Scrutiny told new shared care pathway is key to help with treatment of ADHD in Jersey
Scrutiny
21 October 2024
A Scrutiny Panel has been told that the introduction of a new ‘shared care’ pathway in Jersey would help to alleviate the pressure on the consultant psychiatrist responsible for prescribing ADHD (Attention Deficit Hyperactivity Disorder) medication to adults. The Health and Social Security Scrutiny Panel is conducting a review into the current procedures in place for prescribing ADHD medication and the impact any delays may have on patients' health and wellbeing together with any obstacles they face.
During a public hearing with the Minister for Health and Social Services, the Panel heard the psychiatrist is currently writing approximately 300 adult patient prescriptions each month.
Andy Weir, Director of Mental Health and Adult Social Care, told the Panel that prescriptions for ADHD medication would not usually be done on a monthly basis, but the system has been introduced in response to the current global shortage of this type of medication.
The Panel were told attempts by the health department to employ another specialist prescriber to assist with the work had failed, with a lack of specialists in this area worldwide cited as the main reason. Funding for any post would also depend on the outcome of the debate in the States Assembly on the Government’s proposed Budget 2025-2028 and the subsequent allocation of the agreed Budget within the health department.
At an earlier public hearing with the Minister for Social Security, the Panel heard the global shortage of ADHD medication was the primary reason behind its exclusion from the list of medications covered by the Health Insurance Fund (HIF) and that more work was needed on the shared care pathway before it could be included.
Under the proposed shared care pathway, a patient would be seen by a specialist consultant who would make a diagnosis and start treatment. Once the correct medication and dosage has been established, and the patient is stable, care would move into the primary care sector, with GPs able to prescribe the same medication and continue treatment. If there were any changes in the patient’s condition, the GP would refer them back to the specialist consultant.
The Panel also heard during the earlier hearing that some GPs did not feel confident in their knowledge of the complex condition, but that training is being developed. If an agreement could be reached, the Panel were told that between 50% and 70% of ADHD patients eligible for the pathway would join it.
The Minister for Health and Social Services confirmed to the Panel that discussions regarding the shared care pathway were ongoing and that he was hopeful an agreement could be reached and did not rule out using political intervention to help the process.
The Minister also said he would consider funding GPs to run a central clinic or hub for ADHD patients. A similar model has been used previously in the Alcohol and Drugs Service where a GP would run sessions that provided care for patients, funded by the health department. The Panel heard conversations have been had with the Jersey Primary Care Body about GPs undertaking special interest sessions, which would allow them to gain extra knowledge in a specialist area, including ADHD. The Minister told the Panel any initiative would need to be properly funded and resourced and has committed to discussing it further with the Primary Care Body and Minister for Social Security.
There are currently 873 adults and 590 young people waiting for an ADHD assessment, with the average waiting time for an adult around 3.5 years. The Panel were told it is the longest waiting list within Jersey’s mental health services. The department admitted that it needed to improve its communication with patients on the waiting list and that it would look to put in a system that would routinely advise people how the list was progressing. It also confirmed it would look to proactively publish the waiting list so Islanders could better understand waiting times.
Deputy Louise Doublet, Chair of the Health and Social Security Panel, said: ‘The Minister for Health and Social Services committed to discussing some of the ideas shared with the Panel during our review with his officers and I strongly encourage him to hold those conversations as soon as possible, particularly concerning the shared care pathway with GPs. The Panel understands that stock levels for some ADHD medications are improving globally. We would encourage the Minister to resolve the issues with the pathway, so that by the time there are sufficient levels of medication, they can be included on the prescribed list. While the Panel recognises the system will see GPs take on more responsibilities, it would take some of the pressure off the consultant, allowing them to focus on seeing patients and potentially reducing the waiting list. The Panel understands conversations around the allocation of the health budget to the different services is ongoing. We will look forward to finding out the detail of the allocations, once the Budget has been agreed by the States Assembly and will monitor how that money is being used within the department.’
The Panel plans to publish the report together with its findings and recommendations to the Minister by the end of the year.
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