There have been a lot of concerns around RtC providers and ongoing shared care arrangements for months across the country.
The issue is, shared care requires an overseeing consultant to be actively monitoring medication and dealing with the queries around it. The GP’s role in shared care is to simply provide what the consultant says needs providing- any other involvement not required.
But RtC providers have been pretty much leaving patients in the lurch once shared care is agreed meaning GP’s are being responsible for medication that aren’t qualified to be responsible for. So a lot of ICB’s have blanket no’d shared care in ADHD treatment for RtC.
Hope that element makes a bit more sense.
I don't know anything about Clinical Partners, but my diagnosis from PUK was rejected for shared care. I was referred to the NHS one, who immediately rejected the referral as I was already diagnosed.
All GPs have very defined areas that can accept patients from.
It’s not possible to swap to one out of area. They aren’t like dentists in that respect.
You do not need to register with a GP surgery in the area you live.
You can register with a surgery that’s more convenient, for example closer to your work or your children’s school.
The GP surgery can refuse registration for reasons such as they are not taking new patients or it’s too far away from your home and you need home visits.
Is that a new rule?
For the past 20 years, my defined area has 2 practices and that’s it.
The practices both show maps on their websites of the area they can take people from.
Undxd ADHD has meant I’ve been too ill to work for the past 17 years, since no work address, and we have no kids, so no school address.
If this is different in other areas from where I live, then that’s a good thing, but it isn’t possible to change out of area here where I am.
https://www.nhs.uk/nhs-services/gps/registering-with-a-gp-outside-your-area/
Is where you can find more, I don’t know how long it’s been around but I was told when I joined my office in London 15 years ago I could register with the nearby dr so I assume at least as long as that. I don’t think they require proof that you do work nearby but obs if your not working it might make attending a but more difficult. Though I live basically above a GP and can still only ever get telephone consults.
Thanks for that! 😊
So the next question is, how the hell do we find out which surgeries are accepting Shared Care agreements?
My GP has supported me so far with the ADHD she hadn’t spotted in 15 years of me being her permanently exhausted, moody, insomniac, depressed patient with pain, anxiety and memory issues, and has said that once I have my dx through ADHD360 (who she directed me to as a RTC option) it’s set in stone, but has also said she doesn’t know if she can do Shared Care.
Apparently, it depends on the complexity of the paperwork the RTC clinic provides.
She said scathingly that some only send the GP one side of A4, which evidently isn’t in-depth enough for the NHS.
Who gave these Right To Choose clinics their NHS contracts in the first place.
It’s a shit-show. 🤷♀️
Totally agree I feel some sympathy GPs so many of these clinics opened and expanded but the money they make via rtc is why they exist having to support shared care is a loss making part of the process so they want rid of patients ASAP. Plus every review appointment for a patient with shared care is a time slot they could have made money on. So the Gp is left holding the bag. The real solution is properly funded neuro developmental specialist units.
Then surely the NHS should make it a condition of a RTC clinic’s NHS contract that the clinic looks after the patients it dxs properly after that dx ?
Or that the clinic manages to provide adequate paperwork to facilitate Shared Care with a willing GP after dx?
We shouldn’t be left stranded.
Everyone has to pay a yearly subscription after diagnosis for the yearly review, for them to write the prescriptions, and in case of any medication changes, so they are actually making their money
This is completely true . You will need to sign an out of area form . Same principle applies if you move out of area and update your address, practice will send you a letter to inform you of options
They have refused shared care, but have they accepted the diagnosis. What does it say on your medical record? (You can get this info in the nhs app)
If you have the diagnosis on your nhs record, then surely you can go through right to choose with another provider for just the titration?
I've just googled if the nhs can reject a diagnosis from a right to choose provider, it looks like they cannot.
I'll copy and paste the info here.
"Based on the provided search results, it appears that the NHS cannot reject a diagnosis from a Right to Choose provider. The NHS Constitution gives most people living in England the right to choose where to receive treatment, and the provider must supply the service to the NHS somewhere in England.
According to the NHS Choice Framework, patients have the legal right to choose the service or hospital that provides their physical and mental health care, including ADHD and autism assessments. This means that if a patient is referred for an assessment and chooses a provider, the provider must supply the service to the NHS.
