ADHD Assessment and Management

It is well known that the UK is in an ADHD service provision crisis. Many patients seeking an ADHD diagnosis and treatment are often left waiting for years to get the service on the NHS.

In the wake of this, many people are turning to private ADHD assessment services. I and the specialist nurse prescriber with whom I work have many years experience carrying out medical ADHD assessments and provision of treatment.

There is a standardised protocol for diagnosing and initiating treatment for ADHD. As follows:

Before the Initial Medical Assessment:

The patient must supply details of their GP and their Summary Care Record (SCR).
The patient must complete standardised Self Report and Informant Report questionnaires describing their ADHD symptoms.
The patient must provide measurements of blood pressure (BP), heart rate (HR), weight and height (in order to calculate BMI).
When indicated, the patient may also be required to undergo a full physical examination, have blood tests and an ECG test.
The specialist nurse can carry out these pre-assessment interventions. They will then refer the patient to the psychiatrist for the initial assessment.

At the Initial Medical Assessment appointment

Assessment, diagnosis, and initiation of drug treatment must be carried out by a specialist - such as a consultant psychiatrist. This appointment may be online or face-to-face, as the patient preferes.
The psychiatrist will review the results of the pre-assessment interventions.
They will go through the ADHD symptoms with the patient and review the responses to the questionnaires provided.
If the diagnosis is confirmed, the psychiatrist will discuss with the patient recommended treatments, and explain the process going forward.
The psychiatrist may also discuss additional (or alternative) psychotherapy options for the patient.
The psychiatrist will write a detailed report letter outlining the diagnosis and proposed treatment, which will be sent to the patient, the GP and the specialist nurse.
The patient will then proceed to the titration (onto medication) phase.

Titration Phase

This phase is carried out by the specialist nurse prescriber.
The first-line treatment for ADHD (and ADD) is stimulant medication. There are several different forms of stimulants available in the UK.
Stimulant medication is started in a slow and gradual fashion (a process called titration).
The nurse prescriber will use questionnaires and rating scales to assess the patient's response to medication and address any adverse effects if they occur. In discussion with the patient, the nurse prescriber will adjust the dose accordingly.
Sometimes the first medication used is not effective or tolerated, in which case the prescriber will change to a different drug until the best management of symptoms is achieved. It can sometimes take several months before the patient finds the best treatment regimen that suits them.
The GP will not provide ADHD/ADD medication on the NHS until the patient has reached stability on a regular medication regimen. Therefore, all the prescriptions in the early stages of initiation and titration are provided by the specialist provider on 'pink' Controlled Drugs prescription forms.
When the patient has reached stability on the best drug treatment that suits them, the nurse prescriber will refer the patient back to the psychiatrist for a final review session, with a report of how they got on with the titration process.

Final Medical Review Session

This is carried out by the psychiatrist.
The psychiatrist will review the report from the nurse prescriber, outlining how the titration went.
The psychiatrist and patient will discuss the current stable drug treatment, and if agreed, the patient will then be referred back to their GP for 'shared care' thereafter.
NOTE:Occasionally some GPs are not able to take over the care of the patient, even after 3-months when they have reached stability. Under these circumstances, the patient may have to remain being prescribed by the private specialist in order to continue their treatment.

Treatment Continues under Shared Care arrangement with the GP

The patient will no longer require 'pink' private prescriptions from the nurse prescriber.
Rather, the GP will issue monthly NHS prescriptions for the ADHD medication going forward.
The patient will then be reviewed once a year by the psychiatrist who initiated the treatment.
If the patient requires any additional reviews between annual monitoring sessions, (for example because they want to change their medication routine), these will be carried out by the specialist doctor or the nurse prescriber, not the GP.

ADULT ADHD Consultation Fees:

Sending, Collecting and Reviewing Pre-Assessment Questionnaires = £50.00
Initial Assessment Session (60-minutes) + detailed written report = £450.00
Titration Session (30-minutes) and Sending Prescription = £150.00*
Follow-Up Medical Review Session (30 minutes) with written report = £200.00

*Several titration / follow-up sessions will be required, depending on response to medication and whether multiple changes of medication are required to reach stability. Private prescriptions will be required for at least 3-months before the GP takes over the prescribing. Patients will also pay the pharmacist to pick-up a private prescription (pharmacist costs vary locally).

Therefore, the total cost of the full ADHD Assessment + Titration Sessions + Medical Review Sessions may vary. Typically it may be between £2000 and £3000.

Click Here to Submit ADHD Assessment Form