Local Area Position Statements

Buckinghamshire Local Area Position Statement on Autism and/or ADHD (neurodevelopmental) diagnostic assessment for children and young people.

Autism is not a mental health problem. but autistic people can have good and bad mental health like anyone else. Some things that can help:

• talking to people
• seeking professional help (if you need it)
• online help from Autism UK

In April 2023, the Child and Adolescent Mental Health Service (CAMHS) took over full responsibility for the diagnostic assessment of Autism and ADHD for children and young people aged 5 to 18 years.

But, children who have turned 5 whilst on the Community Paediatric waiting list will remain with that service until completion of the assessment.

You can request advice and support or assessment for children and young people aged 5 to 18 with a neurodevelopmental need via CAMHS Single Point of Access (SPA). A parent, school, or medical professional can complete the request.

For those under five. a request should be to the Community Paediatric service.

As part of the assessment parents, carers, and your child's school will have to complete forms. This will help the service to decide whether the child or young person meets the criteria for assessment.

The child’s education setting will be asked to provide information. They are often best placed to:

• make the referral
• and/or provide a report to support the referral

This is not the CAMHS waiting list.

Children and young people with mental health needs such as anxiety or depression are usually offered an assessment within six weeks, or sooner if an urgent need.

Healios and The Owl Centre are currently supporting the local NHS services in diagnostic assessments of children and young people.

Buckinghamshire CAMHS or the Community Paediatric Servicemay contact families to offer an assessment with one of these providers if the child's need is assessable through these virtual services.

Pre-diagnostic support is available while you are waiting, and the service will be able to tell you your options.

Demand for assessments and long waiting times are a national issue, as shown by NHSE, in the new national framework for all Age Autism Pathways

This challenge is part of the Local Area’s strategic priorities for action after the OFSTED/CQC inspection in 2022 and extra funds have been assigned to this pathway.

If your GP feels that a diagnostic assessment is clinically appropriate for your child or young person, in most cases, you have the legal right to choose the hospital or service you would like to go to. This may include private hospitals if they provide contracted services to the NHS.

The Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care Board (ICB) are aware that some providers are suggesting that referrals can be made directly to the provider and that the ICB will pay for these services. Please note that for a Choice referral, the referral must be from a GP, and the provider must have an NHS commissioning contract.

Parents wanting to explore this option should provide information from the education setting to the GP to help inform the referral.

The child or young person is still entitled to free NHS care. If parents/carers choose to pay for extra private care, this will not affect the child’s position on the NHS waiting list.

The parent/carer should research private providers and ask them if their assessment is in line with NICE Guidance (National Institute for Health and Care Excellence). NICE guidelines are evidence-based recommendations for health and care in England.

A full discussion with the private provider about all costs, including those for ADHD treatment should take place.

If you pay for an ADHD assessment privately and it does not meet the standards set out in the NICE guidance then NHS services cannot provide further treatments, such as medication, based on it. Further assessment will be required first, and these would be subject to the usual waiting times.

If the assessment is completed using the NICE guidance recognised approach, this will usually be accepted as part of the assessment of special educational needs (SEN).

However, support can be provided in school without a diagnosis and requesting an education, health and care plan (EHCP) will not speed up the diagnostic assessment.

The child should be referred to the pathway even if parents are seeking a private assessment. You will then be able to access other support offers, including any pre-diagnostic support offered through the service.

When arranging with a private provider for any diagnostic assessment or treatment, you should check with your GP surgery whether they would accept a shared care agreement with your private provider.

A shared care agreement means that your child’s care and treatment will be shared between your private provider and your GP. This would allow your GP to continue most standard treatments started privately.

In these cases, your GP would be able to take over prescribing, but, if you do need any reviews, you would still need to access and pay for these privately up until the time you are offered an appointment and your child’s care taken over in the NHS.

If your GP declines a shared care agreement with your chosen private provider, then you will need to continue to pay privately for the medication as well as for the medication reviews.

Any review offered by the local NHS service following starting treatment privately would be subject to the service’s usual waiting times.

We would suggest that the child is referred to the pathway even if parents/carers are seeking a private assessment.

Please note it is NOT mandatory for your GP to participate in a shared care prescribing arrangement. Your GP may have reservations about the safe prescribing of ADHD medications with an unfamiliar non-NHS provider. They may request that the private provider take sole responsibility for prescribing.