ADHD Shared Care Agreements: Getting Your Private Prescription on the NHS

What Happens After Your Private Diagnosis?

You have been diagnosed with ADHD privately, whether through the Right to Choose pathway, a private assessment, or another private route. Your specialist has prescribed medication and you are finally getting the treatment you need. But private prescriptions are expensive, often 100-300 per month for the medication alone, plus ongoing specialist fees.

This is where shared care agreements come in. And this is where things can get frustrating.

What Is a Shared Care Agreement?

A shared care agreement (SCA) is a formal arrangement between your private ADHD specialist and your GP. The specialist retains clinical oversight of your ADHD treatment (recommending medication, doses, and monitoring), and the GP agrees to prescribe the medication on the NHS.

This means:

• Your medication moves from a private prescription to an NHS prescription, reducing the cost to the standard prescription charge (about 9.90 per item in England, or free in Scotland, Wales, and Northern Ireland)
• Your GP handles the routine prescriptions and basic monitoring (blood pressure, heart rate, weight checks)
• Your specialist continues to manage the clinical decisions (medication choice, dose adjustments, annual reviews)

The NICE guidelines (NG87) explicitly state that shared care arrangements should be used for ADHD medication, and that GPs should be willing to enter into them.

How Shared Care Is Supposed to Work

Step 1: Stabilisation With Your Specialist

Your specialist starts you on medication and adjusts the dose until you are stable and the medication is working well. This titration period usually takes a few months and involves regular check-ins.

Step 2: Specialist Sends Shared Care Letter

Once your medication is stable, your specialist writes to your GP with a formal shared care request. This letter should include:

• Your ADHD diagnosis and supporting evidence
• The medication, dose, and any adjustments made during titration
• What monitoring the GP is asked to do (typically blood pressure, heart rate, and weight every 6-12 months)
• What the specialist will continue to do (annual reviews, dose change recommendations)
• Emergency contact details for the specialist

Step 3: GP Agrees and Starts Prescribing

Your GP reviews the shared care request, agrees to it, and begins issuing NHS prescriptions for your ADHD medication. You continue to see your specialist for annual reviews or if medication changes are needed.

What If Your GP Refuses?

This is unfortunately common, and it is one of the most frustrating experiences in the entire ADHD system. GPs refuse shared care for various reasons:

• "We do not do shared care" — this is not a valid clinical reason. NICE guidelines recommend shared care for ADHD.
• "We are not confident prescribing ADHD medication" — understandable, but the shared care agreement provides the specialist guidance they need. Additional training is available.
• "The private provider is not recognised" — some GPs are cautious about specific private providers. This can sometimes be addressed by providing additional information about the provider's accreditation.
• "We have a practice policy against shared care" — policies can be changed, and blanket policies against shared care are not consistent with NICE guidance.

What to Do If Your GP Refuses

Step 1: Ask for the Refusal in Writing

Request a written explanation for the refusal. This creates a record and often prompts the GP to reconsider, particularly if their reason does not hold up in writing.

Step 2: Reference NICE Guidelines

Politely point out that NICE guideline NG87 explicitly recommends shared care for ADHD medication. Print the relevant section and bring it to your appointment. The specific recommendation is:

"Following titration and stabilisation of treatment, prescribing and monitoring of ADHD medication should be carried out under shared care arrangements with primary care."

Step 3: Ask for a Second Opinion Within the Practice

If your GP is not comfortable, another GP at the same practice may be. Ask if there is a GP with more experience in mental health or ADHD.

Step 4: Contact the ICB (Integrated Care Board)

Your local ICB (formerly CCG) oversees GP services in your area. If a GP is refusing shared care in a way that contradicts NICE guidance, the ICB can intervene. You can find your ICB through the NHS website.

Step 5: Formal Complaint

If other approaches have not worked, you can make a formal complaint through:

• The practice's own complaints procedure
• The Parliamentary and Health Service Ombudsman
• NHS England

Step 6: Change GP

If your GP practice is consistently unhelpful, you have the right to register with a different practice. Some practices and GPs are more experienced and willing to work with ADHD.

Tips for a Smooth Shared Care Process

For Patients

• Ask your specialist to send the shared care letter promptly after stabilisation
• Follow up with your GP to check they have received it
• Be patient but persistent — the process can take weeks
• Bring a printed copy of the shared care letter to your GP appointment
• Be calm and collaborative — approaching the conversation as a partnership works better than a demand

For Conversations With Your GP

A script that works well:

"My ADHD specialist has written to you requesting a shared care agreement for my ADHD medication. I understand this is the standard pathway recommended by NICE guideline NG87. The specialist will continue to manage the clinical decisions and I will continue to have annual reviews with them. I would really appreciate your support with this."

The Cost Difference

For many people, shared care is the difference between being able to afford ongoing ADHD treatment and not. It is not a luxury, it is a necessity.

You Deserve Affordable Treatment

Getting shared care can feel like yet another battle in a system that has already made you fight for diagnosis, wait years for assessment, and navigate bureaucracy that was not designed for ADHD brains. It is exhausting. But it is worth pursuing, because affordable, consistent access to medication can be genuinely life-changing.

If the process feels overwhelming, an ADHD mentor can help you prepare for GP conversations, draft letters, and navigate the system. That is exactly the kind of practical support mentoring provides.

If you need help navigating shared care, the healthcare system, or any other practical aspect of living with ADHD, book a free discovery call. It is exactly what I am here for.