SCA practice case · Telephone consultation
“My ADHD clinic has sent you a letter — can you take over my prescription?”
Telephone consultation
Adult patient
Typical
Professional & ethical dilemmasMental health & addiction
The candidate brief
This is what you would read in the 3-minute window before the patient connects. Read it once, note two or three hypotheses and one thing you must not miss, then stop.
Patient
Daniel Okonkwo · 31-year-old man
Setting
Telephone — a patient asking the GP to take over prescribing started by a private provider.
Past history
- ADHD — diagnosed privately 5 months ago (online provider; consultant psychiatrist report on file)
- Anxiety 2021 — CBT via NHS Talking Therapies, discharged
Medication
- Lisdexamfetamine 50 mg each morning — prescribed privately (not on NHS repeat)
Allergies
No known drug allergies
Recent notes
Letter from private ADHD provider (3 days ago): “Stable on lisdexamfetamine 50 mg. We request that the GP takes over prescribing under our shared care agreement. Our follow-up: annual review (fee payable by patient).” Report: diagnosis by consultant psychiatrist using DIVA-5 with collateral history from his mother. Pre-treatment BP 124/78, pulse 72, weight 78 kg. At last private review (1 month ago): BP 132/84, pulse 88, weight 74 kg. Practice intranet — local ICB policy: adult ADHD shared care accepted only from NHS-commissioned providers (including Right to Choose providers).
Reason for contact
Telephone call: “Wants to talk about my ADHD prescription.”
Practise this case
The full case is in the Hot Seat with the Gold plan. You get a 12-minute timer, a role-player script with facts released only when asked, examiner checkpoints by the three RCGP domains, a model consultation and the guidance behind it.
What this case tests
Show the learning points (spoiler: read after you have practised)
Shared care is a voluntary agreement in which a specialist initiates and stabilises treatment and the GP takes over prescribing with defined monitoring and specialist support; GPs can decline if they are not confident, if the arrangement does not meet local commissioning requirements, or if ongoing specialist support is not assured. Department of Health guidance requires NHS and private care to be kept as separate as possible and the NHS must not subsidise private care, but patients can move between private and NHS care and are entitled to NHS services on the same basis as others. For adult ADHD in England, an NHS route is a Right to Choose referral to an NHS-commissioned provider or the local service; the private provider remains responsible for prescribing until a transfer. Declining must not become abandoning: explain reasons neutrally, offer the NHS route the same day, and address safety. Lisdexamfetamine is a Schedule 2 controlled drug; extra self-dosing, poor sleep, alcohol use, rising pulse and weight loss need the prescriber informed (with consent) and monitoring. Job loss is a time to screen mood and suicide risk and signpost financial support.
The guidance behind it
Similar SCA cases
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