Response to Local Medical Committees Recommendations for GPs to Cease ADHD Shared Care Agreements

As an evidence-based charity dedicated to supporting adults with ADHD, ADHDadultUK is deeply concerned about recent advisories from Local Medical Committees (LMCs) recommending that GPs cease prescribing ADHD medication under shared care agreements (SCAs) for patients, risking disruptions to essential care. In some areas, these directives apply to both new and existing patients.

Medication is the cornerstone of effective ADHD management, and medications for ADHD are effective and relatively well tolerated1. Medication not only improves core symptoms but also reduces the impact of co-occurring mental health challenges and has been shown to be more cost effective than non-treatment2,3. ADHD medication has been shown to reduce the impact of common co-existing conditions of ADHD, including depression, bipolar disorder, and substance abuse4,5. Removing access to medication, therefore, does not come without risks6.

Implications for Patients

For patients managing long-term conditions like ADHD, consistent and continuous access to treatment is not just important, it is critical to maintaining stability and improving outcomes.

As recommended by NICE, primary care providers should support shared care for ADHD by managing routine prescribing and monitoring once patients are stabilised on medication. This transition of routine follow-up to primary care also frees up capacity in secondary and tertiary services capacity to handle new referrals and complex cases3.

Equality and Legal Considerations

The cessation of SCAs raises serious concerns about compliance with the Equality Act 2010, which requires reasonable adjustments to ensure equitable access to healthcare. ADHD is a long-term condition, and individuals with ADHD deserve the same level of support as those managing other chronic health conditions.

Under the NHS Act 2006, GPs have a legal duty to meet the reasonable needs of their patients, including providing treatments aligned with clinical guidelines. Blanket recommendations to cease prescribing ADHD medication may conflict with these obligations, NHS principles, and the fundamental ethos of providing equitable healthcare based on clinical need.

Supporting General Practice

We understand the immense challenges faced by GPs, including the pressures of unfunded responsibilities. ADHDadultUK supports GPs in exercising their professional judgment and autonomy regarding SCAs. However, issuing blanket recommendations to withdraw from SCAs without offering alternatives fails to address the underlying issues of underfunding and insufficient mental health resources.

Many studies across different Western Countries with broadly similar systems to the UK have examined the cost to society of untreated ADHD, and delays in effective treatment are likely to increase public costs, including healthcare, social care and payment of state benefits7,8.  Unmedicated adults with ADHD are higher users of primary care and secondary care services and are more likely to experience time off work with the associated ongoing healthcare cost of managing periods of illness.  Managing ADHD with medication has been demonstrated to reduce health costs9 and health care use in the short and long term, especially with early intervention. 

Call to Action

ADHDadultUK urges all stakeholders, including NHS trusts, Integrated Care Boards (ICBs), and policymakers, to act immediately to:

  1. Improved funding: Provide sufficient resources for SCAs to relieve financial pressures on GPs.
  2. Collaborate Effectively: Foster better communication between GPs, specialists, and patients to maintain continuity of care.
  3. Review Policies: Ensure policies comply with legal obligations under the Equality Act to safeguard neurodivergent individuals.

Conclusion

ADHDadultUK remains committed to advocating for adults with ADHD and their families. We encourage the healthcare community to collaborate on sustainable solutions that uphold the well-being of ADHD patients while supporting GPs in delivering high-quality care.

References

  1. Edvinsson, D. and Ekselius, L. (2018) ‘Long-term tolerability and safety of pharmacological treatment of adult attention-deficit/hyperactivity disorder’, Journal of Clinical Psychopharmacology, 38(4), pp. 370–375. doi:10.1097/jcp.0000000000000917.
  2. Dijk, H.H. et al. (2021) ‘Cost-effectiveness and cost utility of treatment of attention-deficit/hyperactivity disorder: A systematic review’, Journal of Child and Adolescent Psychopharmacology, 31(9), pp. 578–596. doi:10.1089/cap.2021.0068. Chang, Z. et al. (2019) ‘Risks and benefits of attention-deficit/hyperactivity disorder medication on behavioral and neuropsychiatric outcomes: A qualitative review of pharmacoepidemiology studies using linked prescription databases’, Biological Psychiatry, 86(5), pp. 335–343. doi:10.1016/j.biopsych.2019.04.009. Boland, H. et al. (2020) ‘A literature review and meta-analysis on the effects of ADHD medications on functional outcomes’, Journal of Psychiatric Research, 123, pp. 21–30. doi:10.1016/j.jpsychires.2020.01.006.
  3. Wu, E.Q., Hodgkins, P., Ben-Hamadi, R. et al. Cost Effectiveness of Pharmacotherapies for Attention-Deficit Hyperactivity Disorder. CNS Drugs 26, 581–600 (2012). https://doi.org/10.2165/11633900-000000000-00000 Chen MH, Pan TL, Hsu JW, Huang KL, Su TP, Li CT, Lin WC, Tsai SJ, Chang WH, Chen TJ, Bai YM. Attention-deficit hyperactivity disorder comorbidity and antidepressant resistance among patients with major depression: A nationwide longitudinal study. Eur Neuropsychopharmacol. 2016 Nov;26(11):1760-1767. doi: 10.1016/j.euroneuro.2016.09.369. Epub 2016 Sep 22. PMID: 27667705.
  4. Tsujii, N. et al. (2020) ‘Effect of continuing and discontinuing medications on quality of life after symptomatic remission in attention-deficit/hyperactivity disorder’, The Journal of Clinical Psychiatry, 81(3). doi:10.4088/jcp.19r13015.
  5. Asherson, P. et al. (2022) ‘Mainstreaming adult ADHD into primary care in the UK: Guidance, practice, and best practice recommendations’, BMC Psychiatry, 22(1). doi:10.1186/s12888-022-04290-7.
  6. Daley D, Jacobsen RH, Lange A-M, Sørensen A, Walldorf J. The economic burden of adult attention deficit hyperactivity disorder: A sibling comparison cost analysis. European Psychiatry. 2019;61:41-48. doi:10.1016/j.eurpsy.2019.06.011
  7. Demos. (2018). Your attention please: The social and economic impact of ADHD. Demos. https://www.demos.co.uk/wp-content/uploads/2018/02/Your-Attention-Please-the-social-and-economic-impact-of-ADHD-.pdf, Accessed January 23rd 2025.
  8. Lee, L. et al. (2023) ‘The burden of attention-deficit/hyperactivity disorder in adults’, The Primary Care Companion For CNS Disorders, 25(2). doi:10.4088/pcc.22m03348.
  9. Sampaio F, Feldman I, Lavelle TA, Skokauskas N. The cost-effectiveness of treatments for attention deficit-hyperactivity disorder and autism spectrum disorder in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry. 2022 Nov;31(11):1655-1670. doi: 10.1007/s00787-021-01748-z. Epub 2021 Mar 9. PMID: 33751229; PMCID: PMC9666301.

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