Prescribing for ADHD in primary care following consultation with private providers

At Woodlands surgery our primary commitment is to ensure patients receive the best possible care while maintaining transparency and adhering to established guidelines. To this end, we have formulated the following policy statement regarding ‘prescribing for ADHD in primary care following consultation with private providers’

Key considerations: 

We understand that due to long NHS waiting lists, some patients opt to have some or all their treatment privately and we support your right to do so.

The decision to prescribe any medication is ultimately down to individual clinicians and whether they feel clinically competent and appropriate to do so.

It is the responsibility of the GP to ensure the ADHD assessment was robust and the correct diagnosis was reached in accordance with NICE principles. They must also be satisfied that pre-treatment and long-term monitoring, was and is, intended to be carried out in line with local guidance. This includes monitoring of appropriate physical observations, ADHD symptoms, psychiatric status and potential for misuse and diversion of medication. Regarding private providers, we do not have the required training to reach this decision and there is no system in place to ensure patients are getting their necessary specialist monitoring.

Therefore, the practice has come to the decision that any new requests from private specialists to prescribe ADHD medication will be declined.    

The only exception will be those patients that have been diagnosed through a right to choose provider where an NHS approved shared care protocol is in place.

In accordance with Thames Valley Priorities Committee Commissioning Policy Statement 35- Patients who have been diagnosed and treated privately may be transferred to the NHS and should be re-assessed for NHS treatment.

We are happy to refer to the appropriate clinic for confirmation of diagnosis. Where medication is indicated, the appropriate treatment will be initiated, or existing medication continued according to these guidelines.

We acknowledge that there may be some delay in some patients accessing their medication but ultimately this decision is to ensure patient safety. We understand patients may seek to remain with private providers, where they have the financial means to do so, due to the long waiting lists.

Patients should not be left without the care they need, due to a lack of comprehensive NHS funding, and our local representatives have raised this issue with local funding and decision-making groups. If you also wish to raise this issue, you may want to contact the “planned care team” at the local Integrated Care Board, [email protected] , and/or your MP.

Buckinghamshire, Oxfordshire, Berkshire West ICB
First Floor
Unipart House
Garsington Road
Cowley
OX4 2PG

Telephone: 01296 587220

General enquiries email: [email protected]

To ensure the safe and effective prescribing and management of controlled drugs, the surgery may ask some patients to sign a controlled drugs contract.

Where appropriate, the GP will discuss the contract and it’s use with any relevant patient. Copies of the contract are available on request.

Use of Diazepam (and other benzodiazepines) for Fear of Flying

Woodlands Surgery Policy

We are often asked to prescribe sedative drugs, such as diazepam for fear of flying or to assist with sleep during flights. We have agreed a practice policy that we will no longer prescribe these drugs for fear of flying.

There are several good reasons why prescribing drugs such as diazepam for flying is not safe and no longer recommended:

1. Diazepam is a sedative, which means it makes you sleepy and more relaxed. If there is an emergency during the flight, it may impair your ability to concentrate, follow instructions and react quickly to the situation. This could have serious safety consequences for yourself and for those around you. Incapacitation from benzodiazepines is a risk to the lives of all on board the aircraft in the event of an emergency requiring evacuation.
2. Sedative drugs can make you fall into an unnaturally deep, non-REM sleep. This means you won’t move around as much as during natural sleep, increasing your risk of developing a blood clot (DVT) in the leg or lungs. Blood clots are very dangerous and can be fatal. This risk is even greater if your flight is longer than four hours.
3. Whilst most people find benzodiazepines like diazepam sedating, a small number can experience agitation and aggression. Benzodiazepines can also cause disinhibition and lead you to behave in a way that you would not normally. This could impact on your safety as well as that of other passengers and could also get you into trouble with the law.
4. The sedative effects of benzodiazepines can affect breathing and cause low oxygen levels, which could be life threatening, especially with lower circulating oxygen levels on an aeroplane, in people with breathing problems or when combined with alcohol.
5. Diazepam and similar drugs are illegal in several countries. They may be confiscated, or you may find yourself in trouble with the police.
6. Diazepam stays in your system for quite a while. If your job requires you to submit to random drug testing, you may fail this having taken diazepam.
7. According to the prescribing guidelines doctors follow (British National Formulary) diazepam is contraindicated (not allowed) for treating phobias (fears). It also states that “the use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate.” Your doctor would be taking a significant legal risk by prescribing against these guidelines. They are only licensed short term for a crisis in generalised anxiety. If this is the case, you should be getting proper care and support for your mental health and not travelling on a flight. Fear of flying in isolation is not a generalised anxiety disorder.
8. NICE guidelines state that medication should not be used for mild and self-limiting mental health disorders. In more significant anxiety related states, benzodiazepines, sedating antihistamines, or antipsychotics should not be prescribed.
9. A study published in 1997 from the Stanford University School of Medicine showed that there is evidence use of benzodiazepines stops the normal adjustment response that would gradually lessen anxiety over time and therefore perpetuates (and may increase) anxiety in the long term, especially if used repeatedly.

