What is Attention Deficit/Hyperactivity Disorder (ADHD)?

Diagnosing ADHD

Penrose Health Action Plan

Treatment Goals

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Our aim is to work in partnership with our patients to achieve lifelong mental health and wellbeing for them. The goals of treatment and how we accomplish them are:

Patient Journey - Determining Schedule of Reviews

Click toggle for a schematic of the action plan/treatment policy for all Penrose Health Surgeries, or follow the guidance below.

Suspected ADHD → assess using appropriate screening tools and thorough patient history, including:

• childhood symptoms
• current vocational or social impairment

Consider concurrent diagnosis (e.g. Depression or Anxiety): perform thorough assessment and if suggestive → rebook and follow that pathway.

• Once depression/anxiety treated → Consider re-doing assessment and/or referral to ADHD secondary care service.

Only refer to ADHD secondary services if history suggestive of ADHD and symptoms significantly affect day-to-day life and any concurrent diagnoses have been screened for and treated.

• If patient wants to obtain a private diagnosis due to long NHS wait times, we should explain that we do not take over care from any/all services to avoid disappointment later down the line.

If no other concurrent diagnosis, but patient struggling with self care → rebook for single appointment in 6 weeks.

If patient has no active issues and just awaiting diagnosis/shared care agreement → liaise with other services as necessary but conclude routine MHN appointments.

If patient has no other concurrent diagnosis, but is struggling with self care → focus of this appointment should be how to manage ADHD and signposting to services.

ADHD Shared Care Agreements (SCA)

If a SCA is suggested, our pharmacy team must do the following:

1. Check that the requesting prescriber is:
• on the GMC Specialist Register, if they are a psychiatrist (click here to check). If they are on the register, you must also check that they have credentials for specialising in ADHD.
• registered as a specialist / prescriber, if they are an ADHD-specialist pharmacist or nurse (check via nmc.org.uk for nurses, or General Pharmaceutical Council for pharmacists).
2. Confirm that the prescriber’s clinic is CQC regulated. This will be listed on their website. If it is not, please email the clinic to confirm.
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If the clinic is NOT CQC regulated, please discuss with the Lead GP to confirm if they are willing to accept the SCA.

If you reject the SCA, please inform the patient of this via call / email.

3. If the clinic is CQC regulated, please check that we have received the following documentation:
• diagnostic assessment (which includes evidence of significant impairment) from a GMC-registered psychiatrist
• a record of when medication was commenced
• evidence that the patient has been stable on medication for at least 3 months
4. Once you have received a SCA, check that it includes the following:
• Patient details
• Name of specialist
• Name of medication, formulation, daily dosage
• Monitoring requirements (weight, height, BMI, blood pressure, blood tests etc.)
• Primary care responsibilities specified (including when to refer back to specialist)
• Patient and specialist responsibilities
• Signature of agreement by specialist and patient
• Space for GP to agree and sign SCA
5. Contact the patient to confirm that the medication and dosage is in line with what the patient expects and is currently taking.
6. For Southwark patients only, share the SCA with Dr Pearson (ADHD specialist) of the 🧠Primary Care Mental Health Team (PCMHT) Southwark (referral details within link). Once approved, move onto the next step.
7. Pass the SCA onto the Lead GP for consideration. In the meantime, add medication onto a repeat prescription and ensure this is tagged with monitoring requirements of 6-monthly BP, pulse and weight check.
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Do NOT issue medication until the SCA is signed and accepted by a GP.
8. After the GP accepts the SCA:
• clinical admin must send a signed copy to the specialist
• pharmacy team must let the patient know that shared care has been accepted, and instruct on monitoring requirements (this will be dependent on medication).
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Once a SCA has been approved, we can take over prescribing and issue medication to the patient.

We don’t need a new agreement if the specialist decides to increase / decrease the dose or if there are any brand changes due to shortages.

If the patient decides to decrease their dosage themselves, please inform the specialist. If they’d like to increase it, this must be agreed with their specialist.

Monitoring ADHD patient taking medication

Shared care protocols will usually require the routine monitoring and documentation of the following:

• Effectiveness and adverse effects of drug treatments
• BMI: Every 6 months in adults
• Blood Pressure & Heart Rate:
• before and after each dose change
• routinely every 6 months

Compare results with the normal range for the person's age.

Routinely review patient and their family/partners/carers, using clinical judgement on a case by case basis, to ensure that they are coping well/receiving suitable support → signpost to support services, as appropriate.

Referring/Signposting Onward

Below are some services to which you can signpost/refer patients. More services can be found on the Penrose Portal in 🧠Mental Health Services Database.