A practice in the Colchester area

5. Mr X complains about the Practice. He says that following the advice from his general practitioner (GP) he sought a private diagnosis and treatment for his Attention-Deficit/ Hyperactivity disorder (ADHD). He says the GP confirmed following this a SCA would be established. He complains:

• the Practice is not willing to establish a SCA • the Practice failed to communicate this change to him prior to him going private.

6. Mr X also complains about how the ICB has managed this change following SCA(s) being discontinued. He complains the ICB failed to: • prioritise referrals to NHS providers for patients like him who have been affected by this change • keep him informed of the changes in policy.

7. Mr X says because of the events he has been affected financially. He says he has paid for a private diagnosis and continues to pay a higher fee for a private prescription and medication. He says the events have also caused him distress.

8. Mr X also says it has the potential to affect his job. This is because he holds a high responsibility role and if he does not take the medication, it will affect his performance at work.

9. As an outcome he would like an apology and a financial remedy of £3,025.16 for the private expenses he has incurred.

10. ADHD (attention deficit hyperactivity disorder) is a condition where the brain works differently to most people. People with ADHD may have trouble with things like concentrating and sitting still.

11. A SCA is a formal agreement between a patient, the GP and a psychiatrist. It enables the care and treatment a patient receives for ADHD to be shared between the psychiatrist and the GP.

12. Mr X tells us he spoke to his GP and it was agreed that he would obtain a private diagnosis for his ADHD. Following this, a SCA would be established which would have meant that the treatment (including his medication) would have been managed and prescribed under NHS funding and by his GP.

13. It was later decided that GP Practices were withdrawing from SCA(s) specifically relating to the prescribing and monitoring of adult ADHD medications.

14. This change meant that the Practice did not agree to establish a SCA. Mr X has received a private diagnosis and is currently paying private fees of £50 per month for his prescription and £160 per month for his medication.

15. Mr X complained to both the Practice and the ICB about these decisions and how the change in policy has been managed.

Issue one- concerns relating to the Practice’s decision to not enter into a SCA

19. Mr X tells us that following a consultation with the Practice, he decided to obtain a private diagnosis for his ADHD. He says he was told by the Practice once this had been received, the Practice would establish a SCA which would mean that his treatment and medication would be managed by the Practice.

20. Mr X says he has obtained the private diagnosis on the advice of the Practice, but the Practice is now not agreeing to establish a SCA despite him following its advice.

21. The Practice’s response dated 16 January 2025 explains its reasons for not establishing a SCA. It says the Practice is not currently contracted to provide this service and has, in the past, been doing as a matter of good will. It says these services were previously managed in secondary care but over time moved to primary care without necessary resources to deliver them.

22. It further says because of the lack of resources, and the ICB not choosing to commission these services from Practices; the Practice has decided not to continue with SCA for the prescribing or ADHD medications.

23. We can see the Practice also referred Mr X’s complaint to PALS who responded on the 21 January 2025. It says: ‘As a result of national GP ‘Collective Action’ many GP practices in North East Essex are withdrawing services that they are not required to provide under the terms of their contract. This is an action proposed by the Local Medical Committee (LMC), as part of national GP collective action. As entry into ADHD shared care agreement is not a contractual requirement, it cannot be assumed to be available from any GP Practice in north east Essex at the current time’.

24. We have obtained clinical advice to aid our understanding of this complaint. Our adviser referred us to relevant guidance.

25. NHS England guidance, ‘Responsibility for prescribing between primary and secondary/tertiary care’, provides ‘circumstances where it may not be appropriate for a SCA to be agreed, or where an exception to an agreement may be appropriate, so that the hospital/specialist retains responsibility for prescribing’.

26. The NHS England guidance includes ADHD medications, as these are medicines which ‘require ongoing specialist intervention and specialist monitoring’. It also includes circumstances where ‘patients receive the majority of ongoing care, including monitoring, from the provider and the only benefit of transferring care would be to provider costs’. This would be applicable for Mr X’s case.

27. We consider the Practice’s decision to not enter a SCA were in line with the NHS England guidance referenced above.

28. In addition to this, BMA guidance ‘General practice responsibility in responding to private healthcare’, says ‘all SCA are voluntary, so even where agreements are in place, Practices can decline share care requires on clinical and capacity grounds. The responsibility for the patient’s care and ongoing prescribing then remains the responsibility of the private provider’.

