ADHD Shared Care Agreements: GP Prescribing Guide

What Is an ADHD Shared Care Agreement?

An ADHD shared care agreement sets out how a specialist service and a primary care prescriber will divide responsibility for medication after titration and dose stabilisation.

It can allow a GP practice to issue repeat NHS prescriptions while specialist input continues. It is not a transfer of all care to the GP. The arrangement should say who:

• prescribes the medicine
• completes each type of monitoring
• reviews effectiveness and adverse effects
• advises on dose changes
• provides ongoing specialist review
• answers clinical questions
• acts if the medicine becomes unavailable
• takes responsibility if shared care ends

NICE recommends prescribing and monitoring under a Shared Care Protocol after ADHD medication titration and stabilisation. However, shared care requires agreement. The recommendation does not force an individual GP practice to accept responsibility.

This guide focuses on England because commissioning and prescription charges differ across the UK. Local policies also vary, so check the protocol that applies to your specialist, GP and area.

If organising letters, dates and questions is the main barrier, ADHD mentoring can provide practical planning and accountability. It cannot advise whether a medicine is suitable, persuade a GP to prescribe or replace the specialist.

When Is Shared Care Usually Considered?

NICE places shared care after titration and dose stabilisation. Before then, a healthcare professional with appropriate ADHD expertise should normally initiate medication, adjust the dose and monitor the response.

There is no single number of weeks that makes a person stable. The clinician considers symptoms, function, adverse effects, dose changes and any coexisting conditions. NICE recommends slower titration and more frequent monitoring in some circumstances.

The specialist should not assume that the GP has accepted simply because a request was sent. Until responsibility has been explicitly agreed and transferred, confirm which clinician will prescribe and monitor.

Shared Care Is Not the Same as Right to Choose

NHS Right to Choose for ADHD concerns eligible provider choice at referral. Shared care concerns later clinical responsibility for prescribing and monitoring.

An NHS-funded assessment does not automatically mean:

• medication will be recommended
• the provider's NHS contract includes titration
• the GP will accept shared care
• the specialist can discharge you after sending a request

Before choosing an ADHD assessment provider, ask what happens after diagnosis. NHS England's patient-choice guidance tells referrers to consider ongoing care, including how requests for shared-care protocols will be handled.

What Should the Agreement Cover?

A useful shared care document should be specific enough for each party to act safely. It may include:

• the confirmed diagnosis and relevant history
• the medicine, formulation, dose and directions
• the titration and stabilisation record
• benefits and adverse effects observed
• baseline checks and recent monitoring results
• monitoring tasks and frequency for each clinician
• thresholds or circumstances requiring specialist advice
• arrangements for dose changes and annual review
• specialist contact details and expected response route
• action for missed appointments, supply problems or non-adherence
• responsibilities during pregnancy planning or a change in health
• the process for ending or returning prescribing responsibility

The exact contents depend on the medicine and local protocol. Do not use a generic online checklist as a substitute for the clinical agreement.

The General Medical Council says a prescriber accepting a colleague's recommendation must be satisfied that the prescription is needed, appropriate, within their competence and supported by enough information. It also says shared care requires agreement by all parties, including the patient.

Can a GP Refuse ADHD Shared Care?

Yes. Current BMA guidance describes shared care as voluntary non-core activity that a GP practice can decline. Reasons may involve capacity, competence, clinical governance, lack of a commissioned pathway or insufficient ongoing specialist support.

This remains true even though NICE recommends shared care after titration and stabilisation. NICE describes the desired care model. It does not remove the accepting prescriber's responsibility for each prescription.

The current context is particularly important. From July 2026, BMA GP collective-action guidance in England asks practices to decline new shared care arrangements that do not have a locally commissioned formal agreement, adequate resourcing and clear clinical responsibilities. This may affect how practices respond, and it makes early pathway checks more important.

A refusal does not necessarily dispute the diagnosis or mean that the GP is unwilling to treat ADHD. Ask for the exact reason rather than assuming.

Private, NHS-Funded and Local NHS Pathways

The next step after a refusal depends partly on the route.

Local NHS Specialist Care

Ask the specialist and GP whether there is an adopted local protocol and which requirement is not met. The integrated care board's medicines-optimisation team may publish local shared-care criteria.

NHS Right to Choose Care

Ask the provider what its NHS contract includes if the GP declines. This could involve continued specialist prescribing, a different commissioned arrangement or contact with the integrated care board. Do not assume you must pay privately for care that should remain within an NHS-funded episode.

Fully Private Care

The specialist normally remains responsible unless and until the GP agrees to take over defined tasks. Ask in advance about the cost of prescriptions, medicine, monitoring and reviews if shared care is declined or later ends.

