What a shared care agreement actually is
ADHD medication in the UK has to be started by a specialist. But specialists are not set up to issue your repeat prescription every month for years, so once you are stable, the system hands the routine work to your GP. The handover document is the shared care agreement.
Under shared care, the responsibilities split. The specialist remains responsible for the diagnosis, annual reviews, and any dose or medication changes. Your GP issues the regular prescriptions and does the routine monitoring: blood pressure, pulse, and weight checks at agreed intervals. You collect your medication from a normal pharmacy on a standard NHS prescription, paying the usual charge or nothing if you are exempt.
The key word is voluntary. Your GP practice can decline a shared care agreement. That is different from the referral stage: a referral for assessment is your right, but taking on prescribing afterwards is a clinical and workload decision each practice makes for itself. This is the single most misunderstood part of the ADHD pathway, and the reason this page exists.
The typical timeline
Titration with the specialist
After diagnosis, your prescriber starts titration: finding the medication and dose that works for you. The specialist service prescribes throughout this period. Titration commonly takes a few months; our titration guide covers what to track at each stage.
Stabilisation
Once a dose is working, the specialist keeps you on it unchanged for a stability period, commonly around three months, to confirm it holds up in normal life. Consistent logging matters here: stable, documented response is exactly what the specialist needs to see before recommending handover.
The shared care request
The specialist writes to your GP setting out the diagnosis, the stable dose, the monitoring schedule, and each side's responsibilities, and asks the practice to take over routine prescribing. The practice reviews it and accepts or declines.
Handover, or not
If the practice accepts, your prescriptions move to the GP and the specialist drops back to annual reviews. If it declines, prescribing stays where it is while you work through the options in the next section.
Why GPs decline
It is rarely personal, and it is rarely about doubting your diagnosis. The common reasons: ADHD medications are controlled drugs with specific monitoring requirements, and a practice that does not feel competent or resourced to manage them safely is professionally entitled to say so. Workload is real: every shared care patient adds prescribing and monitoring work that practices are not always funded for. And some practices follow local ICB guidance that is cautious about agreements with providers the area does not contract with directly, which affects some online Right to Choose providers.
Practices have also become more cautious as ADHD referral volumes have grown. Some now decline all new ADHD shared care as policy, which is frustrating, but knowing the reason shapes your next move: a capacity refusal and a provider-specific refusal have different solutions.
If your GP declines
Get the reason in writing. Ask the practice to confirm the refusal and the reason. "We do not have capacity" and "we do not accept shared care with this provider" lead to different options, and a written reason is what you need for any escalation.
Ask your provider what happens next. Pathways differ. Some NHS providers continue prescribing while shared care is unresolved; some areas have arrangements for prescribing where practices decline. Do not assume your prescription stops; ask the provider directly what their process is when shared care is refused.
Contact your ICB. The Integrated Care Board commissions local services and is responsible for making sure patients can actually access prescribed NHS treatment. Ask, politely and in writing, what provision exists for patients whose practices decline ADHD shared care. PALS (Patient Advice and Liaison Service) can help you route the question.
Consider a different practice. Practices set their own positions, and they differ even within one town. If a nearby practice is known to accept ADHD shared care, registering there is a legitimate and often the fastest fix.
Private prescribing is the costly fallback. Paying for private prescriptions of stimulant medication adds up quickly between consultation fees and private dispensing costs. Treat it as a bridge while you pursue the routes above, not a destination.
Making shared care easy to say yes to
You cannot force a practice to accept shared care, but you can remove the reasons to hesitate. A practice agreeing to shared care is taking on clinical responsibility for a patient whose response to medication it has never seen. The less of a black box you are, the easier the yes.
Attend every review, and turn up to the monitoring appointments without being chased: a patient who reliably shows up for blood pressure checks is a low-risk patient on paper. Keep your own record of your response at each dose. ADHDose builds this for you: it logs focus, sleep, and energy against your medication levels through each titration stage, and its Appointment Prep feature compiles the last 28 days into a Clinician Summary you can export as a PDF. A documented, stable response handed to a hesitant GP answers the exact question they are weighing up: is this patient stable and engaged?
And start early. Asking your practice how it handles ADHD shared care requests at the start of titration, rather than at the end, means a provider-specific objection surfaces while you can still do something about it.
Common questions about shared care
Heading towards shared care?
ADHDose logs your response at every dose and compiles it into a Clinician Summary, so your stability is documented, not just described.
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