ADHD Shared Care Agreement UK
What it means, how it works, and what to do if your GP refuses.
Quick Answer
An ADHD shared care agreement in the UK is when your GP takes over prescribing your ADHD medication after a specialist has diagnosed you and stabilised your treatment.
This allows you to receive ongoing prescriptions through the NHS instead of continuing to pay privately.
However, shared care is not guaranteed, and some GPs refuse. Understanding how it works early can save you months of stress and thousands of pounds.
Why This Matters
Many people assume that once they have been diagnosed, their GP will simply take over prescribing. That getting a diagnosis is the hard part, and everything after that is straightforward.
In reality, shared care is one of the most common sticking points in ADHD treatment in the UK. Some GPs refuse it outright. Others delay it for months. Some do not fully understand how ADHD medication works and are uncomfortable taking on the responsibility.
This can leave you:
- Stuck paying privately for prescriptions indefinitely
- Unable to access medication at all
- Unsure what your options are or who to ask
- Feeling like you have hit a wall after finally getting diagnosed
Understanding shared care before you even start the assessment process prevents this. It is one of the most important things you can prepare for, and one of the least talked about.
What Is a Shared Care Agreement?
A shared care agreement is a formal arrangement between your ADHD specialist (the psychiatrist or provider who diagnosed you) and your GP. It transfers the responsibility for ongoing prescribing from the specialist to the GP, so that you can receive your ADHD medication through the NHS on a standard prescription.
How It Works
Diagnosis
You are diagnosed by a specialist, either through the NHS, Right to Choose, or a private provider.
Titration
Your specialist starts medication and adjusts the dose over several weeks or months until it is stable and working well. This is called titration.
Shared care request
Once your medication is stable, your specialist writes to your GP requesting that they take over prescribing. This letter includes your diagnosis, medication details, dosage, and monitoring instructions.
GP takes over
If your GP agrees, they begin issuing your prescriptions through the NHS. You pay standard NHS prescription charges (currently around £9.90 per item in England) or nothing at all if you have a prepayment certificate or exemption.
Important reality
Shared care is not automatic. It is not a legal right in the same way that Right to Choose is. Your GP has discretion over whether they accept shared care, and many factors influence their decision.
Why GPs Refuse Shared Care
This is one of the biggest pain points in ADHD treatment in the UK. It catches people off guard because they expect the GP to simply follow the specialist's recommendation. Common reasons include:
Lack of confidence with ADHD medication
Many GPs received minimal training on ADHD, particularly adult ADHD. Prescribing controlled substances like methylphenidate or lisdexamfetamine feels unfamiliar and risky to them.
Local ICB policies
Some Integrated Care Boards have restrictive policies around shared care, particularly for patients diagnosed through private providers. These policies vary widely across England.
Workload pressures
ADHD monitoring requires regular check-ups, blood pressure readings, and heart rate checks. Some GPs feel they do not have the capacity for additional ongoing patients.
Unfamiliarity with your provider
If you were diagnosed by a provider your GP has not worked with before, they may be reluctant to accept the shared care request without further reassurance.
Concerns about private diagnoses
Some GPs are sceptical of private ADHD diagnoses and may question whether the assessment was thorough enough to justify ongoing NHS prescribing.
Real-World Scenario
You get diagnosed through Right to Choose or a private provider. Medication is started and it works well. After three months of titration, your specialist writes to your GP asking them to take over prescribing.
Your GP says no. They are not comfortable prescribing ADHD medication. Or they say the practice does not have a policy for it. Or they want to wait and see.
Now you are stuck. You are paying your specialist monthly for private prescriptions. The medication is working, but the cost is adding up. You do not know whether to push back, complain, switch GP, or just accept it.
This happens to thousands of people every year. It does not have to happen to you if you plan ahead.
What You Should Do Before You Even Start
This is the most important step most people miss. Before you begin the assessment process, before you choose a provider, ask your GP directly:
"If I am diagnosed with ADHD and my specialist requests shared care, would you be willing to accept it?"
This single question gives you clarity before you invest time and money in the process. If your GP says no, you know early enough to consider switching practice. If they say yes, you have something to reference later. Either way, you are prepared.
How to Improve Your Chances of Shared Care
1. Choose your provider carefully
Some providers are better recognised by GPs and have clearer shared care processes. Providers like Psychiatry-UK and Clinical Partners have well-established shared care pathways that GPs are familiar with. A provider your GP has never heard of is more likely to face pushback. Compare providers and their shared care track records.