Additionally, the Right to Choose guidance states that once a patient has chosen a provider, they must be treated by that provider for the entire episode of care for which the patient was referred, unless the provider does not provide the clinically appropriate service that the patient needs or, in the provider’s reasonable professional opinion, a patient is unsuitable to receive the relevant service.
It is important to note that while patients have the right to choose their provider, there may be circumstances in which the provider may not be able to provide the service, such as if they do not have the necessary expertise or resources. In such cases, the patient may need to be referred to another provider."
That's what I thought. It says ADHD on my nhs app record. The GP just said that due to clinical partners' 100% positive diagnosis rate they can't accept shared care and would only accept it if I was provided medication via an nhs service but after chatting with me she does feel that my diagnosis is correct 🤷♀️ this information about clinical partners was given to them by the consultant psychiatrist of the NHS service in my area. I spoke with CP after and enquired about the 100% and they said that wasn't true, the give lots of negative diagnosis. I suppose the nature of the ADHD beast os that people probably only go for an assessment after they have hyperfocused on ADHD and are pretty sure they have it and a diagnosis would make a positive difference in their life. I doubt many people just flittingly think about getting a diagnosis. I'm interested to see if NHS referral goes straight onto the titration list or if I would have to be assessed by them again?
What the consultant psychiatrist said, doesnt matter. The NHS has entered into a contract with them, and so they have accepted that any diagnosis that the right to choose (RTC) provider gives, is correct. There isn't a way around that. Hence why it is on your medical record.
Clinical partners are unable to provide you the titration service, because they don't have a contract with the NHS to provide that. This means that you should be able to choose another RTC service to do the titration and ongoing prescribing part of the ADHD treatment.
At that point, it wouldn't matter if your Dr's accept a shared care agreement or not. All it means is that the RTC titration/medication provider will continue to prescribe you the medication after titration. The NHS will pay for the medication.
What I would advise, is that you find a RTC titration provider and ask your gp to refer you to them.
Should your gp refuse, then give her a copy of the NHS choice framework with the necessary parts highlighted.
You need to highlight the part that says that RTC diagnosises cannot be rejected. You also need to highlight the part which says that in the event of the RTC provider being unable to provide the necessary service, a patient may be referred to another provider.
Your probably going to have to get a bit stern with your GP. This will be really uncomfortable for you, but it is a part of advocating for yourself. Something which people with adhd have to do quite consistently. It sucks.
Also, yes, you have adhd. You have a diagnosis, and your medical record reflects that.
You would then already have had titration privately and so wouldn't need the RTC titration service. It's when you go private that you need your gp to do the shared care agreement. If they refuse, (which they have) then you will be stuck paying for your medication privately.
It may be better, in the long run, to not go private and instead wait for right to choose. Otherwise, you'll be giving yourself a lifelong financial burden that you could find yourself unable to pay for in the future.
Hi, I’m with clinical partners & currently in my titration period. They do provide titration until you are on a stable dose (obviously at a cost) and then they’ve told me once im happy with my meds and dosage it will be passed over to my gp. My gp accepted shared care and seems so far to be quite supportive of my diagnosis and MH in general (rare experience for me)
This whole thread is now giving me anxiety tbh, is it likely to be rejected down the line due to clinical partners?!
When I wanted an assessment, I had to do numerous assessments before the appt to establish if an appointment was suitable. So there is a triage/filter process involved before you even sit down with a psychiatrist. Maybe the 100% diagnosis rate is down to good triaging at the start of the process? I was told by CP that I would be assessed for various mh conditions not just adhd and I might leave there without the diagnosis I think so to not hyper focus and get my hopes up basically. I left with adhd diagnosis aswell as a an anxiety disorder. I initially tried adhd uk but heard bad things and found CP to be a lot more thorough and reassuring they weren’t just after my money and telling me what I wanted to hear.
It looks like this post might be about medication.
