The text of the letter reads as follows:
As chairs of Local Medical Committees in London we represent over 7,000 of GPs, covering a population of more than eight million patients. We have seen the BBC request for contact from those whose shared care has been ‘dropped’ by their NHS GP and are writing to ensure that any programme resulting from this request is fair and balanced. The reasons why GPs often decline to share care are linked to safety, and the fact that care is often just transferred to the GP, rather than genuinely being shared.
It may be useful for you to understand the following points:
- Shared care with NHS trusts who provide ADHD care is not always devised in a way that GPs consider safe. Many trusts will discharge patients and will not proactively provide an annual review, as advised by NICE guidance. Communication is also often an issue, with emails going unanswered. These issues are due to a lack of resources in the NHS trust, but they add up to a system which many consider to be unsafe; the tragic case of Jacob Wooderson, whose inquest led to a Prevention of Future Deaths report shows that ADHD medications are not always benign and need proper monitoring. A GP who prescribed in an unsafe manner, to cover holes in service provision elsewhere, would be acting against the principles of Good Medical Practice and would rightly be criticised if things went wrong. It is important to remember that the entire medicolegal responsibility for a prescription lies with the clinician who signs it; this does not change if a shared care agreement is in place.
- NHS waiting lists are long, driving many patients towards privately owned Right to Choose (RTC) providers. We fully understand why a patient facing a wait of many years may choose to do that, but it adds extra complexity:
- Many RTC providers provide assessments which are not carried out by doctors (consultant psychiatrists or appropriately qualified GPs with an extended role). Assessments can be brief and done by a nurse, pharmacist or other professional, whose qualifications to make the diagnosis and advise on medication are not always clear.
- Communication can be poor, with copies of the full assessment not always provided and a lack of prompt replies to email. Some providers state that any review will require a new referral, against NHSE guidance which states that, when shared care takes place, ‘the appropriate level of care and/or advice should be available from the secondary care team in a timely manner without necessarily requiring a new referral’.
- If a RTC provider leaves the market or is commissioned in such a way that they cannot provide regular annual reviews, then the GP is left sharing care with no-one, with the local NHS trust usually unable to take over care in a timeframe less than several years. This is unsafe, against NICE guidance, and not in the patient’s best interest.
- The same applies when patients self-pay in the private sector; if they become unable or unwilling to pay for follow-up then the GP is left with no specialist support.
- The British Medical Association have advised against shared care with private providers.
- Safe shared care for ADHD requires a significant amount of clinician time; in most areas, this is not resourced and therefore takes GPs away from providing primary care for their other patients. NHS England (NHSE) are clear that ‘resources and capacity to ensure consistent delivery must be determined before shared care prescribing is implemented’ – this has not yet happened.
We all went into medicine to help people, and we regularly see the effects that under-resourced ADHD care has on our patients. Treating co-existing conditions such as anxiety and depression may not be successful when the underlying ADHD has not been addressed, and this is frustrating for both GP and patient.
We hope that this letter allows you to see the broader picture of ADHD care in the UK, and that your programme will be a balanced review, addressing the issues of resources, communication and safety which leave many GPs with no choice but to refuse unsafe shared care arrangements.
Yours sincerely,
| Dr Toni Hazell Chair Haringey LMC | Dr Farzana Vanat Co-Chair Barnet LMC | Dr Pippa Vincent Chair Enfield |
| Dr Karen Summerfield Chair Islington | Dr Vinay Patel Chair City and Hackney LMC | Dr Asad Ashraf Chair Waltham Forest LMC |
| Dr Najib Seedat Chair Redbridge LMC | Dr Tamara Hibbert Chair Newham LMC | Dr Emma Radcliffe Chair Tower Hamlets LMC |
| Dr Michael Edbury Chair Brent LMC | Dr Mark Mikhail Chair Ealing LMC | Dr Kyla Cranmer Chair Hammersmith and Fulham LMC |
| Dr Chaand Nagpaul Chair Harrow LMC | Dr Veno Suri Chair Hillingdon LMC | Dr Kapil Kotecha Chair Hounslow LMC |
| Dr Paul O’Reilly Chair Kensington, Chelsea and Westminster LMC | Dr Sid Datta Chair Ealing, Hammersmith and Hounslow | Dr Simon Parton Chair Lewisham LMC |
| Dr Hannah Josty Chair Bromley LMC | Dr Penelope Jarrett Chair Lambeth LMC | Dr Ami Kanabar Chair Southwark LMC |
| Dr Jeremy Gray Chair Wandsworth LMC | Dr Marek Jarzembowski Chair Merton LMC | Dr Vidhya Thiagamoorthy Chair Sutton LMC |
| Dr Lindsey MacLeod Chair Greenwich LMC |