ADHD Policy 

Increasing numbers of adults are wondering whether they have a diagnosis of ADHD. Fortunately, there is a pathway in Bristol which enables an assessment of ADHD. The following link gives you the information you need to understand the Bristol Adult ADHD pathway:-

https://remedy.bnssg.icb.nhs.uk/adults/mental-health/adhd-adult/ 

We are aware that there are increasing numbers of private providers who are offering ADHD assessments and then requesting that GP practices prescribe the medication. The private providers request we provide 'shared care.' At Nightingale Valley Practice our policy is that we cannot do this. The only private providers we accept are the ones we refer you to as outlined in the link above. If you want to go privately for an ADHD assessment you are absolutely entitled to do this, but we cannot take on the prescribing of the ADHD medication. With increasing numbers of private provider’s we cannot ensure the quality and accuracy of the assessments. 

The following link gives you the information you need to understand the Bristol Children ADHD pathway:-
https://remedy.bnssg.icb.nhs.uk/children-young-people/special-educational-needs-disability-send/adhd-care-pathway/

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. Separate forms are available for Bristol/ South Glos and North Somerset. These should also be available as EMIS templates.

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 February 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.

Clinical Partners offer assessments and diagnosis for suspected ADHD in children via the Right to Choose option but referrers should be aware that they are not able to prescribe if a diagnosis of ADHD is made. This may not therefore be an appropriate referral option for some children and it is important an informed discussion is held between GP and parent/guardian before referring to a Right to Choose provider. 

Clinical Partners will only accept referrals from GPs and not from schools or SENCOs, under Right to Choose rules.

Waiting time for assessment is currently 30 weeks (January 2024 - according to the Clinical Partners website).

If prescribing is advised or requested following a diagnosis, then the community paediatric referral pathway described above should then be used to access further care and prescribing.

BNSSG ICB does not currently have a direct contract with Clinical Partners and this is currently being reviewed. The ICB contracts team recognise that the current situation is not ideal and the provider will be undertaking a BNSSG accreditation process and if criteria are met will hold a contract direct with BNSSG ICB. Updates on this contract and pathway will be published here when available.