Shared Care Agreements for ADHD in the UK - What You Need to Know

Titration is the process of finding the right medication and the right dose for you. It happens before shared care begins and is managed by your specialist (the psychiatrist who diagnosed you, or their prescribing team).

During titration, you start on a low dose of your prescribed medication. The dose is gradually increased over several weeks until you reach a level that provides good symptom control without unacceptable side effects. This process typically takes 6 to 12 weeks, depending on the medication and your individual response.

For stimulant medications like methylphenidate (brands include Concerta, Ritalin, Medikinet) or lisdexamfetamine (Elvanse), titration usually starts at the lowest available dose. You will have regular check-ins with your specialist - typically every two to four weeks - where they assess how you are responding and adjust the dose accordingly.

During titration, you will be asked about symptom improvement, side effects, sleep quality, appetite changes, mood, and heart rate or blood pressure. Your specialist may ask you to monitor your blood pressure at home using a simple home monitor, or they may arrange for your GP to take readings between specialist appointments.

Titration is not always straightforward. Some people respond well to the first medication tried. Others need to try two or three different medications or formulations before finding the right one. This is completely normal and does not mean anything is wrong - it simply reflects the fact that ADHD medication affects everyone differently.

Once your medication is stable (meaning you have been on the same dose for at least four weeks with good symptom control and manageable side effects), your specialist will write to your GP to initiate the shared care agreement.

The handover from specialist to GP typically happens three to six months after your initial diagnosis, once titration is complete and your medication is stable. The exact timing depends on how quickly titration goes and how soon your GP accepts the shared care agreement.

Your specialist will send your GP a shared care protocol letter. This letter includes your diagnosis, the medication you are taking (name, dose, formulation), a monitoring schedule (how often blood pressure and heart rate should be checked), guidance on when to refer you back to the specialist, and any other relevant clinical information.

Your GP then reviews the shared care protocol and decides whether to accept it. In most cases, GPs accept because shared care is the recommended pathway under NICE guidelines and because the specialist has provided clear instructions.

Once the GP accepts, they begin issuing your repeat prescriptions. You will typically need to see your GP (or a practice nurse) for blood pressure and heart rate checks every six months, though some practices do this annually. The frequency depends on local protocols and your individual risk factors.

During shared care, you should still have access to your specialist for annual reviews or if problems arise. If your medication stops working, causes new side effects, or you want to try a different medication, your GP can refer you back to the specialist for reassessment.

GP refusal of shared care is one of the most frustrating issues in UK ADHD treatment. While most GPs accept shared care, some refuse, citing lack of knowledge, concerns about controlled substances, or general reluctance to prescribe psychiatric medication.

It is important to understand that GPs are not legally obligated to accept shared care. NICE guidelines recommend it, and the BMA (British Medical Association) supports it, but individual GPs can decline if they feel clinically uncomfortable. This creates a difficult situation where you have a valid diagnosis and a treatment recommendation but no one willing to prescribe.

If your GP refuses shared care, start by asking them to explain their reasons in writing. Common reasons include: they are not confident prescribing controlled substances, their practice has a policy against shared care, or they want more information from the specialist. Each of these can be addressed.

Ask the specialist to contact your GP directly. A phone call or letter from the diagnosing psychiatrist, explaining the shared care protocol in detail and offering ongoing support, often resolves GP reluctance. Specialists are used to doing this and most are happy to help.

If the GP still refuses after direct specialist contact, ask another GP at the same practice. Different GPs within the same surgery may have different comfort levels. You can request to see a specific GP for your ADHD care.

As a last resort, you can register with a different GP practice. Before doing so, call prospective practices and ask whether they accept ADHD shared care agreements. Some practices are much more experienced with ADHD than others. You can also contact ADHD UK for advice on GP practices in your area that are known to be supportive.

One of the major benefits of shared care is cost. When your GP prescribes your ADHD medication under the NHS, you pay standard NHS prescription charges. In England, this is currently 9.90 pounds per item (as of April 2026). In Scotland, Wales, and Northern Ireland, prescriptions are free.

If you are in England and take monthly medication, you will pay 9.90 pounds per month. However, you can buy a prepayment certificate (PPC) which caps your prescription costs. A 12-month PPC costs around 111 pounds, which works out to about 9.25 pounds per month. If you have more than one prescription per month (for ADHD and another condition, for example), the PPC saves you even more.

Without shared care, if you are still being prescribed by your private specialist, medication costs are dramatically higher. Private prescriptions for Elvanse (lisdexamfetamine) can cost 80 to 150 pounds per month. Private prescriptions for Concerta (methylphenidate) cost 50 to 100 pounds per month. These costs add up quickly.

