During your assessment with the Consultant, you may discuss whether medication would be appropriate to help you manage your ADHD symptoms. If you decide that you might find this beneficial, you will be referred to our Titration Team.
Titration is the process that introduces your body to medication safely. During this period you will have regular contact with your prescriber, who will adjust and monitor the treatment until you reach a stable or ‘optimised’ dose to help you achieve the maximum benefit with minimum side effects.
What does the process involve?
Getting started
You will have an Initial Assessment with one of our Consultants. If they believe that you would benefit from receiving ADHD medication then your name will be put on our Titration waiting list (See here for waiting times).
When you reach the top of that list one of our prescribers will get in contact with you via the patient portal to introduce you to the process and give you some background information.
Your feedback and observations are an essential part of the process
Before starting your medication, we will ask you to send in some baseline observations including your blood pressure, pulse and weight. You may also be asked to send in the results of an ECG and/or blood tests if these have been advised by your assessing consultant. Your Consultant will have written to your GP to request these, but it often helps if you can contact them directly to make the arrangements go more smoothly.
During the titration process, you will be asked to monitor and record your blood pressure, pulse and weight on a weekly basis, reporting it back to your prescriber towards the end of each four-week prescription period, so you may find it helpful to purchase a blood pressure monitor to keep at home.
Once your baseline information has been received, it will be reviewed by your titration prescriber and if your observations are within a normal range you will be ready to start the treatment process.
Receiving your medication
At this stage we will send out your first prescription, together with a treatment plan, which will give guidance on how and when to take the medication. You will also receive a Response to Treatment Form, where you will be required to record your blood pressure, pulse and weight on a weekly basis, returning it to us towards the end of each four-weekly prescribing period.
The guidance we send will contain details of how to check your blood pressure, and what to do if it is outside the normal range. If you are ever unsure or feel that you need more support during this process, you can contact the team at any time via your portal.
In Week 3, we will ask you to complete an Adult ADHD Self-Report Scale (ASRS), which is included in your Response to Treatment Form. If there is anything of concern in your updates, we will get in touch.
In Week 4 we will review your progress and, if everything is going smoothly, we will send out your second month’s prescription. This may be a continuation of your current treatment titration, or we may need to make some adjustments to your treatment plan.
End of Titration Review
Once you have begun titration, the process typically takes 8-12 weeks. This allows your body to adjust to the new medication and find your optimal dose. This means that you will feel maximum treatment effects from your medication with minimum side effects.
At this stage, you will be referred back to your assessing Consultant for an End of Titration Review.
If your Consultant is happy that your treatment is now stabilised, they will write to your GP to recommend that your prescription be continued under a Shared Care Agreement. This means that ongoing prescriptions will be issued by your GP surgery, and there will be an expectation that your medication will be reviewed on a six-monthly basis by your GP. You will also be offered an annual review by Psychiatry-UK (PUK) – or perhaps by another service, such as your local NHS team.
Annual Review
At the end of the first year, you may be invited back for review by your PUK Consultant to check that everything remains stable and that you are still receiving the maximum benefit from your medication, with continuation of as few side-effects as possible.
Can I receive titration through my GP?
Right to Choose Patients
If you live in England and have been referred to PUK via the NHS Right to Choose (RTC) scheme, we are bound by the guidelines of the National Institute for Health and Care Excellence (NICE) to ensure that any medicine you receive is issued by a specialist ADHD titration service.
Your prescription will be delivered by our private online pharmacy, PPG, and you will only be required to pay the standard NHS prescription fee.
Private Patients or ICB Referrals
If you have been referred by your GP and your assessment is being funded by your local Integrated Care Board (ICB), or if you are a private patient, you can choose which pharmacy to use.
Why are waiting times longer than usual at PUK?
In December 2020, PUK became a designated RTC provider for mental health assessment. This resulted in an unanticipated influx of new patients accessing its ADHD services.
