)
• Dr J & Colleagues 
• Harrow Health CIC (can prescribe but not commissioned to provide continued prescribing and annual review. It is expected that this will be taken over by primary care once the patient is stabilised on medication)
• Holistic ADHD Solutions Ltd
• Oakdale Therapies 
• The Owl Centre
• ProblemShared 
• Psychiatry UK 
• RTN Medical 

The list of Right to Choose providers above is not exhaustive. If a patient requests referral to a provider that is not listed then please email the mental health contracts team on bnssg.mh.contract@nhs.net who can check that the appropriate Right to Choose contract is in place.

 For suspected ADHD in children please see the ADHD (children) page.

Right to Choose Providers

Please note that there may still be long waits for services that provide Non-Contracted Activity for NHS patients, although generally their waiting lists are not as long as the local AWP service. See their websites for further details.

The legal rights to choice of mental health provider and team apply when:

• the patient has an elective referral for a first outpatient appointment
• the patient is referred by a GP
• the referral is clinically appropriate
• the service and team are led by a consultant or a mental healthcare professional
• the provider has a commissioning contract with any Integrated Care Board (ICB) or NHS England for the required service.

For patients wishing to choose a “Right to Choose” provider it is important the patient understands that the provider may not integrate with local BNSSG pathways and/or other services as the provider does not hold a contract directly with BNSSG ICB. They may not offer medication initiation or may expect the GP to prescribe which they may not be willing to do. It is advisable for the GP and patient to agree the most suitable provider as the referral must be “clinically appropriate” for the patient under choice framework.

Patients will only be eligible for NHS treatment if referred by their GP (they may also offer private services for ADHD and a range of other psychiatric conditions).

GP (and patient) referral information is available on their respective websites.

The attached spreadsheet summarises the current services offered by RTC providers, including referral information and exclusions. See the relevant tab at the bottom of the page for ADHD/ASD Adults/Children.

Post diagnostic support - where a provider has indicated availability of post diagnostic support, referrers/patients should contact them directly to check what this includes before making a decision on this basis. Some post diagnostic support offers for ADHD and Autism may be limited to signposting to other organisations; so patient expectation around this should be managed at the outset.

Who to Refer

Please see CKS for advice on when to suspect attention deficit hyperactivity disorder (ADHD)

Patients who think they have ADHD should first see their GP or other health professional and complete an ASRS questionnaire. 

Refer people who meet the criteria for referral who do not already have a prior diagnosis of childhood ADHD.

Referral processes for the current providers of ADHD are summarised in the sections below.

If you refer a patient to a Right to Choose provider who is already on the waiting list for AWP, then please ask the patient to inform AWP so that they can be removed from their list. 

Referrals to AWP

Please note that average waiting time for AWP referrals is around 5 years. (2024)

Referrals will be accepted subject to referral criteria being met and should be made using the referral form part 1. 

Prior to referral you will also need the patient to complete the ADHD referral form part 2 which includes the self report scale (ASRS) symptom checklist.

The GP should check BP, pulse and weight prior to referral. The GP should also carry out cardiac exam/ ECG if clinically indicated (e.g. family history of early CHD etc) prior to referral.

When making an adult ADHD referral, including detailed and relevant information ensures the case is appropriately triaged. If not using AWP referral forms please include, demographic Information; presenting symptoms, history (developmental educational, employment, family), up to date information on current psychiatric presentation, current substance misuse, forensic history and risk assessment (to self and others), current and previous medication reports, previous assessments or school reports and any reasonable adjustments needed. This comprehensive information helps the triaging team determine urgency, complexity, and the best pathway for assessment and treatment.

AWP do have ‘Priority Criteria’ as indicated in the ‘additional referral considerations’ of part 1 of the AWP referral form, please indicate if the patient meets any of this criteria.

Those wanting more information about the AWP service should contact the team at the Petherton Resource Centre in Bristol:

Telephone: 01275 796262   Email: awp.specialisedADHDServices@nhs.net

Referrals should be sent via email to: awp.specialisedADHDservices@nhs.net 

Referrals to Clinical Partners

 ADHD & autism assessments | Clinical Partners

Clinical Partners are commissioned to provide ADHD services for adults in BNSSG, from 1^st December 2024. Age range for the service is 18 years and over. They have delivered services under Right to Choose in BNSSG for some time and going forward, the service offer will include ADHD titration and medication across CYP and Adults.

Patients should complete the relevant self-report questionnaire using the link above.

Referrals can be made using the link above (You will need the patient's completed self-report questionnaire, NHS number, and contact details ready) or GP referral form to rtc@clinical-partners.co.uk

Right to choose referrals

Please see the attached spreadsheet which summarises the current services offered by RTC providers, including referral information and exclusions.

See the relevant tab at the bottom of the page for ADHD/ASD Adults/Children.

Shared care and follow up

Patients who have a confirmed diagnosis and are started on treatment should be monitored by their provider. Right to choose providers (e.g. Psychiatry UK or ADHD 360) should undertake monitoring remotely (self reported height, weight and BP) but may ask patients to visit their GP for these physical checks.

Shared Care

Once treatment has been stabilised then GPs will be asked to continue prescribing under the BNSSG Shared Care Protocols.

As part of the SCP, physical checks including BP, pulse and weight should be done by primary care at 6 monthly intervals.

An annual review of their condition will be undertaken by the provider unless a practice has signed up for the ADHD LES.

ADHD LES

An ADHD LES has been introduced for follow up of patients with ADHD in BNSSG. Practices that have signed up to this will have patients discharged to their care and should undertake annual reviews of their patients in primary care in addition to 6 monthly physical health checks. If there are any problems then GPs can refer back to the patient's provider.

ADHD Annual Review Care Pathway

ADHD Annual review checklist rationale

ADHD Annual Review Checklist - includes Adverse effects questionnaire and Weiss scale score.

Patients who are registered with a practice that has not signed up will continue to be followed up by their provider.

Transfers from other providers

The AWP Adult ADHD clinic will be able to accept patients wishing to transfer in from other providers, if they meet the standards outlined in this document. Please send a letter or email to AWP using the address above, and include copies of correspondence from any other provider the patient has seen.

Transfers from paediatric services

A young person with stable ADHD without other complex mental health problems who has been under care of community paediatrics  should be automatically transferred to the adult ADHD service at AWP. If a practice is signed up to the ADHD LES then the young person can be discharged for ongoing care by the GP instead.

A young person with other mental health problems who has been under care of CAMHS should be transferred to AWP for ongoing care.

In neither situation should the young person need a new referral. 

Lost to follow up

For patients with a previous diagnosis of ADHD who have been under local services but lost to follow, then please email or send previous information to AWP who should be able to arrange ongoing care.

awp.specialisedADHDservices@nhs.net

Resources

Guide to ADHD Assessments - BJGP October 2023 - pdf

Right to Choose - ADHD UK Other Right to Choose Providers may also be available. ADHD - UK has a page that lists these providers although please view this with caution as BNSSG ICB cannot validate these providers at this time.

Think ADHD Resource Hub

Provides useful resources for GPs and patients. It was developed by a GP to professionalise and streamline the data collection process for ADHD screening. Patients using Think ADHD can record their story at their own pace, and in their own time, without the pressure of short GP clinic appointment times.

Once complete, the validated ASRS score and comprehensive patient symptom history report can then easily be sent back to you via email, dedicated text message service or in printed form.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.