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Introduction

At Daybrook Medical Practice we are committed to providing comprehensive and equitable healthcare to all our patients. This includes a commitment to supporting patients with neurodevelopmental diagnoses.

We are mindful that pressures on NHS services have increased in recent years, and that patients may seek private diagnosis and treatment as a result. Patients may also be referred by a GP to a private provider offering NHS services, under patient choice (Right to Choose).

We have therefore reviewed our policy regarding the management of ADHD and the prescribing of ADHD medication, which can only be prescribed by GPs under a ‘Shared Care Agreement’.

Guidelines for Diagnosis and Management of ADHD

This Practice Policy is based on national and local guidance, specifically NICE guidance, and the Nottinghamshire Area Prescribing Committee (APC) Shared Care Information for Patients. The individual prescribing information forms for children and adults can be downloaded from the Nottinghamshire APC website.

Initiation of medication for ADHD must be by a specialist, after they have assessed the patient and provided a diagnosis. This will include:

• a shared decision-making approach with the patient regarding the risks and benefits of medication
• a review of mental health and social circumstances
• a review of physical health, including some baseline investigations. In some circumstances an electrocardiogram (ECG) or a cardiac assessment may be required.
• initiation and optimisation of the medication, including initial monitoring. After dose stabilisation, the specialist may request that prescribing and monitoring of ADHD medication is carried out under a ‘Shared Care Agreement’ with the GP.

The practice does not organise any of the above physical checks, as these are explicitly for the specialist initiating medication to undertake. This is specified both in NICE and Nottinghamshire APC guidance, and as a Practice we apply the same rules to private providers as are applicable NHS providers.

What is a ‘Shared Care Agreement’?

A Shared Care Agreement is a formal agreement between you (the patient), your GP and your specialist. It enables a GP to accept responsibility for the safe prescribing and monitoring of specialist medicines, where appropriate, whilst the specialist retains overall oversight, including the responsibility for regular reviews.

A GP is not legally bound to agree to a Shared Care Agreement. It is a ‘professional courtesy’ that GPs can agree to, to support the partial transfer of care from a specialist to the GP, where this is appropriate and, in the patient’s best interests.

If a GP is unable to agree to shared care, then ‘appropriate arrangements for the continuing care’ of a patient are warranted, which is likely to mean that the specialist who made the assessment and diagnosis will be requested to prescribe the medication.

The General Medical Council have published ethical guidance on Shared Care Agreements here.

Whilst this practice remains dedicated to delivering high quality care to our patients, we are not able to accept Shared Care Agreements with private providers, including with those offering NHS services under patient choice (Right to Choose). This decision is based on several important factors:

1. Capacity and Workload: Our Practice is experiencing unprecedented workload pressures. Engaging in shared care with private providers would divert our resources and impact our ability to provide care to patients within our NHS Contract.
2. Safety Concerns: Shared Care requires close collaboration and communication between healthcare providers. Unfortunately, we often encounter challenges in obtaining timely and comprehensive information from private providers, which can compromise patient safety.
3. Expert Support: Managing ADHD medication requires specialist knowledge and support. In many cases private providers do not offer the necessary guidance for ongoing management, leaving GPs without the expert support that is required to ensure safe prescribing.

We therefore kindly request that patients who have received a diagnosis of ADHD from a private provider, including from those offering NHS services under patient choice (Right to Choose), continue to request prescriptions from their chosen provider. This ensures that patients receive care tailored to their specific needs, under the clinical expertise of a specialist who is able to provide ongoing support and monitoring.

Options when Shared Care is declined

You can request a referral from your GP to the Neurodevelopmental Specialist Service (NeSS), which is the Nottinghamshire NHS Provider for adult autism and adult ADHD assessment, treatment and support. Further information regarding this service can be found at:

https://www.nottinghamshirehealthcare.nhs.uk/neurodevelopmental-specialist-service/

You will be referred to the medicine pathway of the service which has a shorter waiting time than the assessment pathway.

Information about your assessment and diagnosis from your private provider will need to be provided, in order that NeSS can review the referral.  NeSS may reject the referral if insufficient information is provided.

We can only accept ADHD Shared Care requests from NeSS.

Reviewed March 2025 Sarah Brown and Dr Lisa Bouch
Next review due March 2027

We make every effort to give the best service possible to everyone who attends our practice.

However, we are aware that things can go wrong resulting in a patient feeling that they have a genuine cause for complaint. If this is so, we would wish for the matter to be settled as quickly, and as amicably, as possible.

To pursue a complaint please contact the practice business  manager or operations manager who will deal with your concerns appropriately. Further written information is available regarding the complaints procedure from reception.

In the event of anyone not wishing to complain to the practice they should be directed to make their complaint to NHSE at:   

By telephone: 03003 11 22 33

By email: england.contactus@nhs.net

By post: NHS England, PO Box 16738, Redditch, B97 9PT

In those cases where the complaint is made to NHS England, the practice will comply with all appropriate requests for information and co-operate fully in assisting them to investigate and respond to the complaint.

We make every effort to give the best service possible to everyone who attends our practice.

However, we are aware that things can go wrong resulting in a patient feeling that they have a genuine cause for complaint. If this is so, we would wish for the matter to be settled as quickly, and as amicably, as possible.

To pursue a complaint please contact the practice business  manager or operations manager who will deal with your concerns appropriately. Further written information is available regarding the complaints procedure from reception.

How do I complain to someone Independent?

