ADHD Care Pathway Obsolete June 2024

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, 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. 

Happymaps also has useful resources for parents and professionals for children at different ages:

• Pre-school age
• Primary school age
• Secondary school age

Referral

School Referral - preferred route

Children with suspected ADHD who are at school and aged 5 and over can usually be assessed and referred by school SENCOs. Parents should initially raise concerns via this route if possible, rather than via a GP.

GP Referral

If the school referral route is not available, a GP or other health care professional can make a referral to community paediatrics via an SPE referral form. This should also be available as an EMIS template.

If there are more complex mental health co-morbidities then a referral to CAMHS can be made. Please note that a cardiovascular examination is required (see Referral Pathway below).

Children under 5

Although children can present from an early age with ADHD symptoms, local community paediatric services are not able to prescribe medication for ADHD in children under the age of 5 and restrict assessments until children are over this age. 

However, families who have children with ADHD symptoms that are aged under 5 years can receive support through locally delivered behavioural interventions focussing on the management of attention difficulties and challenging behaviour, such as the Incredible Years course. These can be accessed without a formal diagnosis of ADHD. Links for courses are available below:

• Bristol
• South Glos
• North Somerset

Right to Choose (update April 2024)

For patients wishing to choose a “Right to Choose” provider it is important they understand 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. 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 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.

Clinical Partners have paused offering CYP RTC assessment for ADHD

Evolve Psychology

Evolve Psychology offer ADHD assessment only for Children and Young People (5 years +).

Please see https://evolvepsychology.org/fees-and-funding/ for more information about referrals under NHS Right to Choose.

ADHD 360

ADHD 360 offer ADHD assessment for Children and Young People (14 years +) and will titrate and medicate where appropriate.

See the Adults ADHD Remedy page for further details.

Healios

Healios is an organisation that is currently contracted by Sirona to carry out ADHD / ASD assessments to help them clear their backlog. GPs and school nurses cannot refer directly as they do not have a Right to Choose contract. Referrals need to go to the Sirona services who in turn may or may not send them on to Healios or they can go directly to a RTC provider as described above.

Changes are being proposed in 2023

In order to meet referral demand and to follow the principles of iThrive, local services (Sirona) are exploring changing the referral pathway for ADHD in 2023. At present referrals are required to allow parents and school to access information about the non-medical management of inattention and hyperactivity from their first paediatric appointment. 

Sirona are working with stakeholders to explore whether schools are able to become the principal referrers to this service, as the child’s education setting has the relevant information required for a referral to be accepted. This will also involve GPs as we recognise there will be circumstances when it may not be possible for a school to be a principal referrer such as when children are not permanently in an education setting

Until any changes are launched, patients can be referred as in the Referral section above.

Resources

12/10/23 -  ADHD Medicines Shortages – Advice for Primary Care on prescribing in Children

Happymaps

A locally developed website which includes information on ADHD, SEND and Autism in children. See the Happymaps Remedy page for more details.

Please also see the SEND page in Remedy for further resources.

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.