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.

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

• Psychiatry UK 18 and over
• ProblemShared 18 and over
• Clinical Partners 18 and over (assessment only - they do not prescribe under Right to Choose)
• ADHD 360 14 years and over 
• Dr J & Colleagues 18 and over 
• Harrow Health CIC 18 and over (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)

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

AWP 

Please note that there are very long waits for new referrals to the AWP ADHD service. 

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.

To find out about attention deficit hyperactivity disorder and support groups refer to the service's website.

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.

The BNSSG contracts team will try to validate Right to Choose providers as they get to know about them and find out what their services offer. The following are those currently known to have contracts with other NHS organisations:

• Psychiatry-UK
• ProblemShared
• ADHD 360
• Jawaji & Asker (trading as: Dr J & Colleagues)
• Clinical Partners
• Harrow Health CIC

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.

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 Psychiatry UK

Psychiatry UK request that the following information is included in a referral:

1. ASRS questionnaire (available as a document in EMIS or can be downloaded from their website) to be completed by the patient.
2. A short referral letter from the GP stating that you wish to refer this patient to Psychiatry-UK, for an ADHD assessment, under NHS Right to Choose legislation. Please give a brief explanation for referral. This letter should be addressed to Psychiatry-UK and should have a GP name at the bottom (not ANP or other). Please also include the patient’s email address as this is an online service.
3. A brief medical summary of the patient.

Referrals not including all of this information may be returned.

Psychiatry UK offer assessment, titration and medication is available under Right to Choose, where appropriate

March 2024: current waiting time for assessment is 12 months.

GP referrals should be sent by email to: 

p-uk.RTC-referrals@nhs.net (professional use only)

Referrals to Clinical Partners

Right to choose ADHD & autism assessments (clinical-partners.co.uk)

Please note Clinical Partners provide assessment only - they do not prescribe under Right to Choose

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

GPs should complete the online referral form, also available on the link above. You will need the patient's completed self-report questionnaire, NHS number, and contact details ready.

Referrals to ADHD 360

ADHD 360 request that the following is included in a referral:

1. ASRS questionniare (available as a document in EMIS or can be downloaded from their website) to be completed by the patient.
2. Patient waiting list risk assessment to be completed by the patient.
3. ADHD 360 referral proforma (available as a document in EMIS or can be downloaded from their website) to be completed by the GP.

ADHD 360 have confirmed that assessment, titration and medication is available under Right to Choose, where appropriate.

GP referrals should be sent by email to:

righttochoose@adhd-360.com

The email address is also on the form embedded in EMIS or is available on their website. When submitting referrals containing patient details please write SECURE in square brackets in the subject line [SECURE] to encrypt your email.

Referrals to Dr J & Colleagues

Patients need to supply contact details to download relevant forms: Talk With Consultant Psychiatrists UK | Dr J and Colleagues (drsj.co.uk)

Once they have completed the forms they send to the practice, who write a Right to Choose Letter.

Practice to then send both to - salwan.jajawi@nhs.net

Dr J & Colleagues have confirmed that assessment, titration and medication is available under Right to Choose, where appropriate.

Referrals to ProblemShared

Under Right to Choose, ProblemShared offer:

• ADHD and autism assessments for adults aged 18+ 
• Assessment, titration and medication is available under Right to Choose, where appropriate
• Post-diagnostic care including group psychoeducation sessions

Please see this link: Right To Choose England (problemshared.net) for ProblemShared referral information.

The patient must complete a self-report form that the GP will submit on their behalf to the provider as part of the referral process. The self-report form can be completed in one of two ways either patient-led or GP-led.

The GP can then complete the online referral form, also available on the link above. GPs will need the patient's completed self-report questionnaire, NHS number, and contact details ready.

Clinical suitability is listed on the same webpage. The GP will need to confirm suitability as part of the referral process.

Harrow Health CIC

Harrow Health CIC are available for referral via eRS. Referral information is available on the website.

***PLEASE NOTE*** This provider is commissioned to deliver assessment, titration and initial medication; with responsibility for continued prescribing and annual reviews transferring to primary care once the patient is stabilised on medication. They are unable to retain patients where shared care is not available from the GP practice. Please ensure that patients are aware of this upon referral, particularly where the GP practice is not signed up to the ADHD Shared Care LES.

Exclusions: People with moderate to severe learning disability.

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.