A practice in the Wiltshire area

3. Ms A complains about the service she received from the Practice. She complains:

• the Practice failed to prescribe medication to treat symptoms of her attention deficit hyperactivity disorder (ADHD) diagnosis • the Practice’s manager, not a GP, made the decision to not accept her shared care agreement (SCA) • the Practice failed to communicate its decision • the Practice failed to provide alternative support.

4. Ms A says the actions of the Practice have affected her mental health. She tells us it has caused her significant distress, anxiety and uncertainty. She feels it has undone much of the progress she made after receiving her ADHD diagnosis.

5. Ms A feels the refusal to provide support or any alternative care, has created a risk her treatment will be interrupted. This has increased her fear, stress and sense of instability.

6. As a result, she feels helpless and isolated, and has begun to question herself and how others see her.

7. As an outcome to her complaint, Ms A seeks an apology and evidence of service improvements.

8. Prior to registering at the Practice, Ms A was diagnosed with ADHD. She received treatment through an NHS-approved right to choose pathway. An NHS approved pathway refers to a system used to triage and direct patients to the appropriate healthcare services.

9. Before joining the Practice in January 2025, Ms A contacted the Practice to make its staff aware of her diagnosis and treatment plan. Ms A visited the Practice on 9 July 2025 for different health reasons. During this appointment the GP Ms A saw told her the Practice did not accept her SCA. The Practice confirmed this in a text message on the same day.

Refusal to prescribe ADHD medication

13. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs an organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and found no indications the Practice got things wrong.

14. Ms A raises concerns over the Practice’s decision not to prescribe ADHD medication on the SCA pathway. In her complaint to the Practice, she said it refused her SCA without any consideration of her individual needs and circumstances. She said this approach was wrong. Organisations should not reach such decisions based on its preference on whether to enter a SCA or based on any constraints on its service.

15. In its complaint process, the Practice explained it decided not to take on any ADHD shared care from 1 April 2025. This included Ms A’s SCA. It took this decision because of its increased workload and its lack of necessary expertise to manage ADHD medication.

16. We consider the Practice took this decision in line with relevant guidelines.

17. Section nine in the Practice’s SCA Policy says ‘GPs may refuse shared care if they feel unable to safely manage treatment due to lack of expertise, resources or patient complexity’. So, the Practice’s own policy indicates it can refuse to enter SCAs for the reasons the Practice gave.

18. We also considered this aspect of Ms A’s complaint with our adviser, who referred us to national guidance they said was relevant. The BMA Prescribing Guidance says a GP may decline to participate in a SCA if they consider it to be inappropriate. For example, if they consider they have little experience prescribing the medications associated with the SCA.

19. We can see the reasons the Practice gave for declining Ms A’s SCA align with the criteria the above guidelines set out regarding when it can decline accepting SCAs. Our adviser confirmed the Practice could refuse to prescribe ADHD medication in the circumstances.

20. This means we saw the Practice considered and took its decision in line with relevant guidelines. Therefore, we saw no indications of a failing in declining Ms A’s SCA.

21. We understand this must have been frustrating for Ms A as she went through months of treatment to get her ADHD diagnosis, so we empathise with her over what occurred.

The SCA was refused by the Practice’s manager not a GP

22. Ms A complains the decision to refuse her SCA was made by the Practice’s manager and not her GP. She was unhappy a non-clinician made this decision.

23. In its response to Ms A’s complaint, the Practice explained its clinical staff review and sign any formal SCAs. The Practice’s manager does not make clinical decisions.

24. Additionally, the Practice said non-clinical staff including its manager are obligated to follow the Practice’s policies. Therefore, the decision was communicated through the Practice manager, but it was not decided by the manager.

25. We saw no indications of failings from the Practice on this matter.

26. Section nine in the Practice’s SCA Policy says ‘GPs may refuse shared care’. We saw evidence a GP decided against accepting Ms A’s SCA, not the Practice’s manager.

27. Ms A’s consultation records from 9 July 2025 show she had a telephone appointment with a GP. In that appointment, the GP told her the Practice was not accepting her SCA. The GP said they would discuss with the Practice’s manager other options open to Ms A in respect to obtaining the ADHD medication associated with her SCA.

28. Ms A emailed the Practice later in the day. She complained about her appointment with the GP, and that the Practice had rejected her SCA. In response, the Practice’s manager reiterated what the Practice’s decision was and the reasons for it. They explained it was the Practice’s policy not to accept SCAs for ADHD patients.

29. As documentary evidence from the time of events, we consider this compelling evidence about what happened. It shows GP input in the decision not to accept Ms A’s SCA, albeit both a GP and the Practice’s manager were involved in communicating the Practice’s decision.

