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Post by roland on Jul 21, 2010 8:53:30 GMT
I'm putting information on this thread for anyone who is having trouble getting their meds from their GP so feel free to download and print off anything that is useful and give to your GP and/or psych as needed: Some GP's are reluctant to prescribe ADHD meds for a variety of reasons (in subsequent posts I'm going to attach studies that discuss some of these reasons) most of which can be overcome by the use of "Effective Shared Care Agreements" (ESCA) I will also attach templates for ESCAs for the most common ADHD meds in subsequent posts on this thread. An ESCA is a written arrangement between the specialist and the GP for a specific patient and it clearly lays out areas of responsibility for care (what the specialist will do, and what the GP will do) Here's a link to more information about these ESCAs on the Department of Health website www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_4898588
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Post by roland on Jul 21, 2010 9:07:07 GMT
This attachment is for a shared care protocol for the treatment of adult ADHD and it was drawn up by the Sheffield Area Prescribing Committee and was approved in February of this year (2010) and covers Atomoxetine (Strattera), Methylphenidate (Ritalin, Concerta, Equasyn), and Dexedrine In fact this is such a handy document to use as evidence for any adult who's having trouble getting their meds that I won't attach the other templates because they are older and only address the needs of children. One reason for Sheffield being so much on the ball with this protocol is that Dr Tim Kendall is the Medical Director of Sheffield Care Trust, and also the Joint Director of the National Collaborating Centre for Mental Health and he was the Lead Director for the development of the NICE guidelines for assessing and treating ADHD. I wish he would move to Bristol; we could use his help here Attachments:
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Post by roland on Jul 21, 2010 9:22:27 GMT
And now here is a study into what influences GP prescribing. It's dated 2003 and it's about uptake of new drugs but is nevertheless interesting because it does say that patient requests for drugs are a powerful influence upon GPs Attachments:
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Post by roland on Jul 21, 2010 9:50:19 GMT
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Post by Deleted on Sept 29, 2010 18:38:32 GMT
Just finding this one here. I am waitin for my report and then I will march to my GP and ask him for a prescription. I got told that some GPs are willing to prescripe it. I will have a read through this and see where this goes as I need help soon, otherwise my Degree is in extreme danger.
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Post by Deleted on Oct 12, 2010 14:46:09 GMT
Hey Roland,
Thanks so much for your work here, it is invaluable. Just had a look at the Sheffield Pdf. and have a bit of a complicated question. It seems, but I am easily confused right now, that a GP can only take over prescribing after an initial 3 month period under the management of local Mental Health groups while the patient is stabilised - is that correct? The question I have is this, I have been quoted two prices for private assessment, one for the assessment alone and one for the assessment plus a further 3 months' supervision after diagnosis, it would appear that these further three months care will in fact be necessary under the Sheffield Protocol before my GP could start prescribing alone - what do you think?
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Post by Deleted on Oct 12, 2010 17:55:40 GMT
Are you in Sheffield?
If so then the three month period may be required - it's wise to have this in place anyway (when I went private I had telephone advice and a monthly review by e-mail). Follow up after the event to see how the meds are going till they are at full strength and stabilised are pretty much a requirement.
It's nearly two years since I was diagnosed by the NHS and they didn't offer any support apart from an annual review and quarterly check up at the GPs.
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Post by annie on Oct 12, 2010 20:15:54 GMT
Hi Stephen
I'm not surprised your confused - the whole Adhd service provision is a total postcode lottery!!
Each area/region sets up their own "shared care protocol" between specialist's and Gp's. So if you live in Sheffield this is the level of support Gp's would expect before they take on the prescribing for individual patients. However in my area the protocol is quite different.
I notice you had an assurance from your Gp they would be willing to prescribe on the basis of specialist advice be that private or NHS. As your going down the private route (and who can blame you with waiting lists the way they are) it might pay you to ask your Gp what the shared care agrrement is in your area and whether it fits with what he's promised. There have been others on here who have been referred by their Gp for a private consultation, only to find that when the specialist advice was given the Gp has reneged on the agreement.
