ASD & ADHD Assessment Policy

Private clinics and Right to Choose: ASD & ADHD Assessment Pathways

What is Right to Choose?

In England, under the NHS, you now have a legal right to choose your mental healthcare provider, including for Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) assessments. This service, offered through the NHS, is free of charge. This is for diagnosis only though and any ongoing monitoring and medication will be a private arrangement between you and the clinic and so not NHS funded.

Who Can Offer Right to Choose Assessments?

There are a growing number of clinics across the UK that offer Right to Choose ADHD and/or ASD assessments. Private-only clinics are not eligible. Checking a provider’s website is a good way to determine if they offer the services you need.Important Resources

Things to Consider About Right to Choose

It’s important to note that many clinics offering these assessments can diagnose ADHD or ASD but most do not provide ongoing NHS funded monitoring or medication provision and titration. This means you will need a local NHS referral to transfer your care if medication is required to manage symptoms. Your GP cannot provide this specialist care and medication and will not do so under any shared care arrangement with private clinics. This means that the clinic will require you to pay for all medication and ongoing monitoring consultations yourself under a private arrangement.

When Can You Not Use Right to Choose?

There are certain restrictions on eligibility for Right to Choose referrals. You are not eligible if:
  • You require urgent or emergency treatment.
  • You are already receiving care for the condition you are seeking an assessment for.
  • The provider you choose cannot provide appropriate care for your condition.
  • You are a prisoner or in specific secure settings such as a secure hospital or under the Mental Health Act.
  • You are a serving member of the armed forces.

How to Request a Right to Choose Referral from Your GP

Either you or your family (if the patient is a child) will need to research and decide which provider to choose. Your GP cannot advise on which clinic to select. After making your choice, send in a request to the practice with your selection and any relevant forms required by the private clinic to ensure an efficient referral process. The NHS standard contract (section 7.9) dictates the use of the e-RS referral system but does not require the use of a form to accompany such a referral. Your GP will make the referral by letter but will not complete forms created by the providers.

How Much Quicker Will Right to Choose Be?

The speed of the assessment depends on your chosen clinic and whether they offer medication titration. Generally, Right to Choose assessments can take anywhere from 12 weeks to 12 months—much quicker than the local NHS alternatives, which have waiting times of up to 7 years. If a clinic offers a diagnosis but not NHS funded medication and titration, you will need an additional referral for post-diagnostic support, which can take up to 24 months locally. Your GP will not initiate specialist medication or provide ongoing supply and monitoring, this would need to be a private arrangement between yourself and the clinic, all costs being the patient’s responsibility.

Why Choose Right to Choose If Medication May Not Be Accessible?

Many patients find that a diagnosis is sufficient for obtaining additional support from schools or employers, or they may not need medication at all for managing their conditions.
For further research, here are some helpful resources:
Information on ADHD
  • AHD UKD: A charity offering free advice and information on ADHD and Right to Choose referrals
  • ADHD Foundation: The UK’s leading neurodiversity charity, offering services for those who live with ADHD, Autism, Dyslexia, DCD, Dyscalculia, OCD, Tourette’s Syndrome and more
  • NHS Website
  • Mind: ADHD and mental health

Information on ASD

Training Practice

 

Teaching Involvement

Medical Students

We are a teaching practice and medical students sometimes sit in with the doctors and nurses. If you prefer not to have a student sitting in, please let the doctor or receptionist know.

General Practitioner Registrars

GP Registrars are often attached to the practice and are fully qualified doctors gaining experience in general practice.

Training in action

Videoing Consultations

As part of on-going training some doctors may on occasion video their consultations. Consent is always obtained from patients prior to there appointment being videod. You of course have the opportunity to decline.

All telephone calls are recorded for training and monitoring purposes. If a call recording is intended to be used for consulttaion assessment purposes, ie for use in a tutorial or for submission for an exam the trainee will always seek your explicit consent.

