Shared Care Agreements

What a shared care agreement is

A shared care agreement is a written arrangement under which a specialist hands routine prescribing and monitoring of a medicine to a patient's GP, while remaining available for advice and retaining responsibility for the diagnosis and the treatment plan.

It exists because ADHD medicines cannot be started by a GP. Treatment has to be initiated by a specialist, but once a dose is stable there is no clinical need for a specialist to issue every prescription. Shared care is the mechanism that moves that routine work to primary care.

More than 4,000 people assessed at The ADHD Centre are now supported through NHS GP shared care agreements. Our detailed guide to how your GP can take over prescribing sets out the process in full, including what we send to your practice.

For patients the practical effect is usually financial. Where a diagnosis was made privately, shared care moves ongoing prescriptions onto the NHS, subject to the standard prescription charge in England unless you are exempt.

How it works in practice

The sequence is consistent, whether the diagnosis was NHS or private.

• The specialist assesses, diagnoses and starts treatment
• Titration continues until the dose is stable and side effects are settled
• The specialist writes to the GP with the diagnosis, medication history, agreed dose and monitoring plan
• The GP considers the request and either accepts or declines
• If accepted, the GP issues prescriptions and carries out routine monitoring
• You return to the specialist for a six-monthly review, or sooner if anything changes

The agreement itself is a document. It names the medicine, the dose, what the GP is responsible for, what the specialist is responsible for, and what should prompt a referral back. Most areas use a template produced by the local integrated care board.

What to do if your GP declines

A GP practice can decline shared care, and some do. This is the part of the pathway people are least often told about in advance, and it is worth understanding before treatment starts rather than discovering it at the end of titration.

Practices decline for a range of reasons: a local policy on private diagnoses, a view that the practice lacks the capacity for the monitoring involved, or individual clinician discretion. A refusal is not usually personal and is not usually about you.

What you can do

• Ask what specifically is required for the practice to consider it, in writing
• Ask your specialist to supply anything missing, such as a fuller monitoring plan
• Ask whether another GP in the practice takes a different view
• Check the local integrated care board policy, which practices often follow
• Where appropriate, use the practice complaints procedure

If shared care is not agreed, prescribing stays with the specialist and the ongoing cost stays private. That is a legitimate outcome rather than a failure, but it changes the arithmetic, which is why it is worth asking your GP their position early.

What the GP monitors

Shared care agreements set out monitoring rather than leaving it to judgement, which is one of the reasons practices ask for a clear plan before agreeing. The checks are not onerous, but they are not optional either.

• Pulse and blood pressure, usually at each review
• Height and weight in children and young people, at every review
• Whether the medicine is still helping, and at what dose
• Side effects, including appetite, sleep and mood
• For guanfacine, blood pressure and heart rate specifically

At The ADHD Centre, once shared care is in place you return to your Consultant Psychiatrist for a review every six months, in line with BNF guidance, or sooner if something needs to change. Children may be seen more often, because growth is tracked alongside everything else.

Stimulants remain Schedule 2 controlled drugs under shared care, so they are still treated differently from ordinary medicines rather than issued as repeat prescriptions, and identification may be requested at the pharmacy. Shared care changes who writes the prescription, not the rules governing it. Our guide to stimulant medication sets out what those rules mean day to day.

Asking your GP before you start

The most useful thing you can do is ask early. A short conversation or a written query to your practice before assessment tells you what to expect, and costs nothing.

A reasonable question is: if I am diagnosed with ADHD by a private Consultant Psychiatrist and my dose is stabilised, would this practice consider a shared care agreement for ADHD medication. Practices with a settled policy can usually answer that quickly.

If the answer is no, you can still proceed. You will simply be planning for private prescriptions to continue, and you can budget for it rather than being surprised by it.

• What ADHD medication costs NHS prescription charges and private prices
• How to get ADHD medication in the UK The full pathway, NHS and private
• Supply and shortages Current status and what to do

Common questions