Attendance of Children at Medication Reviews

1. Purpose

This policy ensures the safe, ethical, and effective review of children and young people prescribed ADHD medication through ADHD Direct. It defines attendance expectations, clarifies when children must be seen, and aligns with our safeguarding, prescribing, and cancellation policies.

2. Scope

Applies to all patients aged under 18 receiving ADHD medication from ADHD Direct under private prescribing, shared care, or transitional arrangements.

3. Policy Statement

Regular medication reviews are mandatory to:

• Monitor response, side-effects, and physical health.
• Safeguard the wellbeing of children and young people.
• Ensure compliance with NICE guidance and safe prescribing principles.

Children must attend every medication review either in-person or via secure video. Prescribers may require a face-to-face review where clinically or safeguarding-indicated.

4. Definitions

• Attendance: The child’s active participation in a booked medication review, in-person or via secure video, visible and audible throughout.
• TOMIS Review: The Online Medication Intervention Service – a brief follow-up suitable only when the child is clinically stable or minor adjustments to their treatment.
• MDAS: Medication Dose Adjustment Service.
• Parent/Guardian: The person(s) with legal parental responsibility.
• Did Not Proceed: Appointment could not go ahead because the child was absent, measurements were missing, or participation was inadequate.

5. Attendance Requirements

1. Attendance: Every child must attend all scheduled medication reviews. Attendance may be by secure video unless an in-person review is required for clinical or safeguarding reasons.
2. Measurement submission:
   • Up-to-date blood pressure, pulse, weight, and height are required for every review.
   • Measurements may be taken at home or by a GP, pharmacy, or school nurse.
   • If measurements are not provided, the review may be rearranged and prescribing paused until received.
3. Frequency: Reviews occur at intervals of 4 weeks, 3, 6, or 12 months, as determined by the prescriber/clinician and in line with the Repeat Prescribing Policy.
4. TOMIS limit:
   • A maximum of two consecutive TOMIS reviews is permitted before a video or in-person consultation is required.
   • Eligibility: child clinically stable, normal recent vitals, no red-flags or safeguarding concerns.
   • The count resets after a full review with the child present.
5. Failure to attend:
   If the child is not present, or cannot meaningfully engage, the appointment will not proceed and will be managed under the Cancellation & No-Show Policy. Prescribing may be paused until a successful review occurs.

6. Roles & Responsibilities

• Prescriber / Clinician:
  • Determines review frequency and suitability for TOMIS.
  • May require face-to-face attendance.
  • Ensures documentation of measurements and safeguarding review.
• Parent / Guardian:
  • Ensures the child attends and engages.
  • Submits accurate measurements in advance.
  • Maintains a suitable private space and functioning technology for video consultations.
• Child / Young Person:
  • Participates in discussions, shares experience of medication, and provides consent where competent.

7. Capacity, Consent & Safeguarding

• For those aged 16–17, Gillick/Fraser competence will be assessed; consent must be recorded.
• Parental responsibility and custody arrangements must be verified at each review.
• ID verification will occur at the start of each video review.
• A chaperone will be offered for all in-person reviews.
• Any safeguarding or fabricated/induced illness (FII) concerns will be escalated via ADHD Direct’s Safeguarding Policy.

8. Data Handling and Confidentiality

• Any measurement data or photographs submitted are stored securely in the clinical record.
• Video sessions are not recorded unless explicitly authorised and documented.
• All information is processed in accordance with the Privacy Statement and GDPR.

9. Cancellations, Lateness & Refunds

• Appointments that cannot proceed because the child is absent are managed under the Cancellation & No-Show Policy:
  • > 48 hours’ notice: Full refund (minus Stripe fee).
  • 24–48 hours: 50% refund (minus Stripe fee).
  • < 24 hours / no-show: No refund.
• Late arrival (>10 minutes; >5 minutes for MDAS) may result in cancellation and rebooking fee.
• Appointment types are non-interchangeable (e.g. standard TOMIS).

10. Non-Compliance and Impact on Prescribing

Failure to attend reviews, submit required measurements, or comply with this policy may result in:

• Temporary pause of prescribing (private or shared-care).
• Requirement for face-to-face reassessment.
• Potential transfer of care back to the GP if engagement remains inconsistent.

11. Equality & Reasonable Adjustments

ADHD Direct will make reasonable adjustments to facilitate attendance, including flexible scheduling, accessible communication formats, and additional support for neurodivergent families. Any such needs must be communicated in advance.

12. Review and Governance

This policy is reviewed annually by the Clinical Governance Group or sooner if national guidance changes.