The specialist consultations during titration may also have costs, depending on your provider. Right to Choose patients typically have titration covered by NHS funding. If you were assessed privately (not through Right to Choose), you may need to pay for titration appointments until shared care begins.

Monitoring costs under shared care are covered by the NHS. Blood pressure checks, heart rate monitoring, and any blood tests your GP recommends are all part of standard NHS care and cost nothing to you.

Regular monitoring is an essential part of ADHD medication management. Your GP takes responsibility for this once shared care is in place, and the shared care protocol from your specialist will specify exactly what needs to be checked and how often.

Blood pressure and heart rate are the most important routine checks. Stimulant ADHD medications (methylphenidate and lisdexamfetamine) can increase both blood pressure and heart rate. Your GP should check these before starting medication, during titration, and then at least every six months once stable. If your readings are consistently elevated, your GP may refer you back to the specialist.

Weight monitoring is recommended, particularly in the first year. Stimulant medications commonly reduce appetite, which can lead to weight loss. Your GP should track your weight at each monitoring appointment and flag any significant changes.

Some GPs also check height (in younger adults), cardiovascular health (especially if there is a family history of heart problems), and general wellbeing. If you are on atomoxetine (Strattera), liver function tests may be recommended, particularly in the early months.

You should also be asked about side effects at each monitoring appointment. Common questions include: Is the medication still working well? Have you noticed any new side effects? How is your sleep? How is your appetite? Are you experiencing any mood changes? Be honest about side effects - the GP or specialist can adjust your medication if needed.

Keep a record of your monitoring appointments and results. This helps you track trends and ensures nothing is missed. If your GP practice is not scheduling regular monitoring, remind them. It is their responsibility under the shared care agreement.

Shared care typically continues for as long as you take ADHD medication. There is no fixed end date. ADHD is a lifelong condition, and most adults who benefit from medication continue taking it long-term.

Your specialist should offer annual reviews, either directly or through a review of information sent by your GP. These annual reviews assess whether your medication is still appropriate, whether the dose needs adjusting, and whether any alternative treatments should be considered.

In practice, some people remain on the same medication and dose for years without any changes. Others need periodic adjustments as their life circumstances change. Stress, hormonal changes (particularly in women), aging, and changes in work demands can all affect how well your medication works.

If you want to stop medication at any point, discuss it with your GP and specialist first. Stimulant ADHD medications do not need to be tapered (you can stop them immediately without withdrawal effects), but stopping suddenly without a plan can lead to a sudden return of symptoms that may be disruptive.

If you move to a different area, your shared care agreement should transfer to your new GP. Ask your current GP to send the shared care protocol and your medication history to your new practice. Some patients experience a gap in prescribing during a move, so plan ahead and ensure you have enough medication to cover the transition period.

The key difference is who writes your prescription and who pays for it. Under shared care, your NHS GP prescribes your medication and you pay NHS prescription charges (or nothing in Scotland, Wales, and Northern Ireland). Under private prescribing, a private psychiatrist writes the prescription and you pay private pharmacy prices.

Private prescribing is significantly more expensive. A monthly supply of Elvanse on private prescription costs 80 to 150 pounds, compared to 9.90 pounds on NHS prescription. Over a year, this difference amounts to hundreds or even thousands of pounds.

Some people remain on private prescriptions because their GP will not accept shared care, because they prefer the flexibility of a private psychiatrist, or because they want to see a specific specialist who does not participate in shared care. However, for most people, transitioning to shared care as soon as possible is the most practical and affordable option.

If you are currently on private prescriptions and want to move to shared care, ask your private psychiatrist to write a shared care protocol letter to your GP. Most private psychiatrists are willing to do this, and many proactively suggest it once titration is complete.

It is worth noting that some employers or private health insurance plans cover private ADHD prescriptions. If you have private health insurance through work, check whether ADHD medication is covered before assuming you need to move to shared care immediately.

Navigating the shared care process can be confusing, especially if your GP is reluctant. My ADHD Path provides tools and templates to help you at every stage.

My Letter Templates include shared care request letters that you can send to your GP if they are hesitant. These letters reference NICE guidelines, explain the shared care protocol, and make it easy for your GP to say yes.

My Pro AI Chat can help you understand your shared care rights and plan your approach if you are facing GP resistance. Describe your situation and get personalised advice on the best way forward.

For more information on the Right to Choose route that leads to shared care, visit rightochooseadhd.co.uk. For practical next steps after your diagnosis, including setting up shared care, visit adhdnextstep.co.uk.