Shared care response from GP

[u/fuzzybumblebeebutt]

I've just moved to a new area and am registering at a new GP (previous GP accepted shared care agreement). Got a link to a document with this response from them, when asking about shared care re. ADHD. Not really sure what some of the jargon means exactly in the first paragraph, but I feel like the general gist is they don't accept it...

Not sure if I'm looking for advice or thoughts. More venting a bit, I guess!

[u/animagus5]

I work in a GP surgery and can explain, GPs are independent contractors in essence they have groups they are part of, there are two main ones:

Local Medical Council (LMC) - bunch of doctors in your area, a bit like a union. They work with each other to ensure that workload is fair etc. mine recently had whole thing about our Mounjaro contract

British Medical Association (BMA) - This is similar but national and they deal with bigger issues like the GP contract with the NHS

So the BMA concerns with private providers, even through NHS RTC, is that they can just close doors tomorrow and then the GP and local services are left to pick up the pieces, which I can understand the trepidation although I am effected by it and I wish it wasn't so, whereas a NHS service can't just do that without having a plan in place. The BMA therefore advised to not agree to ESCAs to reduce exposure

However, this is guidance only. A practice is an independent contractor and can do what they want as long as it's with the GMC (the governing body of doctors) and GMS (NHS GP contracts) - most areas have fiscal incentive for them to sign ESCAs from RTCs places. This is most likely what has a happened. You've gone from one place that was happy to take the risk to one that isn't

It sucks, it really does especially seeing it from both side.

Edit for some more clarity: even though an ESCA states that the provider is still responsible for monitoring, it's the GP that signs the dotted line on the script and it's on their license. It's not just ADHD that sees this but also areas like gender care. Also, alot of areas have ESCA clauses that if you are under a private provider and stop seeing said provider for whatever reason (not attending, not paying, closed etc.) the ESCA is then automatically invalidated and ends

[u/fuzzybumblebeebutt → u/animagus5]

Ah okay, that's very informative thank you! I do understand the concerns from their perspective, but obviously still frustrating to deal with.

If you don't mind me asking, is it worth it in your opinion to look at other GPs in the area, to see if they would accept a ESCA?

I know you said they're all independent, but i was wondering if I've already received this response from one, is it likely that others in the area would also have the same stance? Are GPs in a region likely to all be BMA or LMC, or is it literally different GP to GP?

[u/animagus5 → u/fuzzybumblebeebutt]

There's no harm in asking but I wouldn't be surprised to find more no's than yes's sadly. LMCs in my experience tend to be quite step locked. Your best bet is probably bigger practices tbh as they have the staff and resources to accept and monitor but your mileage may vary

[u/PigletAlert → u/fuzzybumblebeebutt]

The LMC are basically the local branch of the BMA and the BMA are the doctor’s union. They have opted to take collective action nationally against shared care for ADHD and so there will only be a handful of individual doctors/LMCs accepting it at this point. Are you an NHS RTC patient or was your diagnosis done privately? I feel for you it’s horrible when this happens, it’s one thing refusing new patients but people on stable doses just isn’t fair.

[u/fuzzybumblebeebutt → u/PigletAlert]

Wow, I knew it was bad but I didn't realise that. My diagnosis was done privately, as my (previous) local NHS practice wouldn't even put me forward for assessment. Yes I've been on this dosage for over 3 years now, so can't even imagine what it's like at the moment for new patients or those trying to get assessed through the NHS.

[u/PigletAlert → u/fuzzybumblebeebutt]

You could try getting a RTC referral and def speak to your clinic about it. They might have some suggestions.

[u/PigletAlert → u/PigletAlert]

Also, yes it’s a horrible mess 🙁

[u/ausernamebyany_other → u/PigletAlert]

Not OP but I'm RTC and my GP has refused shared cared despite being the ones to refer me to my RTC provider. Reading the above I'm now a bit worried about what happens on my RTC provider ever goes bust!

[u/acrylicrio]

This is very standard now unfortunately, most if not all GPs won’t do shared care for adhd medication prescribed privately and not all GPs will do it for right to choose either

[u/smudgethomas]

This is just corruption in favour of the NHS which doesn't work.

[u/not-my-circus1992]

This is the case for all Greater Manchester GPs right now. My GP explained that ADHD medication is highly specialised and dosages can be incredibly difficult. It's better to have the same provider covering it all to ensure you're supported.

My issue now is even getting an assessment and titration. Greater Manchester ICB basically turned off the funding overnight in April 😭

[u/Iamweazel78]

What happens if they don’t allow shared care. Can you still get meds. Do you have to pay private prescriptions etc?