The BMA notes that continuing specialist input can be less secure if a self-funding arrangement stops. Discuss long-term affordability before starting a pathway that depends on private follow-up.

What to Do If Shared Care Is Declined

1. Ask for the Reason

Ask whether the issue is:

• the absence of a local commissioned protocol
• concern about provider governance or assessment quality
• incomplete clinical information
• treatment not yet considered stable
• inadequate specialist access or review arrangements
• capacity or competence within the practice
• a medicine-specific safety concern

A written explanation can help the specialist respond to the actual concern. Do not describe every refusal as unlawful or contrary to NICE.

2. Contact the Specialist Promptly

Send the reason and ask:

• Who will issue the next prescription?
• Who is currently responsible for monitoring?
• Can missing information be supplied?
• Is continued prescribing included in the NHS or private service?
• What is the plan if shared care remains unavailable?

Do not wait until the medicine has run out. Do not change the dose, use someone else's medication or stop treatment based on this article. Contact the responsible prescriber or pharmacist for individual advice.

3. Check the Local Protocol

Search the integrated care board or local medicines-formulary site for the medicine and shared-care protocol. A clinician should interpret the protocol, but it can show whether a commissioned pathway exists and what responsibilities it expects.

4. Ask Whether Another Clinician Can Review

You can ask whether another GP in the practice has relevant experience and capacity. They are not required to accept, and changing practice does not guarantee a different answer.

5. Contact the Integrated Care Board

For an NHS-funded pathway, ask the ICB how the relevant service is commissioned and how prescribing continues when primary care does not accept shared care. Frame this as a continuity-of-care question, not a demand that the ICB force a particular GP to prescribe.

6. Use the Correct Complaints Route

If the concern is poor communication, an unexplained delay, lost correspondence or failure to follow the stated process, you can complain either to the GP practice or the ICB that commissions primary care. You cannot send the same formal complaint to both at once.

A complaint can examine the process. It cannot make a clinician prescribe against their professional judgement.

Monitoring Under ADHD Shared Care

The agreement should say who performs and reviews each check. NICE recommendations include:

• recording effectiveness and adverse effects
• measuring heart rate and blood pressure before and after dose changes and every six months
• measuring adult weight every six months
• age-specific height and weight monitoring for children and young people
• reviewing ADHD medication at least once a year with a healthcare professional who has relevant expertise

More frequent or different monitoring may be needed for an individual. A normal check at one appointment does not replace future monitoring.

If you develop a new symptom or health condition, start another medicine, become pregnant or plan pregnancy, contact an appropriate prescriber. Do not wait for the next routine review if the issue may affect safe treatment.

Prescription Costs

At the review date of this article, the NHS prescription charge in England is £9.90 per item unless an exemption applies. NHS Prescription Prepayment Certificates may reduce costs for people who pay for multiple items.

NHS prescriptions are free in Scotland, Wales and Northern Ireland, but their shared-care and commissioning arrangements are different from England.

Private costs vary by provider, medicine, pharmacy and monitoring plan. Ask for:

• prescription-writing fees
• the medicine price
• titration appointment costs
• monitoring costs
• ongoing review fees
• the plan and costs if a GP declines shared care

Do not rely on a single monthly estimate from another patient.

Questions to Ask Before an Assessment or Medication Pathway

• Does the service include medication assessment if ADHD is diagnosed?
• Who initiates and titrates treatment?
• Is the prescribing NHS-funded or private?
• Which local shared-care protocol is used?
• Will the provider continue specialist reviews?
• What happens if my GP declines?
• Who prescribes during a disagreement or delay?
• What ongoing costs could I face?
• How are medicine shortages handled?
• How quickly can the GP contact the specialist?

These questions are relevant whether the route is local NHS, Right to Choose or private.

Shared Care Checklist

• Confirm that titration and stabilisation are complete.
• Ask the specialist when the request was sent.
• Check that the GP received the full agreement and recent monitoring.
• Wait for explicit acceptance before assuming prescribing has transferred.
• Record who issues the next prescription.
• Keep specialist review and monitoring appointments.
• Raise supply or side-effect concerns with a prescriber or pharmacist.
• Ask early what happens if either party ends shared care.

Practical mentoring can help you organise correspondence, prepare questions and follow a plan. It does not give medication advice or determine which clinician should prescribe. If that practical support would help, explore ADHD mentoring services.

Sources and Review Status

This article was substantively updated on 29 July 2026. It has been checked against current professional guidance but has not been reviewed by a pharmacist or prescriber.

• NICE guideline NG87: ADHD diagnosis and management
• GMC: Shared care prescribing
• NHS England: Shared Care Protocols
• NHS England: Responsibility for prescribing between primary and secondary care
• BMA: Principles for Shared Care Prescribing
• BMA: GP collective action in England
• NHSBSA: Help with NHS prescription costs