What is an ADHD shared care agreement?
A shared care agreement is the document that transfers routine ADHD prescribing from the specialist who started it to the patient's GP once the patient is stable. The specialist keeps the diagnosis, the reviews and any dose or medication change. The practice issues the repeat prescriptions and does the routine monitoring, typically blood pressure, pulse and weight at agreed intervals.
The part that causes most of the trouble is that it is voluntary on the practice's side. A referral for assessment is a patient right. Taking on prescribing afterwards is a clinical and workload decision each practice makes for itself, and a practice is professionally entitled to decline.
That asymmetry is the single most misunderstood feature of the pathway, and it is why handover deserves as much thought as titration does. The patient standing in the middle of it usually finds out at the point of refusal, months after the decision that mattered was taken.
What does a GP actually need at handover?
A practice being asked to take over needs to answer one question for itself: is this patient stable, engaged and safe to prescribe for on a routine basis? The shared care letter answers the clinical half. What it usually cannot show is the behavioural half, which is how the patient has actually behaved across the months of titration.
The letter carries the diagnosis, the medication and stable dose, the monitoring schedule and the split of responsibilities. All necessary, all standard. What tends to be missing is any texture on the interval.
What a GP needs on day one
- How stable the stable dose really is. A dose held for around three months is the usual threshold, but the letter states the outcome, not the record behind it.
- What the side effect picture settled at. Not just the ones that resolved, but what remains and how the patient manages it.
- A blood pressure trend rather than a single reading. A practice taking on monitoring is inheriting a baseline it did not set.
- Whether the patient turns up. Adherence and attendance are what a hesitant practice is quietly assessing, and no letter says it out loud.
The third of those is the one a patient can usually evidence themselves. Readings taken at home, grouped by dose period, are the version of a blood pressure history a receiving practice can actually read.
Handing over a patient who can evidence all four is a different conversation from handing over a name and a dose.
Why do practices decline ADHD shared care?
Rarely because they doubt the diagnosis. The common reasons are capacity, confidence and commissioning. ADHD medicines are controlled drugs with specific monitoring requirements, every shared care patient adds prescribing and monitoring work, and some practices follow local ICB guidance that is cautious about agreements with providers the area does not contract with directly.
Every shared care patient adds prescribing and monitoring work to a caseload the practice did not choose.
Controlled drugs with specific monitoring requirements, and an outcome the practice is being asked to take on trust.
Local ICB guidance that is cautious about agreements with providers the area does not contract with directly.
Those three causes have different fixes, which is why a written reason matters so much to the patient standing in the middle. A capacity refusal and a provider specific refusal lead to completely different next steps.
Confidence, and only confidence. A practice that can see a documented, stable response has less to hesitate about than one being asked to take the outcome on trust. Capacity and commissioning are decided somewhere above the letter.
What makes a handover easy to say yes to?
Reduce the unknowns. A practice weighing up a request is pricing risk it cannot see, so anything that makes the patient less of a black box moves the decision. Evidence of a stable dose over time, a blood pressure record it can read, and a patient who reliably attends monitoring appointments all lower the perceived cost of saying yes.
Three things help on the sending side, and none of them are new work for the specialist.
Ask early
Encouraging patients to ask their practice how it handles ADHD shared care at the start of titration, rather than at the end, surfaces a provider specific objection while there is still time to do something about it.
Send the record, not just the conclusion
If the patient has kept a structured log through titration, the letter can arrive with it attached.
Be explicit about what the practice is taking on
The monitoring schedule in plain terms, and who to contact when something looks off.
None of that makes a refusal impossible. It makes an acceptance easier, which over a caseload is the number that matters.
The record the patient keeps anyway.
ADHDose is a consumer medication diary. Through titration, the patient logs doses, sleep, focus, side effects and blood pressure on their own phone, and the app compiles a structured report they can bring to a review or hand on at handover. Every entry is the patient's own record, logged as it happened rather than remembered in the room, and prescribing decisions stay with the clinician. The data stays on the patient's phone by default, and the only copy that travels is the report the patient chooses to share.
For the patient, that means arriving at the handover with proof of stability rather than a claim of it. For the receiving practice, the behavioural half of the picture arrives with the clinical half, in a format that can be read in a couple of minutes. For the specialist, it is a record that exists without anyone having to build it.
What practices and services ask
ADHDose is a consumer medication diary, not a regulated medical device. It does not diagnose, dose or advise, and its output is not clinically validated. All inputs are self reported, and report figures shown here are from a demonstration report built on demo data. This page describes how the UK shared care pathway generally works and is not clinical, legal or commissioning advice; arrangements vary by area and provider. The patient facing version of this material lives on our shared care guide. Written by ADHDOSE LTD, a UK company registered in England and Wales.