Methylphenidate hydrochloride - Attention Deficit Hyperactivity Disorder (ADHD) - Children 6-17yrs

The Surrey Heartlands APC supported the prescribing of ADHD medicines in children and young people, acknowleding that the prescribing responsibilities will differ depending on the stability of the patient:

Stable patients (cohort 1) = BLUE (with specialist team initiation) where:

• open-access discharge has been accepted by GP practice under the LCS from SABPFT.
• and the treatment is stabilised, prior to transfer of care.

Where a GP practice has not signed up to the LCS or a patient does not meet the criteria in the LCS (cohort 1), those patients will remain under shared care and there are non-LCS shared care documents available.

Patients currently receiving specialist treatment for other mental health or neurological comorbidities (cohort 2) = AMBER (shared care)

Where a GP practice has not signed up to the LCS or a patient does not meet the criteria in the LCS (cohort 2), those patients will remain under shared care and there are non-LCS shared care documents available.

Complex patients (cohort 3) = Red (will remain with the specialist service)

Shared Care arrangements for children and adolescents with ADHD are in place with Surrey and Borders Partnership NHS Foundation Trust.

Guildford & Waverley, North West Surrey and Surrey Downs have agreed a Locally Commissioned Service (LCS) for practices entering into the shared care agreement with Surrey & Borders Partnership. The LCS supports the provision of an annual physical medication review by the GP (with an annual review by the specialist so that the patient continues to receive a 6-monthly review in accordance with the product license)
See below for a copy of the Shared care with LCS agreement

There is also a non-LCS shared care agreement that is available for all non-LCS participating practices.

MODIFIED RELEASE TABLETS (18, 27, 36 and 54mg):

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the recommendation to prescribe the branded generic Methylphenidate modified release preparations (18, 27, 36 and 54mg) with the lowest acquisition cost.
Such products have an AMBER traffic light status and are the preferred alternatives to Concerta®.  

N.B. This guidance does not apply to other strengths of modified release methylphenidate as these have different release characteristics

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.