2. The role of the General Practitioner
It is very important that GPs understand their crucial role in the identification and management of ADHD.
Identification, referral and diagnosis:
GPs are gatekeepers to diagnosis and access to care. GPs are not responsible for diagnosing ADHD. Their responsibility is to pick up possible ADHD and refer on to an ADHD specialist. Without a GP referral, it is very difficult, and often impossible for patients to gain access to diagnosis and treatment services. It is also useful if GPs collect the necessary information for ADHD specialists such as questionnaires, school reports etc. This can facilitate and speed up the diagnosis process in secondary care, which is often very slow.
GPs are not responsible for initiating treatment, which is the role of secondary care specialists. However, in many cases, a shared care agreement can be put in place and once the individual with ADHD is happy with the right medication and dosage, the GP often takes over monthly prescriptions and routine monitoring. If the patient experiences any issues with medication, changes are however supervised by ADHD specialists.
To monitor ADHD medication, patients are advised to record the effectiveness and adverse effects. GPs should monitor cardiovascular effects but also effects on weight and height. Potential changes in sleep patterns, worsening behaviour or seizures should also be monitored.
The recently updated NICE guidelines give a comprehensive overview of the role of the GP and can be found in the toolkit at the end of this resource.
View the video of Dr. Corrie Smith, a GP diagnosed with ADHD in adulthood. Corrie explains the complexity of the role of the GP through her own experience of diagnosis.
My names Corrie, I’m a newly qualified GP, erm and I have ADHD, erm so I’m here to talk from both perspectives because I know what it’s like to go a long time with ADHD without a diagnosis but I also appreciate how difficult it is as a GP to pick up on erm on whether someone might have ADHD.
So erm I came from a family with ADHD, my brothers were both diagnosed while they were at school, my dad probably has it although he is undiagnosed. Erm all through my life I assumed I had ADHD traits but because I was passing my exams and got into med school I assumed that it was just nothing, erm it wasn’t ADHD and just to get on with things.
Erm when I took a year out to do a year in research I was great in the trials and atrocious at the writing. Whilst I was at school it was almost like a superpower coz I could do loads of different things, erm you know last minute deadlines and shove everything in together but then things like the research job and assignments and things like that it was more of a hindrance erm when I qualified my jobs were mostly quite acute jobs so always played to my strengths erm but then I ended up in psychiatry and that was much slower paced and a lot more thought and a lot more writing and I did really struggle and it just happened that my supervisor had an interest in adult ADHD and he gave us erm a seminar on ADHD and I realised I ticked every box and I think around that time as well.
I read an article in the paper about women with ADHD and how it presented differently to men erm so I went and asked him a few more questions and I thought I was being subtle but I obviously wasn’t and he told me to go and get a diagnosis and try medication so erm even though I’d erm come from a background with ADHD I’d been to med school was in a psychiatry job, it wasn’t until I was had that erm it put right in front of me that I realised I probably should have a diagnosis erm so it’s hard to GPs to pick up.