Sometimes the care of a patient is shared between two doctors, usually a GP and a specialist, and there is a formalised written ‘shared care agreement’ setting out the position of each, to which both parties have willingly agreed. Where these arrangements are in place, GP providers can arrange the prescriptions and appropriate investigations, and the results are fully dealt with by clinicians with the necessary competence under the shared care arrangement. There is NHS guidance available about this.

Shared Care with private providers is not recommended due to the general NHS constitution principle of keeping as clear a separation as possible between private and NHS care. Shared Care is currently set up as an NHS service, and entering into a shared care arrangement may have implications around governance and quality assurance as well as promoting health inequalities. A private patient seeking access to shared care should, therefore, have their care completely transferred to the NHS. Shared care may be appropriate where private providers are providing commissioned NHS services and where appropriate shared care arrangements are in place.

All shared care arrangements are voluntary, so even where agreements are in place, practices can decline shared care requests on clinical and capacity grounds. The responsibility for the patient’s care and ongoing prescribing then remains the responsibility of the private provider.

If you are under the care of a private specialist, we will not be able to enter into a shared care agreement. You can ask us to refer you to an in-person NHS mental health team, but while waiting to see them, you will need to obtain your treatment from your private specialist directly.

Private Providers and some NHS “Right to Choose” providers

Sometimes patients request their GP to make a referral for an ADHD or ASD assessment or treatment service provider under Right to Choose (RTC). We will write the referral and provide it to you or send it directly to your nominated provider at your request. Right to Choose Providers are usually private companies. When choosing a Right to Choose Provider it is important to consider the following points:

Referral

The number of RTC providers is large and each provider may have its own referral process. It is not practical for your GP to complete a different referral process for every patient who chooses a different provider. Most providers need a core set of information so your GP may ask you to complete a questionnaire, and an ADHD self-assessment score as part of a standardised referral. If the provider needs additional information, they can request it from the practice or by asking you directly

Diagnosis and follow-up

Most RTC providers exclusively perform remote and/or online assessments and local NHS ADHD services may not have sufficient confidence in these diagnostic processes to accept their diagnoses. They may not take over your care unless they have completed their own assessment and diagnostic process. Therefore, your diagnosis may not be universally accepted, and you may find you cannot seek treatment and follow-up directly with local services following an RTC diagnosis.

We will not carry out tests that private providers want you to have, any tests that private providers need to be done must be completed by them. The Right to Choose providers are also commissioned to do things like physical checks and blood tests and therefore this is also something that they should provide. If they are an online/remote provider, you will need to discuss this fully with them on how to proceed.

Prescriptions

If you are diagnosed with ADHD, the RTC provider may suggest medications for you. The specialist service is responsible for prescribing them. They can request that your GP prescribes them under an agreement called a ‘shared care agreement’. Any decisions for your GP to take over prescribing under a Shared Care Agreement is entirely at the discretion of the GP practice. This means that your GP is not required to accept shared care agreements and will consider factors such as clinical safety, local policies set by Integrated Care Boards before making any decisions.

If a Shared Care Agreement is not accepted, your GP will not be able to prescribe ADHD medication on behalf of the specialist provider. In this situation, you will need to continue receiving prescriptions and ongoing monitoring directly from your ADHD service provider. In some cases, you may wish to discuss a referral to a local NHS specialist service; however, waiting times for these services can vary. Patients are encouraged to discuss shared care agreements with their GP practice as early as possible to understand what options are available and to avoid any interruption to treatment.