Strengthening ADHD community paediatric services through prescribing pharmacist integration

Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, characterised by pervasive patterns of inattention, hyperactivity and impulsivity that affect functioning across academic, occupational and social domains. 

Nationally, ADHD services face unprecedented demand, with referral numbers having increased fourfold since 2019^​1​. These pressures have contributed to widely reported delays in diagnosis and treatment, reflecting systemic strain across paediatric services — for example, current wait times are approximately three years. 

Within community paediatric teams, prolonged waiting times for routine prescribing, medication review and follow-up have become increasingly common^​2​. 

East and North Hertfordshire NHS Trust’s ADHD service serves 55,351 children, roughly 80% of whom are initiated on medication. Consultants and specialist nurses frequently spend considerable time on administrative and routine prescribing tasks, reducing their capacity to undertake new assessments and manage complex clinical cases. To address this challenge, our team explored whether a prescribing pharmacist could enhance service efficiency while maintaining safe and patient-centred care.

Developing the pilot

In June 2024, I completed my independent prescribing qualification at the University of Hertfordshire, with a defined scope of practice in ADHD under the supervision of specialist nurse Michelle Atherton. Following qualification, through discussions with lead consultant Susan Ozer and chief pharmacist Andrew Hood at East and North Hertfordshire NHS Trust, opportunities were identified for closer integration between pharmacy and paediatric teams. Ozer agreed to act as clinical supervisor and together we established a structured six-month pilot model supported by regular supervision and review meetings with senior pharmacy leadership.

The programme initially focused on stable, non-complex patients under the care of the consultant paediatrician. The overarching aim was to improve clinical efficiency, streamline prescribing processes and enhance patient support, while preserving consultant time for complex assessments and cases requiring specialist oversight.

Clinical integration 

During each clinic session, I worked alongside the consultant paediatrician and ADHD specialist nurse, supporting between six and eight patients. 

Responsibilities included conducting clinical measurements, providing medication counselling, responding to family queries and issuing prescriptions. This redistribution of routine tasks enhanced clinic flow and reduced consultation times by an estimated ten minutes per patient. In practice, this allowed consultants to see additional patients or allocate more time to complex presentations, improving productivity without compromising care quality.

To strengthen early treatment safety, I introduced a three-week follow-up phone call for patients newly initiated on medication. These reviews enabled the early identification of side effects and dose optimisation, while providing reassurance for families. This intervention introduced a safety net that previously did not exist and was viewed positively by both clinicians and families.

Impact on prescribing processes

A significant component of the pilot involved improving the efficiency of repeat prescribing. The prescribing pharmacist completed 5 hours per week alongside the 2 lead consultants, in total saving between 20.4 and 25.6 hours per month, 5.1 to 6.4 hours per week. 

With pharmacist leadership, prescription requests were typically completed the same day or within the week, substantially reducing administrative delays. Outpatient pharmacy colleagues reported faster resolution of queries and reduced need for consultant intervention, while administrative staff noted clearer communication and fewer bottlenecks in processing.

As part of the initiative, I completed shared-care agreements on behalf of the consultant. This reduced the workload associated with transitioning patients to GP-led prescribing and accelerated access to community-based medication management.

Patient experience 

Patient satisfaction was evaluated through a survey distributed during the programme. The first 40 responses demonstrated 100% satisfaction, with families reporting improved access to timely advice and increased confidence in medication management. 

To support consistent information provision, I developed a patient leaflet containing a QR code linking directly to verified trust resources. This tool facilitated efficient signposting and provided families with reliable guidance outside the clinic setting.

Future integration and sustainability

The prescribing pharmacist role is expected to play an integral part in future developments, including the adoption of electronic prescribing. This will minimise reliance on paper-based systems, reduce transcription errors and enable direct electronic transmission to pharmacies, further improving accuracy and turnaround times.

Following the successful completion of the pilot, a formal business case was developed and approved, enabling continuation and expansion of the prescribing pharmacist’s role within the ADHD paediatric service.

The integration of a prescribing pharmacist into a community paediatric ADHD team demonstrates clear benefits to service delivery. By assuming responsibility for routine prescribing and medication monitoring tasks, pharmacist involvement reduces consultant workload and enhances clinical capacity. 

The model strengthens medication safety, accelerates access to prescriptions and provides an improved patient experience. These findings align with NHS priorities to optimise multidisciplinary working and expand the prescribing workforce, while delivering more efficient and sustainable care.

The pilot has also demonstrated the value of agile skill-mix solutions in responding to rising service demand. Pharmacists with defined prescribing scopes can support high-volume, protocol-driven clinical pathways, freeing consultants to focus on complex assessment, safeguarding concerns and specialist decision-making.

The project has highlighted the significant contribution a prescribing pharmacist can make to community paediatric ADHD services.

Most importantly, it has provided a practical and cost-effective strategy for meeting the escalating demand for ADHD care, while maintaining continuity and quality for children and their families. The successful outcomes support wider adoption of this approach across NHS ADHD services seeking to optimise workforce capacity and improve patient outcomes.