%20(1).webp)
.webp)
If you or your child has received an ADHD diagnosis and been prescribed medication by a specialist, you may have heard the term shared care mentioned. You may have been told that your GP will take over prescribing under a shared care arrangement, or alternatively that your GP has declined to do so.
For patients and families, shared care can feel like an administrative hurdle that stands between a diagnosis and consistent access to treatment. For GPs, it represents a significant clinical responsibility that requires clear guidance and appropriate support. For specialists, setting it up correctly is essential to ensuring patients receive continuity of care without unnecessary gaps or costs.
This article explains exactly what shared care is, how it works in the UK, why it matters particularly in ADHD services, what a Shared Care Agreement should contain, and what to do if your GP declines.
Shared care is a formal arrangement in UK healthcare where the clinical responsibility for a patient's ongoing treatment is shared between a specialist, such as a consultant psychiatrist, paediatrician, or private clinician, and the patient's GP.
Rather than all clinical care being concentrated in one place, shared care creates a structured division of responsibilities. The specialist provides the expertise required to assess, diagnose, and initiate treatment. The GP, who has the most accessible and ongoing relationship with the patient, continues prescribing and monitoring that treatment in primary care under an agreed framework.
Shared care is most commonly used when a condition requires specialist expertise to diagnose or to begin treatment safely, when ongoing management can be handled in primary care once treatment is stable, and when long-term medication is involved that would be impractical or costly for the patient to access indefinitely through private or specialist routes.
It is used across a range of clinical areas, including mental health, ADHD, inflammatory conditions, and transplant medicine. In all of these areas, the principle is the same: the right clinician takes responsibility for the right part of the patient's care, with clear communication and documented agreements between all parties.
Shared care follows a defined process, though the specific steps and timelines can vary depending on local NHS policies, whether the initial assessment was through NHS or private services, and the individual GP's position on shared care.
Stage 1: Specialist AssessmentThe patient is assessed and diagnosed by a specialist clinician with the appropriate expertise. In ADHD, this is typically a consultant psychiatrist, paediatrician, or appropriately trained specialist clinician.
Stage 2: Treatment InitiationThe specialist initiates treatment, which in ADHD typically means starting medication, conducting the titration process to find the optimal dose, and confirming that the patient is stable and responding well before transitioning prescribing responsibility.
Stage 3: Shared Care RequestOnce the patient is stable, the specialist contacts the patient's GP with a formal request to enter into a shared care arrangement. This communication typically includes a clinical summary, details of the diagnosis and current medication, monitoring requirements, and a Shared Care Agreement document for the GP to review and sign.
Stage 4: GP AgreementIf the GP accepts, the Shared Care Agreement is formalised and the GP takes on responsibility for ongoing prescribing and routine monitoring, with the specialist remaining available for advice, review, and re-referral when needed.
Stage 5: Ongoing ManagementThe GP prescribes regular medication, conducts monitoring as specified in the agreement, and communicates with the specialist if concerns arise or if the patient's clinical picture changes. Annual or regular reviews are typically specified in the agreement.
It is important to be aware that shared care is voluntary. A GP is not legally obliged to accept a shared care request. Whether they do depends on local NHS protocols, their clinical confidence in managing the condition, workload considerations, and the quality and completeness of the shared care documentation provided.
Shared care, when it works well, benefits every party involved in the patient's treatment.
For patients, shared care means easier and more convenient access to ongoing prescriptions through their own GP. It removes the need to attend specialist clinics or pay private prescription costs for medication that has already been stabilised. It ensures continuity of care closer to home, within the primary care relationship that is most central to the patient's overall healthcare.
For GPs, shared care provides a clear clinical framework for managing a condition or medication that may sit outside their day-to-day expertise. A well-constructed Shared Care Agreement gives the GP defined responsibilities, clear monitoring protocols, guidance on what to look for and what to do if concerns arise, and direct access to specialist support when needed. This makes the clinical responsibility manageable rather than open-ended.
For specialists, shared care means confidence that appropriate monitoring and prescribing continuity is in place for patients who no longer need frequent specialist review. It enables specialist services to focus their capacity on assessment and treatment initiation rather than routine prescribing reviews, and supports better integration between specialist and primary care.
