Shared Care Agreements for ADHD: What Happens After Your Right to Choose Diagnosis

The Part Nobody Warns You About

You have been through the assessment. You have your diagnosis. Maybe you cried, maybe you felt relief, maybe you felt nothing at all. But now you are holding a report that says you have ADHD, and the specialist has recommended medication.

So you take it to your GP, and... nothing happens. Or worse, they say they will not prescribe it.

This is the part of the ADHD journey that catches people completely off guard. You did everything right. You used your Right to Choose, you waited months for your assessment, you sat through the interview, and now you cannot actually access the medication that was recommended because your GP will not sign a shared care agreement.

I hear this from clients constantly. So let me walk you through exactly what shared care is, how it is supposed to work, and what to do when it does not.

What Is a Shared Care Agreement?

A shared care agreement (sometimes called a shared care protocol or shared care arrangement) is a formal agreement between your ADHD specialist and your GP. It sets out who is responsible for what in managing your medication.

In simple terms:

• Your specialist initiates the medication, manages the titration period, provides clinical guidance, and conducts annual reviews
• Your GP takes over routine prescribing once you are stable, monitors basic health checks (blood pressure, heart rate), and refers back to the specialist if problems arise

This arrangement exists because ADHD medication is a controlled substance (most ADHD medications are Schedule 2 controlled drugs), and initiating treatment requires specialist expertise. But once you are on a stable dose, the day-to-day prescribing is straightforward and does not require a specialist appointment every month.

The Shared Care Timeline: What to Expect

Here is what the process typically looks like after diagnosis:

The whole process from diagnosis to stable shared care typically takes 3-6 months. Some people get through it faster, others hit delays, especially if their GP is reluctant.

What Your Specialist's Letter Should Include

When your specialist requests shared care, they should send your GP a letter that includes:

• Your confirmed ADHD diagnosis and the diagnostic criteria met
• The medication prescribed and current stable dose
• The titration history (what was tried, what worked, any side effects)
• Clear instructions for ongoing prescribing (dose, frequency, repeat prescription)
• Monitoring requirements (typically blood pressure and heart rate checks every 6 months)
• When to refer back to the specialist (dose changes, new side effects, concerns)
• Contact details for the specialist team for GP queries

If the letter is vague or incomplete, your GP is more likely to hesitate. A good specialist will provide everything your GP needs to feel confident taking over. If your letter is missing key information, contact your specialist and ask them to send a more detailed one.

Why GPs Sometimes Refuse Shared Care

Let me be clear: when a GP refuses shared care for ADHD, it is almost always about unfamiliarity, not malice. Most GPs have had very little training on adult ADHD. Many qualified at a time when adult ADHD was barely acknowledged. So when they receive a shared care request, they may feel out of their depth.

The most common reasons GPs refuse:

"I don't feel competent to prescribe this medication"

This is actually the most legitimate concern. NICE guideline NG87 states that GPs should only enter shared care if they feel competent to do so. However, the counter-argument is that shared care protocols are designed to make prescribing straightforward. The specialist has done the complex work of diagnosis and titration. The GP is essentially issuing repeat prescriptions and checking blood pressure.

"We don't have a shared care protocol for ADHD"

Some GP practices or local areas genuinely do not have an established shared care protocol for ADHD. This is a systemic problem rather than a personal refusal. Your specialist provider can usually supply a standard shared care template, and your ICB should have a framework in place.

"The diagnosis was done privately / through Right to Choose"

Some GPs are suspicious of diagnoses made outside the local NHS pathway. This is unfounded. Right to Choose providers are NHS-approved and conduct assessments to the same NICE standards as local services. A Right to Choose diagnosis is an NHS diagnosis.

"I have too many patients on controlled drugs already"

This is not a valid reason to refuse a clinically recommended treatment for a diagnosed condition. If your GP raises this concern, it should be escalated to the practice manager or ICB.

What to Do If Your GP Refuses Shared Care

If your GP will not agree to shared care, do not panic. There are clear escalation steps, and most situations can be resolved.

Step 1: Ask for their reasons in writing. A verbal refusal is easy to dismiss. A written refusal creates accountability and gives you something concrete to escalate with.

