I am an experienced consultant psychiatrist who honed my skills in the esteemed National Health Service (NHS). In my last role as a liaison psychiatrist in a general hospital, I encountered three young men who had impulsively attempted suicide due to underlying attention deficit hyperactivity disorder (ADHD). Unfortunately, I was unable to provide them with effective treatment using evidence-based approaches because local psychiatrists and general practitioners (GPs) were unwilling to take charge of prescribing stimulant medication. This reluctance was primarily due to the fact that the service was not commissioned locally and the medication was not included in the approved formulary.
Several factors contribute to this situation. Firstly, there has been a decline in the autonomy of senior doctors, which hampers their ability to make independent decisions. Additionally, many doctors lack adequate training in ADHD, leading to misconceptions that this disorder is not genuine. Moreover, healthcare professionals fear that taking on ADHD treatment would overwhelm an already burdensome workload. Complicating matters, the growing private sector within the NHS has financial interests that discourage the treatment of ADHD.
To address this issue, the Royal College of Psychiatrists and general practice curriculums must develop a comprehensive five-year plan. This plan should ensure that all future doctors are well-trained in identifying, treating, and managing ADHD as part of their fundamental skill set. Currently, there are numerous undiagnosed or ignored ADHD cases within the healthcare system, resulting in significant problems. However, ADHD is one of the most treatable mental health conditions, with approximately 70% of patients benefiting from medication. It affects 5% of the adult population and is strongly heritable.
By identifying and treating ADHD, we can reduce societal harm since this disorder is significantly associated with criminal behavior, accidents, substance abuse, obesity, and financial difficulties. There is a wealth of research that supports these claims.
I now operate in the private sector, where I am proud to witness life-changing improvements in my ADHD patients. These individuals have faced negative labels imposed upon them solely because of their condition, over which they have no control. However, despite the advantages of starting treatment in the private sector, I still encounter similar challenges when attempting to transfer care. This ongoing struggle with the current system fills me with shame.
In response to the concerns raised by the recent opinion piece titled “Failed by the NHS over our child’s ADHD diagnosis,” I do not believe that NHS GPs refusing to prescribe medication based on private assessments can be deemed “cruel” or reflective of the health service’s secondary care delays. GPs hold legitimate concerns regarding clinical safety and quality.
Private assessments do not always meet the standards set by the NHS. For instance, these assessments may be conducted remotely or fail to involve a medical opinion. Additionally, shared care agreements from private providers may not align with NHS shared care agreements. Furthermore, there is a legitimate concern that the private provider may cease to exist or that patients/parents may struggle to afford the treatment in the future. In such cases, who will shoulder the responsibility of providing care?
GPs should not be blamed for these issues. As a GP myself, I am constantly asked to compensate for the inadequate services and delays within NHS secondary care. However, I do not hold my secondary care colleagues responsible for these challenges. We are all overwhelmed by the overwhelming demand and strive to provide care that is reasonably safe for as many individuals as possible. Regrettably, this often falls short of meeting the wants and needs of patients.
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