Shared Care Agreements

What is a shared care agreement?

A shared care agreement is a formal arrangement between your specialist, your GP, and you. It sets out how responsibility for your ADHD treatment - including prescribing medication - will be shared between the specialist and your GP practice.

This arrangement is recommended by NICE guideline NG87, which states that after titration and dose stabilisation, prescribing and monitoring of ADHD medication should be carried out under shared care arrangements with primary care.¹

How the process works

Step 1: Diagnosis and treatment initiation

Your specialist diagnoses ADHD and recommends treatment. If medication is appropriate, the specialist initiates it and adjusts the dose during a titration period. This typically involves several weeks of careful monitoring to find the right medication and dose.

Step 2: Stabilisation

Once you are stable on a suitable dose - meaning the medication is effective and side effects are manageable - the specialist prepares to transfer ongoing prescribing to your GP.

Step 3: The shared care request

The specialist writes to your GP with a formal shared care request. This letter typically includes:

• Your diagnosis and treatment history
• The medication prescribed, including dose
• Monitoring requirements (blood pressure, heart rate, weight)
• The specialist’s ongoing role (usually 6 to 12-month reviews)
• Contact details for the specialist team if the GP has questions

Step 4: GP accepts or declines

Your GP considers the request and decides whether to accept. If they accept, they take over prescribing and routine monitoring. If they decline, prescribing responsibility remains with the specialist.

Step 5: Ongoing care

Under shared care, your GP issues repeat prescriptions and monitors your physical health (blood pressure, heart rate, and weight at regular intervals). Your specialist continues to review your ADHD treatment periodically - usually every 6 to 12 months - and remains available if your GP has concerns or if your medication needs adjusting.

Your responsibilities

Shared care is a three-way arrangement. Your role includes:

• Taking your medication as prescribed and not changing the dose without consulting your specialist
• Attending regular monitoring appointments with your GP
• Attending your specialist review appointments (usually every 6 to 12 months)
• Reporting any side effects or changes in your mental or physical health to both your GP and your specialist
• Collecting prescriptions on time and managing your medication supply

When GPs decline shared care

GPs are not legally required to accept a shared care agreement. Some GPs decline because they feel they do not have sufficient expertise in ADHD management, because local Integrated Care Board (ICB) guidance does not support it, or because they are uncomfortable prescribing controlled medications on the recommendation of a provider they are unfamiliar with.

Right to Choose assessments

If you were assessed through the Right to Choose pathway, your GP is generally more willing to accept shared care. This is because Right to Choose assessments are NHS-funded, and t²he prescribing relationship follows established NHS protocols.

Private assessments

If you were diagnosed privately, shared care can be more complicated. Some ICBs have issued guidance stating that a private diagnosis does not automatically entitle the patient to NHS prescriptions. In some areas, GPs are instructed that an NHS consultation with an NHS specialist is required before NHS prescribing can begin.³

This does not mean shared care is impossible after a private diagnosis - but it may require more negotiation and may depend on your local ICB’s policy.

What if your GP stops prescribing?

There are several reasons a GP might stop prescribing ADHD medication under shared care:

• You have not attended your specialist review and the GP has not received updated guidance
• Local ICB policy has changed
• The GP practice has decided it no longer has capacity to manage shared care for ADHD
• There is a national or local medication supply issue

If your GP stops prescribing, responsibility for prescribing returns to your specialist. However, this can create a gap in treatment if the specialist does not have capacity to provide repeat prescriptions at short notice.

What you can do

• Contact your specialist to explain the situation and request that they resume prescribing temporarily
• Ask your GP for the specific reason they have stopped prescribing and whether the situation can be resolved
• Check your local ICB guidance - some ICBs have put in place arrangements through GP federations to ensure continuity of ADHD prescribing4
• Consider changing GP practice if your current practice is unwilling to engage with shared care and another local practice is more supportive
• Seek advocacy support from organisations like ADHD UK, which can provide guidance on navigating shared care difficulties

The bigger picture

Shared care for ADHD is an area of significant challenge in the UK. The ADHD Taskforce highlighted that services are under extreme pressure and that the current system creates barriers to ongoing treatment.⁴ The Taskforce recommended a more joined-up approach, with better-resourced primary care and clearer expectations around shared care.

In the meantime, understanding how the system works - and knowing your options when it does not - can help you advocate for the treatment you need.

Getting support

Useful organisations

• ADHD UK - guidance on shared care, GP letters, and advocacy
• AADD-UK - support for adults with ADHD
• Psychiatry-UK - one of the largest Right to Choose providers, with established shared care pathways

neurobetter resources

• ADHD - understanding ADHD as a whole
• Right to Choose - choosing your assessment provider
• ADHD medication - types of medication and how they work
• Getting assessed - the assessment process
• Our Local Services directory - find ADHD services near you
• Our online community - connect with others who understand
• Ask a Counsellor - private, confidential guidance