2. Involve your GP early
Do not wait until after diagnosis to mention shared care. Tell your GP at the referral stage that you expect shared care to follow if you are diagnosed. This gives them time to prepare and removes the surprise factor. If you need help with what to say, use our GP conversation scripts.
3. Ensure proper documentation
Your specialist should provide a full shared care request that includes your diagnosis report, medication plan, titration summary, and clear monitoring instructions. The more thorough the documentation, the more confident your GP will feel. If something is missing, ask your specialist to provide it.
4. Be clear and calm
This is not about confrontation. It is about clarity, process, and communication. GPs respond much better to patients who understand the system and can explain what they are asking for. Knowing your rights and the process puts you in a stronger position without creating conflict.
What to Say If Your GP Refuses Shared Care
If your GP says no, stay calm and ask direct questions:
Why specifically are you refusing shared care?
Is this a practice-wide policy or your individual clinical decision?
Can this be reviewed by another GP at the practice?
Would you be willing to speak with my specialist directly?
Can you document this refusal in my medical record?
Escalation Options
If your GP will not budge, you have clear options. These are listed in order of escalation:
Request a second opinion from another GP at the same practice.
Speak to the practice manager and ask whether shared care is a practice policy or an individual GP decision.
Ask your specialist to contact the GP directly. A clinician-to-clinician conversation often resolves the issue.
Change GP practice. You have the right to register with any practice accepting new patients. Some practices are significantly more experienced with ADHD shared care.
Raise a formal complaint through NHS England if you believe the refusal is unreasonable.
For more on GP refusal routes, see our guide on what to do when your GP says no.
Shared Care vs Private Prescriptions
| Option | Cost | Access | Long-term |
|---|---|---|---|
| Shared care | NHS prescription charges (approx. £9.90/item) | Through your GP | Sustainable, affordable |
| Private prescribing | £50 - £150+ per month | Through your specialist | Expensive, not sustainable for most |
Over a year, the difference between shared care and private prescriptions can be over £1,000. Over a lifetime of ADHD medication, it is tens of thousands. This is why getting shared care right matters.
The Key Takeaway
Shared care is one of the most important parts of ADHD treatment in the UK, and one of the least understood. If you get this wrong, it can cost you thousands of pounds, delay your treatment, and create unnecessary stress at a time when you should be focusing on getting better.
But if you prepare early, choose the right provider, involve your GP from the start, and know your escalation routes, you dramatically improve your chances of a smooth transition to NHS-funded prescribing.
Take Control of Your ADHD Journey
Understanding shared care is just one part of the process. My ADHD Path helps you:
- Understand medication and what to expect
- Prepare for GP conversations with scripts
- Track your progress from referral to treatment
- Avoid the common mistakes that cost time and money
Related Guides
ADHD Medication Guide UK
Stimulants, non-stimulants, titration, and what to expect.
Read guideWhat to Say to Your GP
Scripts and preparation for every GP conversation.
Read guideProvider Comparison
Compare Right to Choose providers and their shared care processes.
Read guideAfter ADHD Diagnosis
What happens next - medication, support, and workplace rights.
Read guideCommon Questions About ADHD Shared Care
Can my GP refuse shared care for ADHD?
Yes. GPs can refuse shared care, but they should provide a clear reason. Shared care is not a legal obligation in the same way Right to Choose is. However, most GPs will accept it when a recognised specialist provides proper documentation.
Is shared care guaranteed after ADHD diagnosis?
No. Shared care depends on your GP, their local ICB policies, and whether they feel confident prescribing ADHD medication. An NHS or Right to Choose diagnosis improves the likelihood, but it is not automatic.
Can I change GP if mine refuses shared care?
Yes. Many people choose to switch practices specifically because their GP will not accept shared care. You have the right to register with any GP practice that is accepting new patients in your area.
Do NHS diagnoses guarantee shared care?
Not always, but they significantly improve the likelihood. GPs are generally more comfortable accepting shared care from NHS or Right to Choose providers than from purely private assessments.
How long does titration take before shared care starts?
Titration typically takes 3 to 6 months. During this period your specialist adjusts your medication dose until it is stable. Only after titration is complete will your specialist request shared care from your GP.
What happens if I cannot get shared care at all?
If no GP will accept shared care, you may need to continue with private prescriptions through your specialist. This costs more long-term but ensures you maintain access to medication while you explore other options.
Does shared care cover all ADHD medications?
Most shared care agreements cover the main ADHD medications including methylphenidate (Concerta, Ritalin), lisdexamfetamine (Elvanse), and atomoxetine (Strattera). Your specialist will confirm which medication is included in the shared care request.