Step 2: Ask to speak to a different GP. Within the same practice, different GPs may have different comfort levels with ADHD prescribing. Another GP at your surgery might agree where the first one would not.

Step 3: Contact your specialist provider. Let them know the GP has refused. Good providers will write a more detailed letter addressing the GP's specific concerns, or offer to speak with the GP directly.

Step 4: Escalate to your Integrated Care Board (ICB). Your ICB has a responsibility to ensure patients can access prescribed medication. Contact them explaining that your GP is refusing a shared care agreement for a diagnosed condition with specialist recommendation. ICBs can intervene and direct GP practices to comply.

Step 5: Contact PALS. The Patient Advice and Liaison Service at your local NHS Trust can advocate on your behalf. They are experienced at resolving these kinds of disputes.

Step 6: Make a formal complaint. If nothing else works, submit a formal complaint through your GP practice's complaints procedure. This triggers a formal review process.

Step 7: Consider changing GP practice. Some practices are simply more experienced with ADHD shared care than others. It should not be necessary to change practice, but sometimes it is the most practical solution. Ask in local ADHD support groups which practices in your area are known to be ADHD-friendly.

For a broader guide on handling GP refusals throughout the ADHD journey, read my post on what to do if your GP refuses Right to Choose.

What NICE Says About Shared Care

NICE guideline NG87 (Attention deficit hyperactivity disorder: diagnosis and management) is clear that GPs should be part of the ongoing care of adults with ADHD. Specifically:

• ADHD medication should be initiated by a specialist, but ongoing prescribing can be managed in primary care under shared care
• GPs should monitor patients on ADHD medication with regular checks including blood pressure, heart rate, and weight
• Annual specialist reviews should continue alongside GP prescribing
• If a GP does not feel competent to prescribe, they should seek training or support rather than simply refusing

The BMA (British Medical Association) has also issued guidance encouraging GPs to engage with shared care for ADHD, recognising the growing number of adults being diagnosed and the need for primary care to support them.

Monitoring Under Shared Care

Once shared care is in place, your GP will typically monitor:

If your GP identifies any concerns during monitoring, they should refer you back to your specialist for review. You should also be offered at least one annual specialist review, even when shared care is working well.

Medication Is Not the Whole Picture

I want to be honest about something. Medication can be transformative. Many of my clients describe starting ADHD medication as "putting on glasses for the first time." But it is not a cure, and it does not fix everything.

Medication helps with the neurological side, the focus, the impulsivity, the restlessness. But it does not automatically undo years of coping mechanisms, procrastination habits, organisational chaos, or the emotional weight of living with undiagnosed ADHD.

That is where practical support comes in. ADHD mentoring focuses on building systems, routines, and strategies that work with your brain. It works alongside medication, not instead of it. Many of my clients find that the combination of medication plus mentoring is what finally makes things click.

What If You Are Not Prescribed Medication?

Not everyone diagnosed with ADHD is offered medication. Some people choose not to take it. Others have health conditions that make stimulant medication unsuitable. If medication is not part of your plan, that does not mean you are stuck.

Non-medication approaches that can help:

• ADHD mentoring for practical strategies and accountability
• Cognitive Behavioural Therapy (CBT) adapted for ADHD
• Exercise, which research consistently shows improves ADHD symptoms (read my post on ADHD and exercise)
• Environmental adjustments such as reasonable adjustments at work
• Self-care tools like Sprout, which can help you build consistent wellbeing habits
• Psychoeducation to understand your brain and develop self-awareness

You Have Got This Far. Keep Going.

If you are reading this, you have probably already done the hardest parts. You recognised something was not right. You pushed for assessment. You got your diagnosis. Do not let a shared care disagreement derail you now.

The system is imperfect, and navigating it can be exhausting, especially when you have the very condition that makes navigating complex systems difficult. But you have options, you have rights, and you do not have to do it alone.

If you want practical support managing your ADHD, whether you are waiting for shared care, already on medication, or exploring non-medication options, I would love to help. Book a free 15-minute discovery call and let's figure out your next step together.