Patient arriving late for appointments

Patients are expected to arrive in good time for their appointments. If patients arrive more than 10 minutes late, they have missed their appointment and will need to rebook a new appointment.  This is to prevent delays to the clinician’s sessions and to ensure fairness for patients who have arrived on time.

We appreciate the effort our patients make to attend on time and therefore do our best to run as close to booked appointment times as possible. Adhering to a Late Patient Policy assists us in doing so. However, due to the nature of a GP surgery, sometimes the doctor or nurse may be running behind. When the clinician is running late our reception staff will advise the patients upon arrival and apologise to them for the delay.

If late, patients will have to rebook, as clinicians need the full allocated time to provide safe, high-quality care.

Further information:

If a patient calls ahead to say they will be late, this does not alter the policy. If they are going to be more than 10 minutes late, the receptionist will advise them on the phone that they should rebook, rather than waste a journey.

The admin staff are not permitted to interrupt a clinician during surgery to request them to see late patients, so to avoid disappointment, please do not ask them to do so.

Signed 

The Partners

Wootton Vale & Shortstown Surgery

Tirzepatide, (weight loss medication) Policy Statement

Please see our policy statement, in conjunction with Bedfordshire, Luton & Milton Keynes Integrated Care Board, (BLMKICB), regarding the prescribing of the weight loss medication, tirzepatide, which you may have heard about in the media.

“23 December 2024

 An update on weight loss medication, tirzepatide

On 23 December 2024 the National Institute for Health and Care Excellence (NICE) published the Technology Appraisal in relation to tirzepatide (Mounjaro™) which is a new drug for managing obesity.

This medication will not be available in Bedfordshire, Luton and Milton Keynes for several months, as we work through a process and undertake clinical steps before for this is available for patients on prescription.

Initially, tirzepatide will only be available in specialist weight management services whilst Integrated Care Boards (ICB) await further national guidance.  In the short term this medication will not be available from GP practices.  NICE have indicated in the guidance that it could take up to 12 years to make it fully available to the eligible population.

Please see the FAQs below, which provide more information on what this means for Bedfordshire, Luton and Milton Keynes residents.

 

What is changing in the management of obesity because of NICE’s announcement?

Tirzepatide is currently prescribed for the treatment of type 2 diabetes but will shortly also be available for weight loss purposes.

People in England over the age of 18 who are living with obesity and another weight-related health issues will be able to access the weight loss drug tirzepatide through specialist weight management services from spring 2025.

 

Who can access tirzepatide?

Eventually this medication will be available for people living with obesity who have a body mass index (BMI) of 35 or over and a weight-related health problem; or a BMI of 32.5 and one weight related health problem; or people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds, who are at a higher risk of medical problems at a lower BMI.

NHS England will provide more information early in 2025 to set out the criteria and the patients who will be eligible for tirzepatide.

 

Can I access tirzepatide straight away?

Introducing this new treatment to NICE’s estimated 3.4 million eligible patients requires the NHS in England to develop a completely new service for primary care and many healthcare professionals will need to be trained to deliver it.

A staged approach will help manage demand on existing healthcare services. This allows the safe prescribing of tirzepatide and the appropriate support for patients.

tirzepatide will initially be offered to individuals facing the most significant health risks related to their weight, starting in spring 2025 through specialist weight management services.

Tirzepatide will not immediately be available and will not be accessible to everyone who wishes to use it.  Initially, tirzepatide will only be available on the NHS to those expected to benefit the most.

 

How does tirzepatide work for weight loss?

Tirzepatide works by supressing appetite centres in the brain that control gut hormones. It decreases the appetite and slows the movement of food passing through the body, making you feel fuller for longer.

Clinical trials have shown tirzepatide can help people living with obesity lose up 20% of their starting body weight, depending on the dose and accompanying diet and lifestyle support.

Tirzepatide can only be prescribed by a healthcare professional alongside programmes which support people to lose weight and live healthier lives by making changes to their diet and physical activity.

