How to develop and maintain an extended role in ADHD

Essential qualifications:

• Full GMC Registration (with Licence to Practice)
• Certificate of Completion of Training - Certificate of Prescribed Experience from JCPTGP or equivalent
• Registered on both the GMC and GP Registers
• Evidence of continuous professional development relating to ADHD care and associated ADHD comorbidities

Desirable qualifications:

• MRCGP (or equivalent) Postgraduate education in the diagnosis and management of ADHD from a recognised provider
• Postgraduate placement and education within a team delivering ADHD services, evidencing external assessment of adequate competencies in ADHD Care

Factors to be considered and practical steps that can be taken to encourage greater sustainability and reduce the environmental impact of work in this area include:

• Implementing evidence-based and cost-effective interventions that are tailored to the individual’s needs and circumstances, and that aim to improve their outcomes and reduce their reliance on medication and other resources.
• Promoting the use of digital and online platforms for delivering services, such as telehealth, e-learning, and e-prescribing, that can reduce the need for travel, paper, and physical infrastructure.
• Applying the principles of green prescribing, which involves recommending activities that involve contact with nature, such as gardening, walking, or cycling, that can benefit the physical and mental health of people with ADHD and their families, as well as the environment.
• Engaging in collaborative and multi-disciplinary work with other professionals, organisations and stakeholders that can share best practice and resources for improving the quality and efficiency of services and in doing so, foster a culture of sustainability and environmental awareness.

The GPwER ADHD can ensure inclusivity by means of the following:

• Recognising the diversity and heterogeneity of people with ADHD, and how their symptoms and needs may vary depending on their age, gender, ethnicity, culture, socio-economic status, co-occurring conditions, and other factors.
• Providing culturally sensitive and competent care, that respects the values, beliefs, and preferences of people with ADHD and their families, and that addresses the potential barriers and challenges they may face in accessing and engaging with services.
• Adopting a strengths-based and positive approach to ADHD, that acknowledges the potential benefits and advantages of having ADHD, such as creativity, resilience, and innovation, and that supports people with ADHD to develop their talents and achieve their goals.
• Collaborating with people with ADHD and their families, carers, and advocates, and involving them in the decision-making process about their assessment, diagnosis, and treatment, as well as in the evaluation and improvement of services.
• Promoting the awareness and understanding of ADHD among other professionals, organisations and stakeholders to reduce stigma, and advocating for the rights and needs of people with ADHD in various settings, such as education, employment, health and justice.

To demonstrate capabilities associated with the extended role, we have taken the five areas of capability described in the RCGP curriculum as a starting point. These are based around the GMC's generic professional capabilities framework.

This section builds on the five areas of capability to explore those which relate to the GPwER in ADHD.

1. Knowing yourself and relating to others

• change management
• driving performance/performance management
• motivating and inspiring
• coaching and decision-making
• collaboration and partnership working
• influencing, negotiating, compassionate leadership, mentoring
• communication and team building

2. Applying clinical knowledge and skill

• shared decision-making
• managing risk
• uses a biopsychosocial approach
• coordinates care

3. Managing complex and long-term care

• provide face-to-face consultations with patients requiring GP input which may involve providing extended appointments and/or home visits
• understand clinical governance and professionals' accountability
• provide a comprehensive assessment of a person's needs 
• settings for assessments can vary from the patient’s home, surgery, education, or hospital setting
• shares relevant information amongst teams involved in the person's care in dedicated time
• may support other GPs to manage patients with ADHD
• may develop patient-specific care plans and treatment escalation plans. May manage these patients on behalf of their registered GPs

4. Working well in organisations and systems

• may undertake assessments independently or maybe with other members of the team.
• may manage complex care patients in the community on behalf of their GP
• may support a GP or other ADHD specialist in managing patients with ADHD
• communicate and build relationships on an individual, multi-professional and team basis with all levels of staff
• enables collective responsibility
• works autonomously
• oversees management, reporting, and analysis
• may provide a link between Neurodevelopmental services, Education or occupation services and GP

5. Caring for the whole person, wider community, and the environment

• may provide or oversee care on behalf of a cluster/primary care network
• may lead a multi-disciplinary team
• maintains an awareness of other resources available for people with ADHD including local resources, non-pharmacological approaches, strategies to support people with ADHD.

View the above information as diagrams (PDF file, 316 KB).

The GPwER ADHD necessitates a unique approach to leadership, distinct from a standard GP role. This is evident through the lens of the RCGP Leadership Capabilities Framework, particularly focusing on the following domains:

Demonstrating personal qualities

The GPwER ADHD must embody heightened personal qualities of empathy, patience, and understanding, recognising the complexities of ADHD and its impact on individuals' lives. This role demands a deeper understanding of neurodevelopmental conditions, necessitating adaptability, resilience, and the ability to manage uncertainty and diverse patient needs effectively.

Working with others

Collaborative and multidisciplinary teamwork is fundamental for GPs in an extended ADHD role. Interacting with psychologists, psychiatrists, educators, and support groups is crucial for a holistic approach to ADHD management. GPs need to effectively communicate, delegate, and coordinate with these stakeholders, fostering a seamless network of care to meet the unique requirements of individuals with ADHD.

Managing services

Managing services in the context of extended ADHD roles involves developing efficient care pathways and service models. GPs need to design systems that facilitate easy access to assessments, referrals, and treatment. Optimising workflows and resource allocation is essential to streamline ADHD care, ensuring timely interventions and minimising bottlenecks in the system.