Your Gp may not be willing but it would be good if he would give you something in writing to say he is supporting this private referral on the basis that there's no specialist services available in your area, and he will be willing to prescribe on the basis of specialist advice.
It shouldn't be this hard to see a specialist but there you are - good luck and keep us posted.
annie
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Post by goosey on Feb 21, 2014 23:41:05 GMT
Finally got my GP to prescribe my meds after an 18 month battle !! The old Shared Care Agreement thingy. The meds used to be classified as 'red label' in Gloucestershire, which meant my GP couldn't prescribe them (and there is no capacity in the PCT for anyone to prescribe). However things have recently changed and they are now classed as 'Amber", which means my GP can now prescribe. I only found this out as I had complained to PALS about the situation and time scale. So now my meds will be 'managed' by a psych in The Forest of Dean but prescribed by my doc !! Thanks for your advice recently guys, it helped get my ass in to gear ! Ah yes.....the only contentious issue is that the psych reckons ADHD is a chronic condition that requires taking meds all the time. He doesn't agree with my 'as and when' attitude for taking them. As far as I am aware there are no long-term studies on the effects (with adults with ADHD) taking stimulants continuously. So I'm going to go along with his thinking (as a means to an end) but will continue to take them as and when I need to. It's my life and I'll decide what's best for me thank you !!!
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mybubble
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Post by mybubble on Apr 6, 2014 17:30:24 GMT
I got the referral from my GP to both private and NHS specialists, I got the private assessment first. The private psychiatrist sent report and supervision of prescribing to my GP who was then rude to me and refused to provide the prescription. I am now taking concerta XL 18 mg for 5 days now, noticeable change on low dose. Unfortunately the medication was SO expensive I cannot afford to pay so much out each month.
I was thinking of going to the NHS appointment but am not sure how to approach it as I have already been diagnosed ADHD (inattentive) and already started on the medication.
Does anyone have any advice or has anyone been through a similar experience?
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Post by Deleted on Apr 6, 2014 18:51:15 GMT
I've done private diagnosis/NHS treatment.
It worked fine because my treatment team wanted to do the best for me.
You can always change GPs.
If that's not feasible then have the second diagnosis (though why an NHS psychiatrist is any better than a private one is beyond me).
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Post by mybubble on Apr 7, 2014 6:59:23 GMT
Yes my first step is definitely changing GP's! Although is difficult as I live in the middle of nowhere. Apparently she said the NHS will not mix with Private healthcare and the psychiatrist was just trying it on. Can only wait and see the outcome from my next assessment.
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Post by Deleted on Apr 7, 2014 9:29:30 GMT
Apparently she's full of brown and trying it on.
Shared care is how GPs work with ANY specialist - one does the diagnosis and tells the other how to treat - ADHD is no different than any other health condition.
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mybubble
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Post by mybubble on Apr 7, 2014 11:39:49 GMT
Thank you, I believe things work differently as I am based in Scotland... I will get in touch with NHS Scotland directly. Thanks Again.
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Post by Deleted on Apr 7, 2014 13:46:30 GMT
Service is essentially the same in Scotland - things like funding might be different but shared care is established procedure throughout the NHS. Unfortunately GPs are not obliged to enter into shared care agreements so stroppy ones need to be sidestepped. Have a word with your local experts Scots ADHD
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Post by twix on Jul 12, 2014 18:59:08 GMT
Its worth trying different gps if you need to. My gp prescribes without any special agreement.
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Post by vagueandrandom on Jan 25, 2016 16:06:51 GMT
This thread's really old and none of the links work.
My meds run out in 4 days and my new GP point blank refuses to prescribe concerta.
The only other GP Practice in the area has a minimum of 4 weeks wait before I can get registered.
The new GP has referred me to 'local services' who she's convinced will give me a prescription without waiting on the waiting list for a consultation (Ha Ha!)
I don't even know who or where I've been referred to because I was so upset and she was so unpleasant.
I registered before xmas and told them what meds I was on. I then had to have a nurse check-up where I mentioned meds when she took my blood pressure.
No-one mentioned that they wouldn't prescribe. I would have gone to the other practice if I'd known.
I want to know what to say when I go back (or write a letter).