Tirzepatide comes as an injection, which can be self-administered once a week.

 

What if a patient is already receiving tirzepatide treatment?

Patients can continue taking tirzepatide if they are prescribed it to manage their diabetes.

If patients are using tirzepatide they have acquired privately, they may be able to access the medication through an NHS prescription if they meet the NICE and NHS qualifying criteria. However, patients should not gain advantage over other patients waiting for NHS care.  More information about this will be made available in the new year.

 

Will everyone who is eligible have access to the drug?

Tirzepatide might not be suitable for everyone and not everyone who meets the eligibility criteria will want to use it to support their weight loss. A healthcare professional will discuss the most appropriate care and support, based on individual patient’s need. This could include behavioural support programmes, medical options including prescribing or bariatric surgery.

 

The NICE announcement mentions ‘wraparound’ care. What does this mean?

Any patient prescribed tirzepatide must participate in the specifically designed ‘wraparound’ care required by NICE guidance. This focuses on diet, nutrition and increasing physical activity. As NHS England develops the service, it will provide more details of the wraparound support offer for patients who qualify.  Patients cannot be prescribed tirzepatide if they do not wish to undertake the wraparound care support.

 

Will there be a cost to the patient for being prescribed tirzepatide?

Normal prescription charges will apply unless you are entitled to free NHS prescriptions (for example, because you have a medical exemption certificate).”

WOOSHMED – 241223 tirzepatide policy statement

Period Delay Medication Policy

Under new prescribing guidelines, we are unable to give medication to delay periods for travel or sport under prescription.
We can also no longer provide a private prescription for this.
If you would like to postpone your period, you can visit a pharmacy website by searching online for ‘delay period pill’, have an online counselling session with a pharmacist and order the medication privately from them.

Diazepam Policy

Policy on the prescribing of benzodiazepine medications for Fear of Flying, dental appointments, scans or other investigations.

We do not prescribe diazepam outside of its terms of license. This includes as a sedative for fear of flying or medical procedures under specialist care. This policy decision has been made by the GP Partners and is adhered to by all prescribers working across the practice.

Benzodiazepines (including diazepam, lorazepam, temazepam, clonazepam) are medicines that have been in use since the 1960s for a wide range of conditions, such as alcohol withdrawal, epilepsy, and muscle spasms. They are strongly sedating drugs that have negative effects on memory, coordination, concentration, and reaction times. They are addictive and withdrawal can lead to seizures, hallucinations, agitation, and confusion.

Unfortunately, benzodiazepines have widely become drugs of abuse, and as a result they are controlled in the UK as Class C, Schedule 4 drugs. This means there are restrictions on when and how much can be prescribed under the Controlled Substances Act, and inappropriate use, supply or possession of these medications is illegal in the UK under the Misuse of Drugs Act.

Fear of Flying

Many people approach their GP practice asking for diazepam to help with fear of flying, or to sleep during a flight. There are several good reasons why prescribing diazepam is not recommended, and as a result we no longer prescribe diazepam for

We do not prescribe diazepam outside of its terms of license. This includes as a sedative for fear of flying or medical procedures under specialist care. This policy decision has been made by the GP Partners and is adhered to by all prescribers working across the practice.

Benzodiazepines (including diazepam, lorazepam, temazepam, clonazepam) are medicines that have been in use since the 1960s for a wide range of conditions, such as alcohol withdrawal, epilepsy, and muscle spasms. They are strongly sedating drugs that have negative effects on memory, coordination, concentration, and reaction times. They are addictive and withdrawal can lead to seizures, hallucinations, agitation, and confusion.

Unfortunately, benzodiazepines have widely become drugs of abuse, and as a result they are controlled in the UK as Class C, Schedule 4 drugs. This means there are restrictions on when and how much can be prescribed under the Controlled Substances Act, and inappropriate use, supply or possession of these medications is illegal in the UK under the Misuse of Drugs Act.

