While people wait, they return repeatedly to the GP practice for reassurance, prescribing queries and crisis support. Right to Choose requests arrive even when the clinical picture is unclear, because no structured pathway tool exists. When the assessment finally happens, the assessing clinician meets the patient with no structured history of how they have been functioning during the wait.
The 10 Year Health Plan shifts care from hospital to community, analogue to digital, sickness to prevention. ADHD Taskforce Part 2 calls for digitised pathways inside neighbourhood health centres. Stage Zero was designed around these policy directions before the Fonagy Review was published.
The patient presents here first. The pathway reply leaves from here. The burden of the unsupported wait lands here. Stage Zero is designed to sit inside that existing pathway reply, with no additional workload, no new appointments and no clinical interpretation required from GPs.
A structured ICF functioning assessment that adults with mild to moderate needs complete at home, on their own device, from the point they first contact the practice about a possible autism or ADHD assessment. Built on the WHO International Classification of Functioning, Disability and Health (ICF), the global standard for describing how people function in daily life, and informed by the Bölte et al. (2024) revision of the ICF Core Sets for autism and ADHD.
The eight domains below were identified through a PPIE focus group of 17 adults with lived experience in Cornwall, mapped against the ICF Core Sets for autism and ADHD.
Sustaining, shifting and dividing attention across tasks
Emotional regulation, impulse control and self-monitoring
Sensory processing, sensitivities and overload
Managing social situations, reading cues, reciprocity
Verbal and written expression, comprehension, conversational flow
Organising tasks, time management, household and self-care
Mood, anxiety, self-perception, coping
Engagement in work, education, community and relationships
At the point of their assessment appointment, the patient can choose to show the clinician their ICF functioning report. There is no digital sharing mechanism and nothing is sent automatically. If the patient brings the report to their appointment, the clinician sees a structured ICF profile designed to be read in under a minute. Instead of meeting the patient blind after years on a waiting list, they start with a functioning baseline across eight domains, plus trajectory data from any reassessments the patient completed during the wait.
The clinician is not required to see this report. It is entirely the patient's choice whether to bring it to their appointment.
How should the Cerina link be added to your pathway reply? Template text, a letter insert, or a link in your existing triage workflow? What wording would feel natural for your practice?
Below is a sample of the report the patient receives. The full output includes a narrative summary, personalised CBT-based self-help recommendations and local VCSE signposting.
What the report is not. It is not a diagnostic assessment. It is not a screening tool. It does not say whether someone has autism or ADHD. It describes how a person is currently functioning across domains relevant to both conditions, using the WHO ICF framework. Non-diagnostic, self-reported, patient-held.
Stage Zero is an ICF functioning assessment for adults with mild to moderate needs who are on the waiting list for an autism or ADHD assessment. It provides CBT-based self-help modules, psychoeducation and VCSE signposting while they wait. It does not interfere with the waiting list, the assessment pathway or any existing referral routes.
If at any point during the assessment or reassessment the content indicates that a person may be experiencing distress or needs immediate support, Cerina directs them to standard NHS crisis resources. The practice carries no responsibility for this signposting.
Cerina is for adults with mild to moderate needs. All safety signposting is handled within the tool. The practice has no additional liability, no escalation responsibility and no named clinical owner requirement. Standard NHS crisis resources (NHS 111, Samaritans, Crisis text line SHOUT, 999) are presented directly to the patient when needed.
| Question | Answer |
|---|---|
| Where is the data stored? | Cerina infrastructure. Not in the clinical system. |
| Who can access it? | The patient holds the report. The practice has no access. |
| Clinical record entries? | Nothing automatically written. If a GP chooses to note that the patient has been offered Stage Zero, that is a clinical decision at practice level. |
| Data sharing agreement? | No GP-level DSA needed. Report is patient-held. |
| Consent | Full informed consent is taken from the patient before they begin the assessment. Consent covers data processing, storage and the nature of the tool as a non-diagnostic functioning assessment. |
| Retention | To be confirmed: how long data is held, what happens on withdrawal. |
| Legal basis | Patient consent for self-directed digital intervention. |
The pilot needs a simple way to record two things: that a patient was offered Stage Zero, and that they completed an assessment. This is for evaluation purposes only. The codes are not about suspecting or diagnosing any condition.
Digital health companies offering patient-facing interventions in primary care typically use a SNOMED code to record that a digital tool was offered or completed. The NHS Data Dictionary defines a Patient Self-Directed Digital Intervention Procedure concept for this purpose. We propose using this concept or a locally agreed code.
| Purpose | Proposed approach |
|---|---|
| Digital intervention offered | Record that Cerina Stage Zero was offered to the patient at the point of pathway reply. Could use the NHS Patient Self-Directed Digital Intervention concept, or a local template code agreed with the practice. |
| Assessment completed / patient onboarded | Record that the patient has completed at least one ICF functioning assessment. This enables evaluation and, if the practice chooses, reminder workflows. |
These codes do not relate to diagnosing or suspecting autism or ADHD. They record only that a digital functioning assessment was offered and/or completed.
Three decisions for this block:
1. Which SNOMED code or local template should record that Stage Zero was offered?
2. Where in the workflow is the code applied, and who applies it (admin team or GP)?
3. Do you want a completion code as well, to enable reminders or evaluation tracking?
| Question | Proposed answer |
|---|---|
| Current waiting list patients | All adults on the existing autism/ADHD waiting list |
| New referrals during pilot | Automatically included |
| Age boundary | 18+ (adult tool) |
| Exclusions | People with severe mental health needs (this tool is for mild to moderate needs only) |
| Who applies the code | Administrative staff at pathway reply |
| Question | Response |
|---|---|
| "What if a patient shares the report and I disagree with it?" | The report is self-reported functioning, not a clinical opinion. There is nothing to agree or disagree with. It describes how the patient experiences their own functioning, using the WHO ICF framework. |
| "Does this change anything about Right to Choose?" | No. Right to Choose routes remain exactly as they are. Stage Zero sits alongside the existing pathway, not in place of it. Cerina does not interfere with the waiting list, the assessment pathway or any existing referral routes. |
| "What if a patient deteriorates?" | The patient remains on the waiting list and retains all existing routes, including self-referral. Cerina provides CBT-based support modules, VCSE signposting and standard NHS crisis resources (NHS 111, Samaritans) throughout. If they deteriorate, they can access support through the same routes available to any patient on the waiting list. Cerina does not add or remove any clinical pathway. |
| "Is this adding work to my day?" | The link goes out with the pathway reply. No new appointments, no inbox items, no clinical interpretation. The only new element is coding for the evaluation cohort, which can be handled administratively. |
| "What happens after the pilot?" | If the pilot demonstrates value, the next step is a broader rollout. The practice is not committing to anything beyond the pilot period. |
| "Who built this?" | Cerina is a product of NoSuffering Ltd (Co. 12605982). Co-produced with a PPIE group of 17 adults in Cornwall. |
Stage Zero is not a one-off assessment. The patient enters a structured cycle that builds trajectory data over time. They can continue using the tool for as long as it is useful to them: while they wait for a diagnosis, and after a diagnosis if they choose. It serves as a personal record of how their functioning changes over time, alongside CBT-based support and VCSE signposting.