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"National shortages" have thrown up another hurdle for making the prescribing of ADHD medication to islanders easier.
Currently, children and young people are facing long waits to receive treatment for ADHD as only CAMHS clinicians are able to prescribe the medication.
To alleviate this, plans were in place to add the medication to a 'white list' to make the drugs available via other medical professionals in the community at no extra charge to the patient.
However, when the latest 'white list' was approved at the end of last month, ADHD medications were left off as a result of national shortages.
Pictured: Medications can be added to the Approved List of Pharmaceutical Preparations to make them available in the community at no charge to the patient.
The Social Security Minister gave the approval approved the addition of six new medications to to the Approved List of Pharmaceutical Preparations, following recommendations made by the Pharmaceutical Benefit Advisory Committee.
Medications can be added to this 'white list' to make them available in the community at no charge to the patient through the Health Insurance Fund.
The changes took effect from 1 August 2024.
The latest additions include two selective serotonin re-uptake inhibitors (SSRIs), tablets which treat anaemia, an inhaler used by COPD patients, migraine pills, and tablets which reduce swelling and pain in a range of conditions.
However, ADHD medications were notably absent from the list – despite ongoing discussion about making repeat prescriptions for these drugs available in the community to reduce Hospital Pharmacy queues and free up Hospital clinicians to carry out more assessments and reduce wait lists.
A report accompanying the ministerial decision confirms that the Pharmaceutical Benefit Advisory Committee considered an application for medicines for ADHD in children and adolescents to be added to the Prescribed List in accordance with shared care protocols.
It comes after a recent inspection of Child and Adolescent Mental Health Services (CAMHS) by the Jersey Care Commission raised concerns over the fact that only CAMHS clinicians are authorised to prescribe medication for service users.
This has “a considerable impact on the capacity and workload of the clinicians responsible for prescribing”, according to the report.
The Care Commission found that the current model “is not sustainable, and collaboration with local GP services is necessary to share the responsibility of prescribing”.
The review highlighted "several challenges related to capacity and workload if this arrangement continues for the limited clinicians that prescribe and undertake six monthly medication reviews".
Pictured: A recent report raised concerns over the fact that only CAMHS clinicians are authorised to prescribe medication for service users.
The Care Commission felt there should be a collaboration with GPs to share the responsibility of prescribing and medication reviews to "alleviate pressure on the CAMHS clinicians".
As a result, CAMHS confirmed it had "supported an application for shared prescribing" which was presented to the Pharmaceutical Benefits Advisory Committee on 7 February 2024.
The Health Department said in April that "the prescribing process remains under active review” – but emphasised that the introduction of shared prescribing would require development of shared care guidelines, as well as GP agreement and funding.
When considering whether to add ADHD drugs to the approved list, the Pharmaceutical Benefits Advisory Committee carried out an email consultation with GP practices.
In response, two GP practices highlighted the current supply shortages for ADHD medication, whilst one smaller practice raised concerns about its ability to manage shared care arrangements.
Pictured: Global shortages of ADHD drugs forced the Health Department to issue monthly rather than six-weekly prescriptions earlier this year.
The Committee "also heard about a current workstream around a pathway for patients with ADHD".
In view of this feedback, the Committee concluded that it "is supportive in principle" of adding ADHD drugs to the white list – "but is not able to recommend inclusion in the Prescribed List while there are national shortages and before the ADHD pathways have been clarified".
It comes after global shortages of ADHD drugs forced the Health Department to issue monthly rather than six-weekly prescriptions earlier this year.
However, the Health Scrutiny Panel is currently conducting a review of the way that ADHD medication is currently prescribed to adults – including how shortages could be mitigated and potential changes to prescribing procedures.
The latest drugs to be added to the Approved List of Pharmaceutical Preparations are:
The estimated cost impact of these additions is expected to be around £135,500.
However, this cost is offset by savings of around £1.4m through the use of cheaper generic versions of apixaban and rivaroxaban rather than branded ones from October 2024.
The Social Security Minister has also approved the removal from some medication from the list, due to either lack of use or the product being discontinued.
"Alternative products are available on the List where necessary," the report says.
Removals from the list are not expected to have any material impact on expenditure as alternatives are available at a broadly similar cost.
You can find out more about the Health Scrutiny Panel's review of ADHD prescriptions HERE.
You can share your experiences by emailing: j.hales@gov.je.
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