Fear of Flying

Many people approach their GP practice asking for diazepam to help with fear of flying, or to sleep during a flight. There are several good reasons why prescribing diazepam is not recommended, and as a result we no longer prescribe diazepam for patients who wish to use this for a fear of flying.

Reasons 

  1. The national prescribing guidelines followed by GPs (the British National Formulary – BNF) states that all benzodiazepines are ‘contraindicated’ (not allowed) in treatment of phobias (fear conditions, such as fear of flying). It also states that the use of benzodiazepines to treat short-term anxiety is ‘inappropriate’. Benzodiazepines are only licensed for short-term use in a generalised anxiety crisis – but if this is the case for you, you should seek proper care and support for your mental health, and it would not be advisable to go on a flight. Your GP would be taking a significant legal risk by prescribing against these national guidelines.
  2. Diazepam is a sedative, so it makes you sleepier. If an emergency occurred during the flight, this could impair your ability to concentrate, follow instructions, or react to the situation. This could seriously affect the safety of you and the people around you. Such incidents are rare but they do occur, and it can be fatal if you are unable to evacuate the plane properly (an example event is flight BA28M, where 55 people sadly died while the plane burned while sat on Manchester Airport runway, and the official AAIB incident report specifically commented on evacuation delays contributing to the deaths). No-one else on board a plane will evacuate for you – the cabin crew are there to guide an evacuation, but you need to be responsible for yourself.
    As a result, many airlines consider sedative medications as a reason why someone would not be allowed on a plane, in a similar way that someone who has consumed excessive alcohol may be removed from a plane.
  3. Sedative drugs can make you fall asleep; however, the sleep is an unnatural non-REM sleep. Your movements during this type of sleep are reduced and this can place you at an even higher risk of developing blood clots in the legs (deep vein thrombosis – a DVT) or lungs (pulmonary embolism – a PE). These blood clots are very dangerous and can even be fatal. This risk further
    increases if your flight is over 4 hours long.
  4. Going on an aeroplane normally involves your blood oxygen levels decreasing from around 98% to as low as 90%, due to the air pressure decrease at cruising altitudes. Normally your body compensates for this by altering the rate and depth of your breathing. However, benzodiazepines work to depress your breathing and this can put you at risk of hypoxia (excessively low blood oxygen), especially if you have lung problems already, which can be very dangerous.
  5. Most people feel sleepy when they take diazepam, but a small proportion of people experience the opposite effect and can become aggressive. This is called a paradoxical effect, and it can be unexpectedly inconsistent, even if diazepam has been used in the past. Alongside aggression and agitation, this response can cause disinhibition and make you behave in ways you normally wouldn’t. This could also impact on your safety and the safety of your fellow passengers or could lead you to get in trouble with the law. Recently, a passenger in this situation was detained by the aircrew, arrested after an emergency landing, given jail time, and was also fined for the costs of redirecting the plane.
  6. In several countries, diazepam and similar drugs are illegal (Greece, Japan, and many Middle Eastern countries including the UAE are just some examples). They would be confiscated, and you might find yourself in trouble with the police for being in control of an illegal substance, even if it has been prescribed by a doctor in the UK. This has led to people spending time in a jail a foreign country.
  7. Diazepam has a long half-life, which means it stays in your system for a significant time. If your job requires you to submit random drug testing, you may fail these tests.
  8. There is a possible link between occasional use of benzodiazepines and earlier onset of dementia in later life.

What you can do 
A fear of flying is frightening and can be debilitating. However, there are much better and effective ways of tackling the problem. We recommend you tackle your problem with a Fear of Flying Course, which are aviation-industry approved and are run by
several airlines. These courses are far more effective than diazepam and have none of the undesirable effects. Also, the positive effects of the courses continue after the courses have been completed.