Improving services

Leadership in extended ADHD roles entails a proactive approach to continuous improvement. GPs should engage in quality improvement projects, data analysis, and feedback mechanisms to enhance services. Incorporating feedback from patients and stakeholders is essential to tailor services, implement evidence-based practices, and address gaps in care effectively.

Setting direction

GPs leading in extended ADHD roles must set a clear strategic direction. This involves envisioning a comprehensive, patient-centric ADHD service that integrates seamlessly with existing healthcare structures. Establishing goals, priorities, and objectives aligned with improving ADHD care and advocating for necessary resources are pivotal aspects of setting the right direction.

In summary, leadership in an extended ADHD role demands a heightened focus on empathy, interdisciplinary collaboration, efficient service management, continuous improvement, and strategic vision. These attributes are essential to navigate the complexities of ADHD care, drive positive outcomes, and shape a holistic approach to managing ADHD within the primary care framework.

The GPwER ADHD should have an appropriate balance of practical and theoretical knowledge in relation to their extended role. Refer to the RCGP Guide to GP Clinical Extended Roles for further information. 

GPs looking to work with an extended role in ADHD can acquire additional experience and knowledge through several strategies to enhance their understanding and competence in managing individuals with ADHD. 

• Specialised training and courses: Participate in specialised training programs, workshops, and courses focused on ADHD diagnosis, treatment, management, and understanding the unique needs of individuals with ADHD.
• Continuing Medical Education (CME) events: Attend CME events, conferences, and seminars related to ADHD. These events often feature expert speakers, the latest research updates, and practical insights into ADHD assessment and management.
• Online learning platforms: Utilise online platforms that offer courses and modules on ADHD, its diagnosis, evidence-based treatments, and strategies for managing ADHD in different age groups.
• Collaboration with specialists: Collaborate with psychiatrists, psychologists, neurologists, and other ADHD specialists to gain insights into their expertise and approaches in diagnosing and managing ADHD. Shadowing or participating in joint consultations can be immensely beneficial.
• Peer learning and discussions: Engage in discussions and knowledge-sharing with peers, especially those who already work with ADHD patients or have expertise in mental health. Learning from their experiences and insights can enhance understanding.
• Mentorship and supervision: Seek mentorship or supervision from experienced GPs or specialists in ADHD. Regular meetings with a mentor can provide guidance, feedback, and opportunities to discuss complex cases.
• Participate in research and studies: Engage in research related to ADHD or clinical trials involving ADHD treatments. Active involvement in research can deepen your understanding and keep you updated with the latest advancements.
• Join professional associations: Become a member of professional organisations related to ADHD, These organisations offer access to resources, conferences, and networking opportunities.
• Subscribe to journals and publications: Subscribe to reputable journals and publications specialising in ADHD research and clinical practice. Regular reading helps GPs to stay informed about the latest research findings and best practices.
• Participate in workshops and webinars: Attend workshops and webinars specifically focused on ADHD, hosted by reputable organisations or institutions. These events often cover various aspects of ADHD management and provide opportunities for interactive learning.
• Case conferencing and reviews: Engage in case conferencing or case reviews with colleagues to discuss complex ADHD cases, exchange ideas, and learn from each other's experiences.
• Hands-on clinical experience: Actively involve yourself in the assessment and management of ADHD cases within your practice. Seek referrals for ADHD assessments, collaborate with specialists, and apply evidence-based approaches to treat patients with ADHD.

By actively seeking out these educational and experiential opportunities, GPs can enhance their skills, knowledge, and confidence in managing ADHD. 

ADHD in adults is a prevalent neurodevelopmental disorder, yet limited resources and awareness hamper diagnosis and care. The GPwER ADHD role supports increasing advocation for patients with ADHD, by establishing ADHD specialisation and the shifting of routine monitoring into primary care, and aligning ADHD care pathways with common mental health disorders. It also encourages a long-term plan that should prioritise integration and flexible provision through a primary care network approach, ensuring effective and accessible treatment for adults with ADHD.

The RCGP’s position is that GPs are expert medical generalists and, as such, do not need formal accreditation in enhanced roles for which they have been trained. However, where formal accreditation is desired by a GP, programmes that offer accreditation should be made available. Refer to the RCGP guide to GP Clinical Extended Roles (PDF file, 440 KB) for further information.

As for all doctors, GPs are required by the GMC to recognise and work within the limits of their competence and should refer to Good Medical Practice for a description of what it means to be a good doctor.

It is worth noting that employers and service commissioners may have specific requirements relating to the provision of a GPwER service.

The evidence that a GPwER is keeping their requisite knowledge and skills up to date and maintaining their competencies should be reviewed through the GPwER's annual whole scope of practice appraisal. This should form part of the discussion of all external roles and include quality improvement activity such as case analysis and audit. This has replaced any need for periodic re-accreditation. Please see the "Governance" section or the RCGP guide to GP Clinical Extended Roles (PDF file, 440 KB) for further information.

The RCGP would expect that, for a GP to describe themselves as a GPwER, at least some ‘core’ general practice should be maintained. This is because as a GP they bring important additional skills in practising holistically and dealing with complexity and uncertainty to their GPwER role. However, we acknowledge that some neurodevelopmental specialist doctors who trained as GPs may have stopped general practice altogether. For such doctors, appraisals may be delivered through the acute trust.

Where there is a need for a GPwER to demonstrate at their annual appraisal that they remain safe, competent and up to date in their core general practice role, they may wish to utilise the Academy of Medical Royal Colleges' factors for consideration template (external PDF).