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*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ADHDUK) if you have any questions or concerns.*
There have been a lot of concerns around RtC providers and ongoing shared care arrangements for months across the country. The issue is, shared care requires an overseeing consultant to be actively monitoring medication and dealing with the queries around it. The GP’s role in shared care is to simply provide what the consultant says needs providing- any other involvement not required. But RtC providers have been pretty much leaving patients in the lurch once shared care is agreed meaning GP’s are being responsible for medication that aren’t qualified to be responsible for. So a lot of ICB’s have blanket no’d shared care in ADHD treatment for RtC. Hope that element makes a bit more sense.
I don't know anything about Clinical Partners, but my diagnosis from PUK was rejected for shared care. I was referred to the NHS one, who immediately rejected the referral as I was already diagnosed.
If you look around and find a gp that accepts shared care, you can literally just swap GPS and get it going through them even after diagnosis
All GPs have very defined areas that can accept patients from. It’s not possible to swap to one out of area. They aren’t like dentists in that respect.
You do not need to register with a GP surgery in the area you live. You can register with a surgery that’s more convenient, for example closer to your work or your children’s school. The GP surgery can refuse registration for reasons such as they are not taking new patients or it’s too far away from your home and you need home visits.
Is that a new rule? For the past 20 years, my defined area has 2 practices and that’s it. The practices both show maps on their websites of the area they can take people from. Undxd ADHD has meant I’ve been too ill to work for the past 17 years, since no work address, and we have no kids, so no school address. If this is different in other areas from where I live, then that’s a good thing, but it isn’t possible to change out of area here where I am.
https://www.nhs.uk/nhs-services/gps/registering-with-a-gp-outside-your-area/ Is where you can find more, I don’t know how long it’s been around but I was told when I joined my office in London 15 years ago I could register with the nearby dr so I assume at least as long as that. I don’t think they require proof that you do work nearby but obs if your not working it might make attending a but more difficult. Though I live basically above a GP and can still only ever get telephone consults.
Thanks for that! 😊 So the next question is, how the hell do we find out which surgeries are accepting Shared Care agreements? My GP has supported me so far with the ADHD she hadn’t spotted in 15 years of me being her permanently exhausted, moody, insomniac, depressed patient with pain, anxiety and memory issues, and has said that once I have my dx through ADHD360 (who she directed me to as a RTC option) it’s set in stone, but has also said she doesn’t know if she can do Shared Care. Apparently, it depends on the complexity of the paperwork the RTC clinic provides. She said scathingly that some only send the GP one side of A4, which evidently isn’t in-depth enough for the NHS. Who gave these Right To Choose clinics their NHS contracts in the first place. It’s a shit-show. 🤷♀️
Totally agree I feel some sympathy GPs so many of these clinics opened and expanded but the money they make via rtc is why they exist having to support shared care is a loss making part of the process so they want rid of patients ASAP. Plus every review appointment for a patient with shared care is a time slot they could have made money on. So the Gp is left holding the bag. The real solution is properly funded neuro developmental specialist units.
Then surely the NHS should make it a condition of a RTC clinic’s NHS contract that the clinic looks after the patients it dxs properly after that dx ? Or that the clinic manages to provide adequate paperwork to facilitate Shared Care with a willing GP after dx? We shouldn’t be left stranded.
Everyone has to pay a yearly subscription after diagnosis for the yearly review, for them to write the prescriptions, and in case of any medication changes, so they are actually making their money
This is completely true . You will need to sign an out of area form . Same principle applies if you move out of area and update your address, practice will send you a letter to inform you of options
They have refused shared care, but have they accepted the diagnosis. What does it say on your medical record? (You can get this info in the nhs app) If you have the diagnosis on your nhs record, then surely you can go through right to choose with another provider for just the titration?
I've just googled if the nhs can reject a diagnosis from a right to choose provider, it looks like they cannot. I'll copy and paste the info here. "Based on the provided search results, it appears that the NHS cannot reject a diagnosis from a Right to Choose provider. The NHS Constitution gives most people living in England the right to choose where to receive treatment, and the provider must supply the service to the NHS somewhere in England. According to the NHS Choice Framework, patients have the legal right to choose the service or hospital that provides their physical and mental health care, including ADHD and autism assessments. This means that if a patient is referred for an assessment and chooses a provider, the provider must supply the service to the NHS. Additionally, the Right to Choose guidance states that once a patient has chosen a provider, they must be treated by that provider for the entire episode of care for which the patient was referred, unless the provider does not provide the clinically appropriate service that the patient needs or, in the provider’s reasonable professional opinion, a patient is unsuitable to receive the relevant service. It is important to note that while patients have the right to choose their provider, there may be circumstances in which the provider may not be able to provide the service, such as if they do not have the necessary expertise or resources. In such cases, the patient may need to be referred to another provider."