When shared care is absent and patients must rely on specialist services or private prescriptions for long-term medication, it creates cost barriers, access difficulties, and pressure on specialist services that are already stretched. Shared care, properly implemented, is a practical and important part of sustainable ADHD care.
ADHD is one of the most common clinical areas in which shared care is used, and also one of the most frequently complicated by GP refusal or uncertainty.
The typical pathway in ADHD works as follows. A patient receives a formal ADHD assessment and diagnosis from a specialist, either through NHS services or privately. The specialist initiates medication and conducts the titration process, adjusting the dose until the patient is stable and responding well. Once stability is confirmed, the specialist requests that the patient's GP take over prescribing under a shared care arrangement.
ADHD medications, particularly stimulant medications such as methylphenidate and lisdexamfetamine, are controlled drugs under the Misuse of Drugs Regulations 2001. This means their prescribing carries additional responsibilities and monitoring requirements. GPs who accept shared care for ADHD medication must be confident in their understanding of the medication, the monitoring requirements, and what to do if problems arise.
This is why the quality of the Shared Care Agreement is particularly important in ADHD. A poorly constructed or incomplete agreement may leave the GP without the clinical guidance they need to accept the responsibility safely, even when they are willing in principle. A clear, detailed, and clinically robust agreement significantly improves acceptance rates.
For children specifically, shared care for ADHD medication must be initiated by a paediatric specialist, and the monitoring requirements typically include height, weight, blood pressure, and regular review of symptom control. For more detail on the child ADHD medication process, see our article on how to get ADHD medication for a child.
For adults, the process follows similar principles. For a full guide to the medication pathway following adult ADHD diagnosis, see our article on how to get ADHD medication after diagnosis.
A Shared Care Agreement is a written document that formally records the shared care arrangement between the specialist and the GP. It is the clinical and administrative foundation of the arrangement.
The agreement serves several important functions. It documents that the specialist has assessed the patient, made a diagnosis, initiated treatment, and confirmed that the patient is stable enough for primary care prescribing to be appropriate. It sets out exactly what the GP's responsibilities are, including what to prescribe, what to monitor, how often, and what action to take if problems arise. And it provides a formal record that protects both the specialist and the GP by making the agreed responsibilities explicit and documented.
Without a Shared Care Agreement, or with a poorly constructed one, both parties are left in an ambiguous position. The GP does not have the clinical guidance they need to prescribe safely. The specialist cannot be confident that appropriate monitoring is taking place. And the patient may find themselves without access to their medication or caught between services that are not communicating effectively.
A well-constructed Shared Care Agreement covers all the information both parties need to fulfil their responsibilities safely and confidently. While formats vary between services and areas, a robust agreement typically includes the following components.
Patient details including full name, date of birth, NHS number, and relevant medical history and current diagnosis. This ensures the GP has the clinical context to understand the patient's situation.
Specialist responsibilities including confirmation of the diagnosis and the basis on which it was made, details of the treatment initiated and the titration process conducted, provision of a clear monitoring and management plan, and confirmation of how the GP can contact the specialist if questions or concerns arise.
GP responsibilities including the medication to be prescribed, the dose and any titration parameters, the monitoring that should be conducted, the frequency of review, and the circumstances under which the patient should be referred back to the specialist.
Medication details including the full name and formulation of the medication, the current dose and any dose range within which the GP can adjust, known side effects and adverse effects to monitor for, and any contraindications or interactions that the GP should be aware of.
Monitoring and review plan specifying exactly what needs to be monitored, how often, what values or findings should prompt action, and when a scheduled annual or six-monthly review should take place.
Patient responsibilities including taking medication as prescribed, attending monitoring appointments, and reporting side effects or concerns to their GP or specialist promptly.
Signatures and dates from both the specialist clinician and, where applicable, the GP accepting the arrangement. This formalises the agreement and provides a clear record.
A clear, detailed, and professionally presented Shared Care Agreement template makes it significantly easier for GPs to review, understand, and accept the arrangement. It signals that the specialist service takes clinical governance seriously and has done the work required to support safe primary care prescribing.
Understanding why GPs decline shared care is important for patients, families, and specialist services, because addressing the underlying reasons is often more effective than simply re-submitting a request.