29. Mr X tells us he was advised to obtain private care after which a SCA would be established. We do not dispute Mr X’s version of events. We have carefully reviewed the records and have found no evidence of this conversation.

30. Any private treatment a patient receives is ultimately done so by their choice. The ICB provides guidance regarding this on its website. It says in guidance ‘Information for patients considering privately funding an ADHD assessment’:

‘You have the right to privately fund an ADHD assessment and diagnosis, but this should be on the expectation that everything subsequent to that diagnosis – including medication costs – will also be self-funded.Your GP has the right to refuse to prescribe ADHD medication on the NHS if you paid for a private assessment and diagnosis’.

31. Based on the evidence we have seen, we find no indications of failings in the Practice’s decision to not enter a SCA. We consider its actions are in line with local and national guidelines.

Issue two- concerns that the Practice and ICB failed to keep Mr X informed

32. Mr X complains that both the Practice and the ICB failed to inform him about the changes in SCAs. He says if he was aware he would not have progressed with the private diagnosis.

33. We have obtained clinical advice in relation to this and have again been directed to relevant guidance.

34. GMC guidance ‘good practice in proposing, prescribing, providing and managing medicines and devices’ says in section ‘shared care’:

‘Shared care requires the agreement of all parties, including the patient. It’s essential that all parties communicate effectively and work together’.

35. While it is acknowledged that in line with the above, ordinarily any changes should be communicated to affected patients, Mr X’s circumstances differ from those of patients as there was at no point an established SCA.

36. Based on this, there is no evidence to suggest that the ICB or Practice had a duty to inform Mr X of the changes. There are therefore no indications of failings in its actions.

Issue three- concerns relating to how the ICB has handled the change

37. Mr X complains the ICB has failed the appropriately manage the change. He specifically complains it has failed to prioritise referrals to NHS providers for patients like him who have been affected by this change.

38. The ICB says in its response dated 23 January 2025 that it has made recommendations to support patients affected by this change. The recommendations include the following steps for Practices’ to follow: • Patients will remain under the care of their private specialist who will take responsibility for prescribing and monitoring a patient's medication • In agreement with patients, the Practice can refer to an NHS specialist for reassessment. The Practice will continue to prescribe their medication until they are seen by the NHS specialist.

39. It further says ‘to support option 2, the ICB has also provided information on Right to Choose providers (RtC) with a shorter or no waiting times that are able to accept new referrals and will provide ongoing prescribing, monitoring and to review practices. Practices have been advised through their practice managers that these may be appropriate choices for adult private patients if they are eligible for RtC referrals’.

40. We have obtained clinical advice in relation to this.

41. We consider the Practice to have acted in line with GMC guidance, good medical practice which says in section ‘managing resources effectively and sustainably’ that: ‘You must make good use of resources available to you, and provide the best service possible, taking account of your responsibilities to patients and wider population’.

42. We highlight that in Mr X’s case he was not a patient under a SCA and therefore the duties listed by the ICB did not extend to him. However, we can see the ICB and Practice have still taken steps to ensure that patients are able to have a continued service of care and mitigate any negative impacts.

Conclusion

43. Having carefully considered the evidence, we have found no indications of failings in the Practice of ICB’s actions.

44. We are sorry to hear about the ongoing financial impact on Mr X and our decision does not detract from his experience of the impact it has had on him.

1. We have carefully considered Mr X’s concerns that he brings to us. We are sorry to hear about the difficulties that he has faced following changes in shared care agreements (SCA). We can understand why this complaint is important to Mr X.

2. Mr X complains about a GP Practice in Colchester’s (the Practice) decision not to establish a SCA despite this initially being agreed. We have carefully considered this and found no indications of failings in the Practice’s decision not to establish a shared care agreement (SCA).

3. Mr X complains about how Suffolk and North East Essex Integrated Care Board (the ICB) has managed changes to SCA(s). He specifically complains the ICB has failed to prioritise referrals to NHS providers for patients like him who have been affected by this change. We have found no evidence to suggest the ICB did not follow national guidelines when managing changes to the SCA.

4. Mr X also complains both the Practice and ICB failed to inform him about the changes in the policy. We have carefully considered these concerns and have found no indications of failings.