ADHD / Autism

GPs are no longer able to directly refer adults for NHS ADHD/Autism assessments and diagnosis. The current referral pathway, put in place by our local ICB (Humber and North Yorkshire Health and Care Partnership), requires patients to complete a self-assessment tool online (The ‘Do IT Profiler’), to assess eligibility. If the details provided meet their acceptance criteria, your referral will be sent on to The Retreat (who run The Tuke Centre in York) for triage (this is the designated provider, in the region, for NHS assessments for ADHD and Autism). If the criteria are not met, you will be given the option of remaining on a waiting list, which is managed by the ICB.

If you wish to complete this self-assessment pathway, please send an eConsult to the surgery, and request that we send you the link for the ‘Do IT Profiler’. If you meet the threshold for referral, you will then be guided through the self-referral pathway.

GP practices are not able to provide evidence for Disabled Student DSA applications. If you are waiting for assessment through this route, the Do-It Profiler will provide a standard letter, signed by an ICB GP, which patients can then pass to the University.

We are aware that NHS services for ADHD/Autism assessment, diagnosis and treatment are limited, with extensive waiting times. An increasing number of patients are therefore choosing to access private providers, sometimes under the NHS ‘Right to Choose’ rules. 

Our ICB has recently updated their advice on making Right to Choose referrals. The Do-IT Profiler no longer has to be completed for these.  We can confirm that as long as the provider has a contract with NHS England for the required service, then you can go ahead and arrange an appointment, or we can refer you, when this is clinically appropriate. No prior commissioner approval is required, provided the service is led by a named consultant or named healthcare professional. 

Please be aware that the ‘Right to Choose’ pathway will not fund subsequent non-NHS prescribing costs or review appointments. 

For the avoidance of doubt, we would not be able to perform any investigations, physical health checks or ongoing monitoring on behalf of a private provider (whether or not you were referred under the ‘Right to Choose’), as this is their responsibility, even if they operate a remote access tele-health service. 

Please be aware that the practice will not be able to do any shared care prescribing with a private provider. If medication is recommended, you would need to be referred to the NHS provider to review and advise if they able to support the decision. If a patient has already been started and stabilised on the medication, we can usually obtain shared care prescribing with the NHS relatively quickly.  Unfortunately, if no medication has been started, there are significant waits for an assessment to be done.

Medication for ADHD can only be initiated by a specialist and must continue to be supervised long term by a specialist. Most of the medications used are legally classified as Controlled Drugs, which means that only a 28-day prescription can be issued at a time.

Please be aware that the practice will not be able to do any shared care prescribing with a private provider. If medication is recommended, you would need to be referred to the NHS provider to review and advise if they able to support the decision. If a patient has already been started and stabilised on the medication, we can usually obtain shared care prescribing with the NHS relatively quickly.  Unfortunately, if no medication has been started, there are significant waits for an assessment to be done.

In order for The Retreat to share care with us on the NHS, you must provide us with all of the following:

1. Your original ADHD diagnostic report.
2. A full medication and prescribing history from your current specialist.
3. The most recent clinic letter from your last review with them, with details of your most up-to-date physical monitoring.

Once we have received this, we can make a shared care referral to The Retreat.  Depending on the source of your diagnosis, it is possible that The Retreat would not recognise this and would not agree to take over prescribing on the NHS. If all the necessary information is received by The Retreat, then they will sign a shared care agreement, and return this back to us.

Once we have received this, we will be able to take over the prescribing of your medication on a monthly prescription. If the correct information is received and approved by The Retreat, this process would be expected to take a few weeks. Until we have received approval for shared care from them, you will be required to continue to obtain your prescriptions from your original provider. We will only be able to continue prescribing your medication if you keep up-to-date with the required physical monitoring and reviews.

Autism assessments are carried out through a dedicated team at Harrogate District Hospital.  ADHD assessments are carried out by a different team, based at CAMHS (part of TEWV NHS Trust). There are self-referral processes for both assessments, which would then be triaged by the relevant service. 

There are lengthy waits for these appointments. 32 months is quoted at the time of writing this (Sept 23) on the HDFT website for an autism assessment. 

• Children’s Autism self-referrals can be made here: Children’s Autism Assessment Service – Harrogate and District NHS Foundation Trust (hdft.nhs.uk)
• Children’s ADHD self-referrals can be made here: Self referral form for Specialist CAMHS referral

Some parents may choose to approach private providers for assessment, diagnosis and management of Autism and ADHD. The Practice operates the same policy for children and adults, as outlined above. We are unable to provide investigations, physical health checks or ongoing monitoring on behalf of the provider, this is their responsibility, even if they operate a remote access tele-health service. 

As with adults, medication for children with ADHD can only be initiated by a specialist and must continue to be supervised long term by a specialist. Most of the medications used are legally classified as Controlled Drugs, which means that only a 28-day prescription can be issued at a time.

Once a child is stable on medication (for at least 3 months), we will usually enter a ‘Shared Care’ arrangement with the NHS team at CAMHs (or HDFT), so that we take over the prescribing. The child will remain under the care of the specialist and will be required to attend regular review appointments. 

We will not enter into a shared care agreement with a private provider, so if you choose to fund the initiation of medication in the private sector, you will be required to do so long term.