Absence of local NHS shared care protocols is one of the most common reasons. Many GP practices will only accept shared care for conditions and medications that have formal shared care guidelines agreed at ICB or clinical network level. Where no such guideline exists, particularly common for private ADHD diagnoses, GPs may decline on the basis that they do not have an agreed framework within which to operate.
Insufficient clinical detail in the agreement leaves GPs without the information they need to prescribe safely and confidently. If the agreement does not clearly specify monitoring requirements, dose parameters, or how to contact the specialist, it places an unclear and potentially unsafe burden on the GP.
Workload and capacity concerns are a reality in primary care. ADHD shared care involves ongoing prescribing, regular monitoring, and the clinical responsibility for a controlled drug. GPs managing significant workload pressures may decline if they do not feel they have the capacity to take this on safely.
Uncertainty about the diagnostic process can arise particularly following private assessments. GPs may have concerns about whether the assessment met appropriate clinical standards if the documentation provided does not clearly demonstrate a rigorous diagnostic process.
For patients whose GP has declined shared care, the options include discussing the situation with the specialist to explore whether a more detailed or differently presented agreement might address the GP's concerns, requesting a review by a different GP within the same practice, exploring whether an NHS Right to Choose referral might bring the care within an NHS framework that the GP is more comfortable with, or continuing private prescriptions while seeking a resolution. For more on the current NHS landscape for ADHD assessment and the Right to Choose pathway, see our article on Right to Choose and ADHD assessments.
For specialist services and private clinics, the quality and presentation of the shared care request is one of the most controllable factors in GP acceptance rates.
Provide a comprehensive, clearly structured Shared Care Agreement that covers all the components described above. A document that is vague, incomplete, or difficult to navigate is far less likely to be accepted than one that is thorough and clearly presented.
Demonstrate clinical rigour in the diagnostic documentation accompanying the request. GPs are more likely to accept shared care responsibility when the diagnostic report clearly shows that a structured, evidence-based assessment process was followed, including the tools used, the information gathered from multiple informants, and the differential diagnosis considered.
Make the monitoring requirements specific and achievable in primary care. GPs are more likely to accept shared care when the monitoring specified is clear, time-defined, and realistic within the constraints of a GP appointment. Open-ended or highly complex monitoring requirements increase the perceived burden and reduce acceptance rates.
Provide clear contact details and a commitment to remain available for advice and re-referral. GPs are more willing to accept shared care responsibility when they know they can reach the specialist if questions arise.
Be aware of local ICB protocols and where possible align the shared care documentation with any existing local guidelines or templates. Engaging with local NHS frameworks rather than working around them tends to produce better outcomes for patients in the long term.
The shared care pathway differs depending on whether the initial assessment was conducted through the NHS or privately.
NHS pathway: Where the specialist assessment and diagnosis have been conducted within NHS services, shared care arrangements are typically supported by local ICB protocols and agreed templates. The GP is more likely to have a clear framework within which to accept the arrangement, and the process is generally more straightforward.
Private pathway: Where the assessment has been conducted privately, the GP does not have the same local NHS framework to refer to. The specialist's documentation and Shared Care Agreement become even more important in this context, because they must effectively substitute for the institutional framework that an NHS referral provides. Some ICBs have developed guidance for GPs on accepting shared care following private diagnoses, but this is not universal.
Understanding which pathway applies to your situation helps set realistic expectations and informs the most effective approach to securing shared care.
Clinicians who work in ADHD services consistently identify shared care as one of the most practically important, and most frequently mishandled, aspects of the patient journey from diagnosis to stable ongoing treatment.
The clinical principles are straightforward: assess carefully, initiate treatment competently, stabilise the patient, and then transfer prescribing responsibility to primary care with clear documentation and ongoing support. In practice, the process breaks down most often at the documentation stage. Shared care agreements that are vague, incomplete, or do not align with what GPs actually need to prescribe safely create unnecessary barriers for patients and avoidable frustration for all involved.
Investing in high-quality shared care documentation is not a bureaucratic exercise. It is a direct investment in patient outcomes. A well-constructed agreement that is accepted by the GP means the patient has consistent, accessible, affordable access to their medication. That matters enormously in a condition where disruption to treatment can have significant consequences for daily functioning and mental health.
For healthcare professionals seeking to develop their ADHD clinical skills, including their understanding of responsible medication management and the broader treatment pathway, our ADHD training for professionals provides CPD-certified education built around current evidence and real-world practice.