GP Practices would prefer to have the opportunity to answer complaints ourselves in the first instance. However, you may pass your complaint directly to:

Patient Experience Team

Nottingham and Nottinghamshire Integrated Care Board

Sir John Robinson House

Sir John Robinson Way

Arnold

Nottingham

NG5 6DA

Tel: 0115 8839570

Email: nnicb-nn.patientexperience@nhs.net

If you would like further information please follow the link to the ICB website: Patient Experience and Complaints – NHS Nottingham and Nottinghamshire ICB

However, please note, patients cannot raise the same complaint with the practice and ICB.

Is there a time limit?

A complaint must be made within 12 months of the date of the incident that caused the problem or the date of discovering the problem.

Please remember, the quicker you complain, the easier it will be to investigate the facts.

If you are not satisfied with the outcome?

You can contact the Parliamentary and Health Service Ombudsman (PHSO) on 0345 015 4033.

For more information see their website www.ombudsman.org.uk

Other useful contacts

POhWER, NHS Complaints Advocacy, on 0300 456 2370. For more information see their website www.pohwer.net

The practice complies with data protection and access to medical records legislation. Identifiable information about you will be shared with others in the following circumstances:

• To provide further medical treatment for you e.g. from district nurses and hospital services.
• To help you get other services e.g. from the social work department. This requires your consent.
• When we have a duty to others e.g. in child protection cases anonymised patient information will also be used at local and national level to help the Health Board and Government plan services e.g. for diabetic care.

If you do not wish anonymous information about you to be used in such a way, please let us know.

Reception and administration staff require access to your medical records in order to do their jobs. These members of staff are bound by the same rules of confidentiality as the medical staff.

Information about the General Practioners and the practice required for disclosure under this act can be made available to the public. All requests for such information should be made to the practice business manager.

Please Click Here to View our Policy

All GP practices are required to declare the mean earnings (e.g. average) for GPs working to deliver NHS services to patients at each practice.

The average pay for GPs working in the Daybrook Medical Practice in the last financial year before tax and National Insurance was £48,402 This is for 2 full time GPs, 5 part time GPs, and 2 locum GPs who worked in the practice for more than 6 months

It should be noted that the prescribed method for calculating earnings is potentially misleading because it takes no account of how much time doctors spend working in the practice, and should not be used to form any judgement about GP earnings, nor to make any comparison with any other practice

Daybrook Medical Practice aim to maintain a safe working environment for all our staff, patients and visitors to the surgery and to help prevent the spread of healthcare associated infections.

Infection Prevention and Control is the prevention and management of infection by use of standard precautions, decontamination, waste management, surveillance and audit.

In order to ensure the above the Practice takes the following measures:

• Working to the most up to date Infection control policies and procedures
• A programme of audits of infection control measures
• Risk assessments are undertaken
• Staff are trained at an appropriate level to their roles and responsibilities

Policies and procedures are reviewed every 2 years or sooner to ensure that they are adequate and meet national guidelines.

The policies are as follows:

Infection Control Procedures, Hand Hygiene, Personal Protective Equipment Management of Healthcare Waste and Sharps/Splash Injuries Cleaning and Decontamination, Management of Spillages of Blood, Body Fluids and Vaccines Minor Surgery 35 Aseptic Non-Touch Technique and Clean , Management of Vaccines and the Cold Chain Handling of Specimens Management of Seasonal Influenza Outbreaks in Care Homes ,Management of Meticillin Resistant Staphylococcus Aureus (MRSA) Management of Panton Valentine Leukocidin (PVL), Management of Clostridioides difficile, Scabies, Spirometry Protocol

These measures will help to ensure compliance with Infection Prevention and Control Policies and to maintain appropriate standards of infection control.

The clinical lead for infection control is Agata Ormita, Practice Nurse

Deputy is Catherine Murphy, Health Care Assistant

December 2024

All patients have now been allocated a named GP.

All patients are allocated to Dr Boruch.

Please be aware that you can still see any GP in the practice.

Daybrook Medical Practice does NOT prescribe sedatives for fear of flying. This policy decision has been made by the GP Clinical Team and is adhered to by all prescribers working in the practice. The reasons for this can be found below:

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 to the situation. This could have serious safety consequences for you and those around you.

2) Sedative drugs can make you fall asleep, however when you do sleep it is an unnatural non-REM sleep. This means you won’t move around as much as during natural sleep. This can cause you to be at increased risk of developing a blood clot (DVT) in the leg or even the lung. Blood clots are very dangerous and can even prove fatal. This risk is even greater if your flight is greater than four hours.

3) Whilst most people find benzodiazepines like diazepam sedating, a small number have paradoxical agitation and in aggression. They 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) According to the prescribing guidelines doctors follow (BNF) Benzodiazepines are contraindicated (not allowed) in phobia. Your doctor is 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 going on a flight.

5) Diazepam and similar drugs are illegal in a number of 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.

We appreciate that fear of flying is very real and very frightening. A much better approach is to tackle this properly with a Fear of Flying course run by the airlines and we have listed a number of these below.

Easy Jet www.fearlessflyer.easyjet.com Tel 0203 8131644

British Airways www.flyingwithconfidence.com Tel 01252 793250

Virgin www.flyingwithoutfear.co.uk Tel 01423 714900

The NHS operate a zero tolerance policy with regard to violence and abuse and the practice has the right to remove violent patients from the list with immediate effect in order to safeguard practice staff, patients and other persons. Violence in this context includes actual or threatened physical violence or verbal abuse which leads to fear for a person’s safety. In this situation we will notify the patient in writing of their removal from the list and record in the patient’s medical records the fact of the removal and the circumstances leading to it.