We recognise that fear of flying is real and frightening and we don’t underestimate the impact it can have. We recommend tackling this by using self-help resources or considering one of the ‘Fear of Flying’ courses run by many airlines. We do not recommend any specific course, but you may find the following links useful:

Self-help options: https://www.nhs.uk/mental-health/conditions/phobias/self-help/

EasyJet: www.fearlessflyer.easyjet.com

British Airways:   www.flyingwithconfidence.com

Virgin: https://flywith.virginatlantic.com/gb/en/wellbeing-and-health/flying-without-fear.html

Flight anxiety does not come under the remit of General Medical Services as defined in the GP contract and so we are not obliged to prescribe for this.

It is important to declare all medical conditions and medications you take to your travel insurer. If not, there is a risk of nullifying any insurance policy you may have.

Information Technology (IT)/ELECTRONIC PATIENT RECORDS

New contractual arrangements came into force on 1st April 2014 requiring GP practices to make available a statement of intent about the following IT developments:

1. Referral Management Information
2. Online Appointment Booking
3. Online Booking of repeat prescriptions
4. Summary Care Record
5. GP2GP transfers of care records
6. Patient Access to electronic records.

Please find below details of the arrangements we have in place for these developments at this Practice.

Referral management Information

Practices must include the NHS Number as the primary identifier in all NHS clinical correspondence issued by the practice.

All letters and information that we send to other organisations such as, hospitals, have an NHS number clearly shown.

Electronic appointment booking

Practices are required to promote and offer the facility for all patients, who wish to book, view, amend, cancel and print appointments online.

We currently offer booking and cancelling of a number of appointments  online. Please ask at reception for more details about how to register for this service.

Online booking of repeat prescriptions

Practices are required to promote and offer the facility for all patients, who wish to order online, view and print a list of their repeat prescriptions for necessary drugs, medicines or appliances.

Interoperable records / Summary Care Record

Practices are required to upload changes to a patient’s summary information, at least daily, to the Summary Care record.

Having your Summary Care Record available will help other doctors and nurses treating you away from your regular surgery, without your full medical record. They will have access to information about any medication you may be taking and any drugs to which you have a recorded allergy or sensitivity. Click here for more details about the Summary Care Record http://www.nhscarerecords.nhs.uk/

This function is already live. However, if you do not want your medical records to be available in this way please let us know. You can do this via the ‘opt out form’, available at reception, or on our website.

GP2GP transfers of Care Records

We are required to utilise the GP2GP facility for the transfer of patient records between practices, when a patient registers or de-registers.

It is very important that you are registered with a doctor at all times. If you leave your GP and register with a new one, your medical records will be removed from your previous doctor and forwarded to your new GP via NHS England. It can take several weeks for paper records to reach the new surgery; with GP2GP, your electronic record is transferred to your new practice much sooner.

GP2GP transfers are already activated at this practice for sending and receiving patient records.

Patient access to their electronic GP record

We are required to promote and offer the facility for patients to view online, export or print any summary of information from their records relating to medications, allergies, adverse reactions and any other additional details which have been agreed with the patient.

All GP practices are required to declare the mean earnings for GPs working to deliver NHS services to patients at each practice.
The mean earnings for GPs working in Woodlands Surgery in the financial year ended 31st March 2023 was £67,199 before deduction of employee’s superannuation contributions, tax and National Insurance. This is the average pay for the 2 full-time, 2 part time GP’s and 1 Locum GP who worked in the practice for more than 6 months during that year.

Please note that with effect from 1st April 2015 all patients, including children have been allocated a named, accountable GP. Patients can continue to choose to see any GP in the practice in line with current arrangements.

We do not accept telephone requests for repeat medication. This is due to local and national guidance regarding patient safety. Patients are able to order repeat medication in person at the surgery (by completing a form), or via letter, email or online.

Woodlands Surgery Philosophy

Our aims are to offer the highest standard of health care and advice to our patients, within the resources available to us.