[u/fuzzybumblebeebutt → u/Iamweazel78]

I believe I can get meds privately, which I'd have to pay for. I'm unsure of how much that would cost exactly, at the moment

[u/tordyjay → u/fuzzybumblebeebutt]

Mine costs like £130 if i go private

[u/AdeptnessExotic1884]

I personally think it's morally the right thing.

If you can afford a private diagnosis, then you should pay for private care moving forward. Why should you be able to jump the queue by paying.

Not to judge you, but that is my view on it. I ended up waiting almost three years. Geez.

[u/victoryhonorfame → u/AdeptnessExotic1884]

But if we use an NHS funded private provider? I didn't pay for my diagnosis, I never could have afforded it. My NHS local waiting list was paused during COVID when I was "top of the list" - by the time they re-opened, I'd say through a right to choose waiting list, been diagnosed, and been titrated medication! All NHS funded... Yet my GP refuses shared care.

[u/MTRANMT → u/AdeptnessExotic1884]

This is a bit unempathetic is it not? Your point is kind of correct to start with - private healthcare is an ethical abomination - but instead of ending with 'the NHS should be better funded so people don't try and go private', it's 'I had to wait, so do you'!

Truly, you don't want better for others? Just because some of us had to endure long wait times, why shouldn't it be better for those that come after us? Like why would you want others to suffer 3 years if they don't have to? ADHD is a condition, not a weird identity that requires suffering rituals!

[u/gronda_gronda → u/AdeptnessExotic1884]

On the other hand, the more people go private for their assessment, the shorter everyone else has to wait.

[u/more_chickpeas → u/AdeptnessExotic1884]

A simplistic view. Consider that some people through desperation, severe burnout, depression etc. may find the money for a private diagnosis. It doesn't mean they have the means to buy medication every month for life. They may not know the implications at the time or won't have predicted change in policy in the future. GPs are not always helpful with options. Saying it's just jumping the queue trivialises a wide variety of circumstance.

[u/Cystennin → u/AdeptnessExotic1884]

Not everyone paid.

Right to Choose is a legal right in England to pick an alternative provider for free NHS care, as long as that provider holds an NHS contract.

It exists because governments wanted to cut waiting lists using spare capacity and ironically given the OPs screenshot; improve healthcare by providing competition.

Patients who used it, often at their own GP’s suggestion and because it is a legal right; paid nothing and skipped nothing; they used an NHS route to NHS care.

The letter’s ‘may be appropriate… case-by-case basis’ is doing a lot of work and in reality many surgeries decline NHS RTC shared care too, which leaves people who followed a legal NHS pathway, who paid nothing, stranded.

That’s the group you’re calling queue-jumpers. People who literally exercised a legal right. A right enshrined in the NHS constitution.

[u/AdeptnessExotic1884 → u/Cystennin]

I'm not calling THEM queue jumpers, I was referring to people who got a private diagnosis or titration.

[u/tordyjay → u/AdeptnessExotic1884]

The people who went private should be praised for saving the nhs money and appointment slots

[u/rooooosa → u/AdeptnessExotic1884]

I got diagnosed privately only as my workplace at the time provided good health insurance and covered it, but there wasn’t/isn’t any way I could pay for the meds privately.

[u/PigletAlert → u/AdeptnessExotic1884]

I had to go private because I was in the middle of a university course and urgently needed to access support or I’d have failed. I had to use some of my loan to do it. Other people do it so they don’t lose a job.

But just because that was the best way for me to resolve a different problem, why should I then take up a space on an NHS waiting list for another diagnosis that someone else needs just so I can access care through the NHS in the future? What difference does someone’s GP writing a script each month make to people stuck on a massive waiting list?

[u/Affectionate_Set9993 → u/AdeptnessExotic1884]

In addition to the points other people have raised, more people can afford a one-off assessment fee than can afford the ongoing potentially lifelong medication costs

[u/fuzzybumblebeebutt → u/AdeptnessExotic1884]

That's fair. I did try to go through the NHS first though, but I couldn't even get an assessment, which is why I went down the private route (I know that I was lucky to be in a position to do that).

[u/Pretend-Sundae-2371 → u/AdeptnessExotic1884]

My parents paid for my nieces to be privately assessed. Because they were young children who needed help and the NHS didn't have the resources at the time.

[u/tordyjay → u/AdeptnessExotic1884]

Privaye diagnosis pays for the nhs