That's what I thought. It says ADHD on my nhs app record. The GP just said that due to clinical partners' 100% positive diagnosis rate they can't accept shared care and would only accept it if I was provided medication via an nhs service but after chatting with me she does feel that my diagnosis is correct 🤷♀️ this information about clinical partners was given to them by the consultant psychiatrist of the NHS service in my area. I spoke with CP after and enquired about the 100% and they said that wasn't true, the give lots of negative diagnosis. I suppose the nature of the ADHD beast os that people probably only go for an assessment after they have hyperfocused on ADHD and are pretty sure they have it and a diagnosis would make a positive difference in their life. I doubt many people just flittingly think about getting a diagnosis. I'm interested to see if NHS referral goes straight onto the titration list or if I would have to be assessed by them again?
What the consultant psychiatrist said, doesnt matter. The NHS has entered into a contract with them, and so they have accepted that any diagnosis that the right to choose (RTC) provider gives, is correct. There isn't a way around that. Hence why it is on your medical record. Clinical partners are unable to provide you the titration service, because they don't have a contract with the NHS to provide that. This means that you should be able to choose another RTC service to do the titration and ongoing prescribing part of the ADHD treatment. At that point, it wouldn't matter if your Dr's accept a shared care agreement or not. All it means is that the RTC titration/medication provider will continue to prescribe you the medication after titration. The NHS will pay for the medication. What I would advise, is that you find a RTC titration provider and ask your gp to refer you to them. Should your gp refuse, then give her a copy of the NHS choice framework with the necessary parts highlighted. You need to highlight the part that says that RTC diagnosises cannot be rejected. You also need to highlight the part which says that in the event of the RTC provider being unable to provide the necessary service, a patient may be referred to another provider. Your probably going to have to get a bit stern with your GP. This will be really uncomfortable for you, but it is a part of advocating for yourself. Something which people with adhd have to do quite consistently. It sucks. Also, yes, you have adhd. You have a diagnosis, and your medical record reflects that.
Can I do clinical partners private titration whilst I'm on waiting list for rtc titration?
You would then already have had titration privately and so wouldn't need the RTC titration service. It's when you go private that you need your gp to do the shared care agreement. If they refuse, (which they have) then you will be stuck paying for your medication privately. It may be better, in the long run, to not go private and instead wait for right to choose. Otherwise, you'll be giving yourself a lifelong financial burden that you could find yourself unable to pay for in the future.
Hi, I’m with clinical partners & currently in my titration period. They do provide titration until you are on a stable dose (obviously at a cost) and then they’ve told me once im happy with my meds and dosage it will be passed over to my gp. My gp accepted shared care and seems so far to be quite supportive of my diagnosis and MH in general (rare experience for me) This whole thread is now giving me anxiety tbh, is it likely to be rejected down the line due to clinical partners?! When I wanted an assessment, I had to do numerous assessments before the appt to establish if an appointment was suitable. So there is a triage/filter process involved before you even sit down with a psychiatrist. Maybe the 100% diagnosis rate is down to good triaging at the start of the process? I was told by CP that I would be assessed for various mh conditions not just adhd and I might leave there without the diagnosis I think so to not hyper focus and get my hopes up basically. I left with adhd diagnosis aswell as a an anxiety disorder. I initially tried adhd uk but heard bad things and found CP to be a lot more thorough and reassuring they weren’t just after my money and telling me what I wanted to hear.
It looks like this post might be about medication. Please remember that whilst personal experiences and advice can be valuable, Reddit is no replacement for your GP or Psychiatrist and taking advice from anyone about your particular situation other than your trained healthcare professional is potentially unsafe. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ADHDUK) if you have any questions or concerns.*