If you are a patient or parent whose GP has declined shared care, do not simply accept this as a final answer. Ask the GP specifically what would need to change for them to reconsider. Ask your specialist to review the shared care documentation and whether additional detail or a different format might address the GP's concerns. Ask whether the Right to Choose pathway might bring your care within an NHS framework that makes shared care more straightforward.
If you are currently managing on private prescriptions while pursuing shared care, factor the ongoing prescription cost into your planning and keep communication open with both your specialist and GP about progress. Many situations that initially result in GP refusal are eventually resolved with persistence and improved documentation.
If you are a specialist or private clinician seeking to improve your shared care acceptance rates, invest in the quality of your shared care documentation. Review it regularly against what GPs actually tell you they need, and consider whether your agreements are as clear, specific, and practically useful as they could be.
If you are a GP who has received a shared care request that you are uncertain about, be specific with the specialist about what additional information or reassurance would allow you to accept the arrangement. A declined shared care request with clear reasoning is more helpful to all parties than a declined request without explanation.
Is a GP legally required to accept shared care?
No. Shared care is voluntary in the UK. A GP cannot be compelled to accept prescribing responsibility for a patient's medication. Whether they accept depends on local protocols, their clinical confidence, workload considerations, and the quality of the shared care documentation provided. If a GP declines, the specialist service must make alternative arrangements to ensure the patient's treatment continues safely.
What happens to my medication if my GP declines shared care?
If your GP declines shared care, your specialist should continue prescribing until an alternative arrangement is in place. You should not be left without access to medication because of a disagreement between services. If you are in this situation, raise it with both your specialist and your GP practice manager, and if necessary contact your ICB's patient services team.
Can I ask my GP to reconsider a declined shared care request?
Yes. You can ask your GP to explain specifically why they declined and what would need to change for them to reconsider. Sharing this feedback with your specialist, who may be able to provide additional documentation or a revised agreement, is often the most productive approach.
Does shared care cost the patient anything?
Shared care through NHS prescribing is covered by the NHS standard prescription charge or is free for those who are exempt. This is typically significantly cheaper than obtaining prescriptions privately, which is one of the main practical benefits of securing a shared care arrangement.
Can shared care be set up following a private diagnosis?
Yes, though it can be more complex than following an NHS diagnosis. GPs are more likely to accept shared care following a private diagnosis when the diagnostic documentation is thorough and clearly demonstrates a clinically rigorous assessment process, and when the Shared Care Agreement provides all the information the GP needs to prescribe safely.
What is the difference between shared care and a referral back to the GP?
A referral back to the GP implies that the specialist is fully discharging the patient and the GP takes on all clinical responsibility without specialist input. Shared care maintains the specialist's involvement for reviews, advice, and re-referral, while delegating the routine prescribing and monitoring to primary care. The specialist remains a named point of contact in the Shared Care Agreement.
How long does a shared care arrangement last?
Shared care arrangements in ADHD are typically long-term, reflecting the nature of ADHD as a condition that usually requires ongoing management. The agreement should specify review intervals, and both parties should review the arrangement if the patient's clinical picture changes significantly, if they wish to change medication, or if there are concerns about monitoring or safety.
Shared care is one of the most practically important, and most frequently misunderstood, elements of the ADHD treatment pathway in the UK. When it works well, it means patients have consistent, affordable, and accessible access to the medication they need, with appropriate monitoring and a clear framework of clinical responsibility between their specialist and their GP.
When it does not work well, it creates gaps in treatment, financial burdens for patients, and frustration across all parties. The most common reasons shared care breaks down are preventable: inadequate documentation, unclear responsibilities, and misalignment with local NHS frameworks.
For patients and families, understanding how shared care works empowers you to advocate effectively when difficulties arise. For clinicians, investing in the quality of shared care documentation is one of the most direct ways to improve outcomes for the patients you serve.
A well-constructed Shared Care Agreement is not red tape. It is the foundation of safe, sustainable, and patient-centred ADHD care.
Medical Disclaimer
This article is intended for educational and informational purposes only. It does not constitute medical or legal advice. Shared care arrangements in the NHS vary by area and are subject to local clinical policies. If you have questions about shared care for your specific situation, please speak with your GP or specialist.