We have a team approach to patient care and endeavour to monitor the service provided to patients, to ensure that it meets current standards of excellence.

We are dedicated to ensuring that Practice staff and Doctors are trained to the highest level and to provide a stimulating and rewarding environment in which to work.

Our Practice Charter

• You will be treated with courtesy and respect by all Practice personnel.
• An on the day appointment with a Clinician will be available on the same day, if appropriate.
• A non-urgent appointment with a doctor will be offered within 14 working days, where possible
• Our standard is to see 80% of patients within 20 minutes of their appointment time. If you have waited longer than this please speak to a Receptionist.
• We aim to answer the telephone within six rings.
• An appointment with a Practice Nurse will be available within three working days, where applicable.
• Requests for repeat prescriptions will be dealt with within 72 hours (3 working days).
• If you have a complaint please speak to any member of staff. Your complaint will be dealt with in a professional and efficient manner.
• We wish to make the Woodlands Surgery as accessible as possible. If you have hearing, visual or physical difficulties please let the receptionist know so that we can enable you to fully use our services.

Patient’s Responsibilities

• If you are unable to attend for an appointment please let us know so that we can offer it to someone else.
• If you are late for your appointment you may be asked to re-book at another time. Try to let us know in advance if you are going to be unavoidably delayed, so that we can make alternative arrangements to help you.
• A home visit should only be requested for those who are unable to come to the surgery because of serious illness or infirmity. Please ring the surgery before 10:30 am if at all possible.
• An on the day appointment is for an on the day medical problem. Please speak to the Receptionist if you require a sick note or repeat prescription.
• We would ask you to be patient if the Clinician is running late. This is often due to unforeseeable emergencies but please speak to a Receptionist.
• Make a separate appointment for each patient that needs to be seen. This allows the Clinician enough time to treat each patient with the time that they deserve.
• Please act in a responsible and courteous manner whilst on the Practice premises for the safety and comfort of others.
• Please treat all surgery staff, fellow patients, carers and visitors politely and with respect. Violence or verbal harassment will not be tolerated or accepted, you may be asked to register at another surgery if this behaviour occurs.

Suggestions Or Complaints

We are very happy to receive constructive comments and suggestions for improving our service to patients. Similarly, if you have a complaint we will deal with it in a constructive way. Please speak to one of our receptionists in the first instance, or if this cannot be resolved to our reception. They will do their best to deal with your complaint there and then.  For complaints which you feel have not been satisfactorily resolved by speaking to one of the receptionists, please ask to  speak to our practice manager.

Confidentiality

We ask you for personal information so that you can receive appropriate care and treatment. This information is recorded on computer and we are registered under the Data Protection Act. The practice will ensure that patient confidentiality is maintained at all times by all members of the practice team. However, for the effective functioning of a multi-disciplinary team it is sometimes necessary that medical information about you is shared between members of the team.

Freedom Of Information – Publication Scheme

The Freedom of Information Act 2000 obliges the practice to produce a Publication Scheme. A Publication Scheme is a guide to the ‘classes’ of information the practice intends to routinely make available. This scheme is available from reception.

Violence and Abuse

We will not tolerate violent behaviour or abuse towards any member of our team. Any such behaviour from patients may result in removal from our list.

What is it and what does it mean?

The General Data Protection Regulation (GDPR) is a legal framework that sets guidelines for the collection and processing of personal information of individuals within the European Union (EU), which came into force on May 25th 2018. It changed how businesses and public sector organisations can handle the information of their customers/patients.

As you have already given us your mobile number and email address, we will continue to contact you with appointment reminders and emails with regards to your health. Should you wish to opt out of this, please send an email to [email protected]

For more information visit This Link

Please see Woodlands Surgery Privacy Notice by clicking on this link.

General Practice Data for Planning & Research (GPDPR) – New July 2021

NHS Digital’s daily collection of GP data will support vital health and care planning and research. The data held in the GP medical records of patients is used every day to support health and care planning and research in England, helping to find better treatments and improve patient outcomes for everyone. NHS Digital has developed a new way to collect this data, called the General Practice Data for Planning and Research data collection.

The new data collection reduces burden on GP practices, allowing doctors and other staff to focus on patient care.  For more information please see here

We are very happy to receive constructive comments and suggestions for improving our service to patients. Similarly, if you have a complaint we will deal with it in a constructive way. Please speak to one of our receptionists in the first instance, or to our reception team leader. They will do their best to deal with your complaint there and then. If they are unable to resolve the matter, please ask to speak to our practice manager.

ComplaintsCommentsLeaflet 2023