We are in the midst of a recruitment drive to engage new Titration Team prescribers to bring down waiting times, as well as recruiting Agency staff to reduce the waiting list as quickly as we can. In fact, our team will increase from four just 18 months ago to 40 members in the coming weeks and months. We ask if you would please bear with us while new team members complete the required onboarding and training processes. Our aim is to increase our capacity to be able to reduce waiting times to a minimum over the course of the next six months.
Why do waiting times vary?
When your referral is picked up by our Titration Team, you will be given a latest date for the start of your titration. At this stage, it is difficult for us to give you an exact start date as the titration period varies from patient to patient, making it difficult to assess how quickly you will move up the list. However, as we increase the capacity of our unit over the next few months, waiting times will reduce and we are doing everything in our power to get this process moving as quickly as possible.
Kate Bevan, Titration Team Lead
Hello,
I was wondering do you accept diagnosis from other private clinics as I’ve been diagnosed with adhd however they do not supply medication and I’m trying to find someone who will help,
Hi Mia – Thank you for getting in touch. Normally we would accept a diagnosis from another clinic and would be able to help with supplying medication.
However, we are currently closed to private referrals, and only able to accept referrals via the Right to Choose scheme.
This situation is set to change in the near future, although we are unable to give a date at present. Please keep an eye on our website if you do not find another provider who can help you sooner.
Hello, is this limited to referrals from GPs in England or is it possible to be referred from my Welsh GP? If not, is there an equivalent in Wales?
Hi Andrea – Unfortunately the Right to Choose scheme is only available to those registered with a GP surgery in England. There is no equivalent in Wales unless you are eligible to apply for an IFR (Individual Funding Request). There is more information about this on the NHS Wales website.
Hi my son has been diagnosed with Adhd via cahms but the waiting list to be seen for medication is 15 months. We can’t wait that long and he also has autism. Could we been seen by yourselves for medication consultation and then the NHS continue? If so how much would that be?
I just want to say a massive thankyou to P UK!
I will be coming to the end of my titration soon and hope the shared care with gp goes as well as p UK .
You have given me my life back. my independence and better health.
Thank you
Hi Emma – Thank you for taking the time to share this feedback. It is always really good to hear that our service has made such a difference to the lives of our patients, and I will make sure your comments are shared with our staff.
My son has already been assessed and diagnosed with autism and adhd and I’m looking at going private to get him on meds. Is it possible to go back to NHS once we have the meds? How much would it cost?
Hi Helen – Thank you for getting in touch. I need to check with our CAMHS team to make sure I am giving you the right information. Please bear with me.
Would it be possible to get a call back at all?
Hi Helen – I have spoken to our Child & Adolescent Lead. Could you please send the diagnostic report, with your query, directly to camhs@psychiatry-uk.com. They will check to see whether it meets P-UK’s criteria and advise on costs if appropriate.
Sent
Hi, I am an existing patient which was diagnosed with ADHD and titrated in 2020 with P-UK. But I can’t find any information on the waiting times for re-starting titration following my annual review. I discussed how my current medication is now ineffective with my psychiatrist and he was very helpful and referred me back to titration to trial another type. I was added to the waitlist however I am now really scared I will need to wait 6 months and have to continue to take my current medication with significant side effects for half a year. Could you please give me any information you may have on this?
Many thanks!
Hi Lia – I will get in touch with our titration team and find out what you need to do.
Hi Lia – Please see our advice below:
1- The best way to get information re. re-starting titration is to log onto the portal and send a message to our Admin Team.
2- Titration Admin will also be able to advise your current position on our waiting list.
3- If you are experiencing significant side effects from your current medication, please contact your Consultant via the portal for advice on how to reduce the dose and stop taking the medication whilst on the waiting list.
I was discharged back to GP from your service after my diagnosis I’m now awaiting a medication review and my GP will not prescribe until I’ve been seen but I’ve been told 6-9 months. i was discharged due to not attending an appointment but i emailed to say i could not access my account 3 times before i was on the highest dose of my medication and now am having none. I’ve already been waiting since January is there anyway i can pay to start titration as I’m struggling severely without being on my medication. im not sure how i can speak to someone in regards to this.
