ADHD medicines are started by a specialist, but many people eventually get their ongoing prescriptions from their GP. The arrangement that makes this possible is called a shared care agreement.
What a shared care agreement is
A shared care agreement is a written arrangement between a specialist and a GP. It sets out who does what when looking after a patient’s medication.
The NHS says a GP may be able to take over prescribing ADHD medicines, but only if there is a shared care agreement between the GP and the ADHD specialist.
NICE guideline NG87 says that after titration and dose stabilisation, prescribing and monitoring of ADHD medication should be carried out under shared care arrangements with primary care. This is the usual model within the NHS.
How it usually works
1. Your specialist starts and adjusts treatment
The specialist assesses you, starts medication and adjusts the dose. This is titration.
2. Your treatment becomes stable
Shared care isn’t normally requested until you’re on a stable dose. BMA guidance for GPs says the stabilisation period is set by the agreement and is often three months.
3. The specialist writes to your GP
The specialist sends your GP a request with details of your diagnosis, medicine, dose, monitoring needs and how to contact the specialist.
4. Your GP decides
Your GP practice reviews the request and decides whether to accept it.
5. Care is shared
If the GP agrees, responsibilities are usually split like this.
| Who | Usual responsibilities |
|---|---|
| Specialist | Diagnosis, starting medicine, titration, advice if problems arise, dose changes, periodic specialist review |
| GP | Ongoing prescriptions, routine checks such as blood pressure, pulse and weight, referring back if concerns arise |
| You | Taking medicine as prescribed, attending reviews and checks, reporting side effects, telling both teams about changes |
Local agreements vary, so the exact split depends on your area and your specialist.
Your GP can say no
This is the most important thing to understand about shared care. It is voluntary for GPs.
BMA guidance describes shared care prescribing as “non-core voluntary activity that can be declined by the GP practice for any reason”. Reasons can include not having capacity, not feeling confident about the medicine, or not being assured of ongoing specialist support. The BMA says practices should make these decisions consistently and not in a discriminatory way.
Private providers and shared care
GP practices take different approaches to requests from private providers. Some accept them. Others don’t take on any shared care with private services. The BMA’s guidance quotes a 2025 policy from the UK conference of Local Medical Committees, which represent GPs, calling shared care with private providers unsafe. It also says ongoing specialist care may be less certain when a patient is self-funding, and that this should be discussed with patients in advance.
Healthwatch England has reported hearing from people whose GP declined shared care after a private diagnosis, and from some whose NHS services wouldn’t accept a private diagnosis.
If your GP declines
A refusal doesn’t mean your treatment has to stop. Common options include the following.
Continue with private prescriptions. Your private specialist can usually keep prescribing. You’ll pay for the appointments and prescription requests, plus the cost of the medicine at the pharmacy. One person told Healthwatch England they were paying £110 a month for medication after their GP refused shared care.
Ask why. Your GP practice should be able to explain its reasons. Sometimes there’s a specific issue, like missing information, that your specialist can address.
Ask again later. Practice policies and local arrangements can change.
Explore NHS options. Your GP may be able to refer you to an NHS ADHD service. In England, you may be able to use your right to choose a provider. Waits can be long, and the NHS service may want to do its own assessment. See NHS or private.
Preparing for a shared care request
A few steps can make a request smoother.
- Keep your GP informed from the start. Ask your specialist to send your clinical summary to your GP, with your consent.
- Attend all titration and monitoring appointments so your records show stable, well-monitored treatment.
- Keep your own records of dose, blood pressure, pulse and weight readings.
- Ask your GP practice whether it uses a local shared care protocol for adult ADHD.
- Be patient. GP practices may take some time to review requests.
Staying on shared care
Once shared care is in place, you’ll still need:
- regular checks of pulse, blood pressure and weight (NICE recommends every six months)
- a medication review at least once a year by a professional with ADHD expertise
- specialist advice if your dose needs changing or problems arise
If you move house or change GP practice, ask your new practice early whether it will continue the arrangement, and tell your specialist.
Shared care with Happy Clinic
Happy Clinic’s consultant psychiatrists can propose a Shared Care Agreement to your NHS GP after your ADHD treatment is stable.
- Shared care appointment: 30 minutes
- Fee: £500, paid in advance
- GP approval: required. Whether your GP accepts is at the GP’s discretion.
If your GP doesn’t agree, you can continue to receive private prescriptions from Happy Clinic at private cost, where clinically appropriate. For existing patients, a repeat prescription request costs £150, subject to clinical review, and follow-up appointments cost £200. Pharmacy dispensing charges are extra. Fees checked September 2026. See Happy Clinic’s pricing page for current fees, or the fees page on this site.