30. As this shows, according to the Practice’s SCA Policy, the correct clinical staff inputted into the decision, we see no indication of a failing. We have seen nothing to indicate the Practice manager alone made the decision to refuse Ms A’s SCA.

31. We understand Ms A found the Practice’s decision disappointing. We hope our decision assures her the correct clinical staff inputted into the Practice’s decision about her SCA.

Communication

32. Ms A complains the Practice failed to communicate its decision not to prescribe ADHD medication on the SCA pathway to her. In her complaint to us, she added the Practice failed to communicate transparently and gave her conflicting information regarding her SCA. She also said it gave no clear explanation for its decision.

33. We saw no indications of failings regarding the Practice’s communication.

34. Sections 28 and 30 in Good Medical Practice say the exchange of information between medical professionals and patients is central to good decision making. Staff must give patients the information they want or need. Staff must make sure the information they give patients is clear, accurate and up to date, and based on the best available evidence.

35. The email exchanges between Ms A and the Practice show staff initially advised her, in February 2025, the Practice does not accept SCAs. Ms A explained this in her email to the Practice on 10 February.

36. In her email, she said she had spoken to a member of staff on the phone. This person had advised her the Practice did not accept SCAs. This member of staff also advised her to email the Practice to clarify the matter. On this basis, her email asked for explanations, so she could decide on the next steps in her care.

37. The Practice’s manager responded on 11 February. They advised Ms A either her or her consultant (managing her ADHD) should send her SCA to the Practice. A GP would then review it and decide whether to accept it based on the terms set out in the SCA.

38. Ms A did not send in her SCA until 5 June because she was still in titration with her private provider (this is the adjustment period of trialling the dosage of medication).

39. As we explained in paragraphs 27 and 28, the Practice then told Ms A it decided not to accept her SCA in July. It explained it made this decision based on the Practice’s SCA Policy.

40. The Practice manager’s later emails in July explained SCAs are voluntary agreements. Due to the Practice’s workload and the lack of necessary experience its doctors had to manage her ADHD medication, it did not take on her SCA.

41. This means we see the Practice initially advised Ms A what it would do in considering her SCA in February. The correspondence indicates staff set expectations on the likely outcome. When it later shared its decision on her SCA, it explained its policy and the reason it made its decision. Its decision was in keeping with the likely outcome staff initially advised her about.

42. This means we consider the Practice shared its decision and gave Ms A the information she needed to understand why the Practice made it. It gave her information in this period based on the information the Practice had available. As this is all in line with Good Medical Practice, we saw no indications of communication failings on this matter.

43. We appreciate Ms A did not agree with the Practice’s decision. We hope we have explained why we have not found indications of failings from the Practice in communicating its decision.

Support

44. Ms A complains the Practice failed to offer alternative support to her. More specifically, she complains that when the Practice declined her SCA it did not offer alternative support which left her at risk.

45. In the ICB’s response to Ms A’s complaint, it said the Practice referred her into a commissioned service for ADHD treatment. Once she was on this pathway, her access to follow up appointments and medication would be through this service.

46. We saw no indications of any failings at the Practice on this matter.

47. Section seven in Good Medical Practice says doctors should provide or arrange suitable advice or treatment where necessary. This can mean referring a patient to another suitably qualified practitioner when this serves their needs.

48. After declining Ms A’s SCA, we saw the Practice advised her about alternative services she could use in respect to obtaining ADHD medication. In its email on 4 August 2025, the Practice suggested it could refer her to one of these services. It asked Ms A to confirm if she wanted the Practice to do so.

49. In Ms A’s correspondence with the Practice, she asked the Practice to make this referral. After gathering the information, it needed from Ms A to do so, the Practice referred her to this specialist provider on 6 August. Ms A thanked the Practice for making this referral.

50. Our adviser said the provider was able to arrange the prescriptions she needed for her ADHD. They added this was suitable alternative support for the Practice to arrange for her.

51. Considering the evidence and advice, we saw the Practice arranged alternative treatment for Ms A with another suitable service. This is in line with Good Medical Practice. For this reason, we saw no indications of a failing.

52. We want to thank Ms A for the time and effort she spent bringing this complaint to us. We understand this will not be the outcome she wanted. We hope we have explained why we saw no indications the Practice got things wrong.

1. We have carefully considered Ms A’s complaint about the Practice. We want to thank Ms A for bringing this complaint to us. We were sorry to hear how Ms A says she has been affected. It is clear she had a difficult and upsetting experience.

2. In relation to Ms A’s complaint about the Practice, we saw no indications of any failings in the care and treatment it provided.