Hi Laura – Just seeking advice on this. I will get back to you asap.
Hi Laura. We are unable to look into individual cases on this platform, to ensure that we protect your data. The best people for you to contact to discuss your situation are our Patient Services Team. You can contact them at: support@psychiatry-uk.com or by calling: 0330 124 1980 (Mon-Fri: 8am-8pm; Sat-Sun: 9am-5pm).
Hi can a diagnosis be made on a 3 year old? And at what age can you prescribe medication?
Hi Kim – Thank you for getting in touch. Unfortunately our service is only available to children over the age of seven.
Extremely concerned regarding this service, I have a full comprehensive diagnosis and my Gp after raising a serious complaint with my practice manager, then referred me to yourselves for a medication review. I was referred in the January of 2023 and even though I raised more then several times that I had a comprehensive diagnosis and all blood tests and ECG ready to go. I was called and offered an assessment appointment of which I was outstanding at the clear lack of communication between your teams.
I spoke to one of your colleagues who had informed me that due to my diagnosis being comprehensive, he had referred my case to a senior psychiatrist and that either the psychiatrist doing the review would either prescribe the medication and that I need to have my passport etc to hand or I would just require a health check and start titration ASAP, not months ASAP.
I have a comprehensive diagnosis of combined ADHD by a psychologist from the Priory which I received in September 2022 and I’ve been on the wrong waiting list for 6 months which is abysmal.
Tomorrow I have my ADHD review appointment and in fairness I would rather stay under the same professional however I am extremely anxious as I just want to finally be in a position where I can manage my ADHD with the correct medication which will be amended and reviewed by a psychiatrist.
I have coped all of my life with ADHD and since the diagnosis all I would like is to manage my condition better. I have a therapist in place, i have Access to work in place plus each of those recommendations. I have also been lucky enough for my employer to pay separately for Egress. However having all of these elements in place with a confirmed diagnosis is basically ineffective.
I have communicated all of these elements at every turn and highlighted the pertinent importance of reading the diagnosis and interpreting the blood and ECG results.
From spending more than 6 months on a waiting list that wasn’t required, I personally feel like I have just been left and forgotten about not only that but that my needs and requirements mean nothing at all to any staff who I had communicated with very clearly.
The management of cases like mine are not fit for purpose in the current climate that is facing the United Kingdom.
On my ADHD medication review tomorrow consultant’s have the right to prescribe medication ( if it is in the best interests of the patient ). By being completely transparent the benefits of prescribing that medication outweighs the re-occurring risks of leaving a patient unmedicated.
This system has to get better and staff need to listen more carefully. If you have titration nurses what is the relevance of a psychiatrist when a psychologist could diagnose just as effectively.
Food for thought. This can not continue to happen it is unfair.
Hi Ellena – Thank you for posting a comment to let us know that you are unhappy with our service. This blog is managed by Psychiatry-UK’s internal Communications Team. We are unable to get involved in individual patient cases, to ensure that your data is kept secure. From reading your note, it sounds as though you will have been able to discuss these issues with your consultant today, and hopefully you will be starting titration. However, if you would like to speak to someone about the issues you have experienced to date, please contact our Patient Experience Team at: experience@psychiatry-uk.com. They will be very happy to help.
Hi there,
I have private health insurance, that have agreed to cover the cost of an ADHD assessment, but not titration for medication. Once I have the diagnosis / assessment, could I be put on the waiting list for titration with right to choose if my NHS GP refers me?
Thank you!
Gemma
Hi Gemma – Thank you for getting in touch. You can indeed ask your GP to be referred to P-UK for titration via the RTC scheme. However, we do have certain conditions: (1) we would need to see a copy of your original assessment report; (2) we would need to arrange a review appointment with you (this could be a full appointment if the report is below standard) before being added to the titration wait list.