Undertaking an extended role in ADHD

ADHD assessments can be delivered in various ways, depending on the individual's needs, the available resources, and the specific context such as:

• GPwER working within primary care
• GPwER working within a specialised ADHD clinic
• GPwER working within paediatric clinics
• GPwER working within a psychiatric team of experts, including psychiatrists, psychologists, and behavioural therapists
• GPwER working within community mental health teams
• GPwER working within integrated care teams

Delivery of care will be in line with NICE guidelines for the diagnosis and management of ADHD.

Referrals to the GPwER ADHD may originate from various sources, including:

• Other GPs
• Paediatricians
• Educational Institutions (schools, colleges, universities)
• Teachers, Special Educational Needs coordinators, educational psychologists, behaviour support teachers
• Mental health professionals
• Psychologists, therapists, or counsellors 
• Specialised clinics or medical centres
• Mental health clinics
• Neurologists
• Self-referral
• Community health services (including public health agencies)
• Occupational health and Employee Assistance Programmes
• Legal and social services
• Specialists in various fields, such as allergists, speech-language pathologists, or developmental paediatricians
• Private practitioners and therapists

The referrals will be influenced by the nature of the healthcare system, the availability of specialised ADHD services, local practices, and the specific circumstances and needs of the patient. 

Collaboration among different professionals is often key to providing comprehensive care and support for individuals with ADHD.

The GPwER ADHD may: 

• be based in primary or secondary care or private health care or may work across a healthcare system depending on need and local resources.
• be working independently or in conjunction with Neurodevelopmental assessment services. 
• provide initial screening, referral, and ongoing support in the form of shared care with secondary care providers or engage in full diagnosis and ongoing management, with access to secondary care specialist advice when required. This might include paediatrics, psychiatry, cardiology or specialist genetic services. 
• attend regular and ad hoc (in-person or remote) meetings with other clinicians either on their own or with patient(s) and carers.

Typically, the GPwER ADHD will have or develop a close relationship with their local secondary care services, (as above, as well as occupational therapy, educational psychology, specialist speech and language therapy). They should be confident and competent in performing physical health assessments with an in-depth understanding of the medications used for ADHD. 

The role involves working with (or leading) ADHD teams.

Patients are accepted by referral from a variety of sources as detailed in the section ‘Patient population’ above.

The GPwER ADHD works autonomously as a GP, but governance may vary depending on the organisation delivering the service. 

The GP appraisal covers the whole scope of a GP’s practice ensuring GPs with extended roles, including those managing ADHD, maintain a high standard of care, engage in continuous professional development, and provide effective and safe services to individuals with ADHD. It promotes accountability, improvement, and excellence in their specialised areas of practice.

As a GP, the GPwER ADHD should bring evidence that they are maintaining competence in this role to their GP appraisal. GPwERs employed outside their Practice should include a performance review by their employer or line manager and they should provide the outcomes as part of their whole scope of practice in their appraisal portfolio. 

They should:

• Evidence their performance, ongoing professional development, and engagement in activities associated with ADHD management. This evidence may include patient cases, audits, educational activities, and feedback from patients and colleagues.
• Reflect on their experiences, challenges, and successes in managing ADHD cases. Reflective discussions help identify areas for improvement and develop strategies to enhance their practice and patient care.
• Obtain feedback from peers, colleagues, multidisciplinary team members, and patients in line with GP Appraisal requirements. If a significant part of an NHS GP’s work is as a GPwER ADHD then the GPwER could best demonstrate feedback in their role by additional colleague and/or patient surveys of their colleagues and/or patients from this role in addition to their surveys as an NHS GP.
• Maintain a CPD portfolio that documents their participation in relevant educational activities, courses, conferences, and workshops related to ADHD management. This portfolio highlights a commitment to ongoing learning and development.

GP appraisal provides assurance to the Responsible Officer (RO) that the GPwER has trained for their role as a GPwER ADHD, that they are staying up-to-date in that role and that they are seeking and reflecting on feedback and outcomes in that role including the outcomes from a performance review with a line manager or medical director or employer.

GPs with extended roles undergo revalidation every five years, to maintain their licence to practice. 

The GPwER ADHD may interface with:

• Hospital neurodevelopmental services
• Private neurodevelopmental services
• Private medical clinics
• Educational establishments such as schools, colleges, universities
• Occupational health teams
• Occupational therapists
• Pharmacists
• GP networks (for example, clusters or PCNs)
• Primary care
• Local authority services
• Local health boards
• Integrated care networks

The time commitment for a GPwER ADHD is flexible, ranging from a single session (per week) to a full-time role.

The GPwER ADHD may be self-employed or employed by a hospital trust, integrated care board, primary care/cluster network (or equivalent in the devolved nations), private healthcare service or other service providers.  The GPwER ADHD may be a partner, a salaried GP, or a sessional GP. Their contract is likely to stipulate that they are a GP and their role/or part thereof is to provide ADHD services.