Fly And Be Calm is an instant download audio course which includes instructions, a fear removal tool and two hypnotic tracks. You can find this at: https://flyandbecalm.co.uk/

Alternatively, you could contact your local psychology therapy provider to consider having Cognitive Behavioural Therapy (CBT). Details of the local Healthy Minds service for Oldham can be found here: https://www.penninecare.nhs.uk/healthymindsoldham

Ultimately, if you still feel unable to fly, then it may be appropriate to consider alternative routes of transport.

If you still wish to consider diazepam for fear of flying, we suggest consulting with a private GP or a private travel clinic, who may be able to help you further. These services are private and not offered by the NHS. The private clinics may then liaise with the airlines directly to arrange a medically-trained escort for a passenger who is taking sedative medications, which can be expensive.

Medical and dental procedures

We do not provide sedative medications such as diazepam for use in other situations, such as for dental/hospital procedures or scans. The Royal College of Radiologists sets out clear guidance for sedation in hospital radiology departments (https://www.rcr.ac.uk/system/files/publication/field_publication_files/bfcr182_safe_se dation.pdf) which states “Safe and effective analgesia and sedation should be delivered by an appropriately trained and credentialed team with good access to anaesthetics, pre-procedure assessment, sedation plan and checklist, with appropriate monitoring and availability of resuscitation equipment and reversal agents.”

The Intercollegiate Advisory Committee for Sedation in Dentistry has a similar guideline (https://www.saad.org.uk/IACSD%202020.pdf) which states “The monitoring and discharge requirements for oral sedation are the same as for intravenous sedation. Oral sedation must only be administered in the place where the dental treatment is provided and must only be carried out by practitioners who are already competent in intravenous sedation.”

As a result, responsibility for this type of treatment lies with your dentist or hospital staff, and not your GP. If you feel this is required, we suggest consulting with your dentist or the hospital teams in good time before any scans or treatments occur.

References: 
https://bnf.nice.org.uk/drugs/diazepam/ 

https://bnf.nice.org.uk/treatment-summaries/hypnotics-and-anxiolytics/ 

Acute and delayed effects of Alprazolam on flight phobics during exposure. Behav Res Ther. 1997 Sep;35(9):831-41

https://travelhealthpro.org.uk/factsheet/43/medicines-abroad

GP Earnings

All GP practices are required to declare the mean earnings (e.g. average pay) for GPs working to deliver NHS services to patients at each practice.

The average pay for GPs who worked for six months or more in in the
last financial year was £57,311 before Tax and National Insurance. This
is for 4 full-time GP’s and 3 locum GP’s.

National Data Opt-Out Programme

NHS Digital is developing a new system to support the national data opt-out which will give patients more control over how confidential patient information is used. The system will offer patients and the public the opportunity to make an informed choice about whether they wish their confidential patient information to be used just for their individual care and treatment or also used for research and planning purposes.

Patients and the public who decide they do not want their confidential patient information used for planning and research purposes will be able to set their national data opt-out choice online.

Your health records contain a type of data called confidential patient information. This data can be used to help with research and planning. You can choose to stop your confidential patient information being used for research and planning. You can also make a choice for someone else like your children under the age of 13. NHS Digital will never sell your data. There are strict rules about how NHS can use your data. It’s only shared securely and safely. Shared data helps the NHS. It has been used to find the first treatment for coronavirus and for vaccine research.

If you’re happy with your confidential patient information being used for research and planning you do not need to do anything.

Any choice you make will not impact your individual care. Please click on the link to find out more and opt out if you wish to do so.

https://www.nhs.uk/your-nhs-data-matters/

For further opt-out information, please visit the NHS Digital site:

And if you would like to opt-out, you can follow the process using the link below;

Our practice policy on this subject is available to review below:

Local Data Opt-Out Program

If you wish to register a local data opt out with your GP practice before data sharing starts with NHS Digital, this should be done by downloading the Type 1 Opt Out form and retuning it to your GP practice. If you have previously registered a Type 1 Opt-out and you would like to withdraw this, you can also use the form to do this.