@planetdave ?
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Post by Deleted on Jan 25, 2016 19:48:11 GMT
vagueandrandomPhone your psych and tell them the situation, since it's after 18:00 email will have to do before hitting the phone in the morning. Hopefully they can ring the surgery to shout at them, or find an alternate way of sorting a prescription. Failing that - have you got a copy of your diagnosis? Any doctor can write a script for you - try A&E, or walk in centre. If you have a diagnosis and they can ring your psych to confirm the situation (take the number) there's no reason why a major hospital can't write a script (you might have to wait for someone from the psych dept to come down to check you out). I'm in favour of making a big stink about having your treatment withdrawn with the GP practice. Here's a quote from 'Healthline' Quitting Concerta should be done slowly and under a doctor’s care. This allows the body to get used to the change in norepinephrine and dopamine levels in the brain. Psychological counseling may also be appropriate to help Concerta users who have low self-esteem, depression, or other psychological disorders.
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Post by vagueandrandom on Jan 25, 2016 21:23:13 GMT
Thanks @planetdave as I have moved cities my psych gave me a letter to give to my new GP which she has seen and photocopied. I also have a copy of my diagnosis. I don't like using the phone. Another reason the GP upset me was that I asked for counseling and she gave me a phone number. When I said that I had difficulties with the phone (I was crying at the time) she said that it was the only way to get help. It's been nearly a week and I've only just recovered enough from the upset to feel up to tackling it. I don't have friends or family to help me. She's not the only GP at the practice, so I'll try another. I'll go to my GP tomorrow and if I can't get an appointment, there's a walk-in centre and hospital with A&E nearby. I fully intend to cause a BIG fuss. . . like I did when my original referral was turned down by the psych. . . BUT i shouldn't have to! Thanks for the quote, I'll write it down to take with me. AND Thank-you @planetdave for your sound advice, as usual
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Post by vagueandrandom on Jan 26, 2016 23:52:41 GMT
OK. . .today I was on a mission . . .went to GP and employed excellent passive-aggressive tactics . . Vague and confused and on the brink of tears. . 'I'd like to speak to someone about my prescription. . ' I saw the doctor last week and she said she wouldn't prescribe - is it policy here?' . . . 'I can't remember what she said that she was doing because I was so upset. . .I don't even know where she's referring me. .' 'I've only got enough left for 3 days and I know that I shouldn't just stop taking it'. . . I had my diagnosis letter, I'd highlighted the bit in the advice leaflet about not stopping suddenly and my last bottle of pills with a label with my name on. They wanted me to go away, but I told them that I don't like using the phone (true) and that I could wait as long as it takes. . . so suggested that I came back in the afternoon. . Which I did, the prescription was there, I took it to the chemist who said they don't stock controlled drugs and the prescription wasn't signed by the doctor anyway. . almost burst into tears, went back to GP, got it signed, but went to a chemist closer to home who filled it with only a slight (do you have any ID) blink. . Thanks @planetdave for giving me the confidence and grit.
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Post by Deleted on Jan 26, 2016 23:58:09 GMT
vagueandrandom - pleased my slight input had an effect. If you need any help mail the address in the footer and I'll try to do something. No guarantees, but I'll try.
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Post by stan1975 on Sept 9, 2016 17:13:59 GMT
Hi im new to this forum and new to my recent diagnosis.
I have had to go Private as i was near breaking point. NHS was a joke for me
I have been diagnosed with Adult ADHD not found as a child. BIPOLAR and Anxiety Disorder.
I have been given depokate no problems . Hardest thing is coming of venlafexine but getting there.
However my Doctor wont prescribe Strattera and has bounced me back to the specialist , who is £100 a visit.
I have been told i can buy the meds direct from the chemist at £70 a month.
The DVLA have taken away my HGV licence as this is my job £100 a go is a struggle.
I am being bounced all over the place and good job i have a very good family support network.
I live in Merseyside and i am told there is no discussion on the meds this is the policy.
I tried to contact Doctors in Lancashire but no one really that bothered to help.
Very hard to do all this with a huge cloud overhead as well. ANY IDEAS?
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