I am a consultant psychiatrist who was trained by, and worked in, the NHS, most recently as a liaison psychiatrist in a general hospital. I saw three young men who had made impulsive suicidal attempts where the underlying cause was attention deficit hyperactivity disorder (ADHD). I was unable to treat them with effective, evidence-based treatment because the psychiatrists in the mental health trust and GP practices locally would not take over the prescribing of stimulant medication. The service was not commissioned locally and the medication was not on the “allowed” formulary.
There seem to be several reasons why this is the case, including an erosion of senior doctors’ autonomy, a lack of training among doctors, persistent views that ADHD is not “real”, worries that taking it on would overwhelm an already unmanageable workload, and now a burgeoning private sector with financial interests in the NHS not treating it.
The Royal College of Psychiatrists and general practice curriculums need to have a five-year plan to ensure all future doctors are trained to identify, treat and manage ADHD as part of their core skill set. There are many patients in the health service with the condition where the diagnosis has been missed or ignored. This is a problem because it is the most easily treatable mental health condition we have, with 70% of people having significant benefits from medication. It affects 5% of the adult population and is highly inheritable within families.
Identification and treatment would reduce much societal harm, as ADHD is significantly associated with crime, accidents, drug and alcohol use, obesity and poor finances. There is plenty of research that supports this.
I now work in the private sector treating ADHD and have the pleasure of seeing life-changing improvement for patients after a life of negative labels imposed on them because of the condition, over which they had no control.
Unfortunately, although starting treatment is now more straightforward for me, I continue to experience similar situations as your letter writer (Failed by the NHS over our child’s ADHD diagnosis, 26 July) when wishing to hand over care. It makes me feel ashamed of the current system.
Dr Vicky Cleak
Southampton
• I do not think NHS GPs declining to prescribe medication advised after private assessments are “cruel” or “ignore” the health service’s secondary care delays, as your letter writer suggests. Their stance stems from concern about clinical safety and quality.
Private assessments do not always seem to be to the standards of NHS assessments – for example, being remote or not involving a medical opinion; shared care agreements from private providers may not match up to NHS shared care agreements; and there is worry that the private provider may cease to exist or that the patient/parents may not be able to pay for it in future. Who is sharing the care then?
GPs are the wrong target here. As a GP, I am asked daily to compensate for the woeful delays in NHS secondary care services – not that I blame my secondary care colleagues for these. We are all overwhelmed with demand, and desperately trying to do something that is just about safe enough for as many people as we can. We are not happy that this often falls short of what patients want and need.
Dr Deborah White
Stockton-on-Tees, County Durham
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