ADHD Shared Care in the UK: Why Your GP Might Say No (and What to Do).

If you’ve been diagnosed with ADHD or you’re considering an assessment, you’ve probably heard the term ‘shared care’. It’s often described as the ‘ideal’ situation, in so much as a specialist team starts and stabilises your medication, then your GP continues prescribing with agreed monitoring with the specialist team.    In reality, many people can experience confusion, delays, or a flat ‘no’ from their GP, especially after a private diagnosis. This isn't unusual and you’re not alone, it also doesn’t automatically mean your diagnosis or treatment plan is wrong; it usually just means that the system is fragmented and each ICB or PCN will have different guidelines and rules.  

What is a Shared Care Agreement for ADHD? 

A Shared Care Agreement, or SCA, is a formal arrangement where a specialist service initiates treatment (including medication titration and stabilisation). Once the dose is stable, a GP practice then takes over the prescribing and monitoring, while the specialist remains responsible for regular specialist review and support.

Why Would a GP Decline Shared Care? 

There are a few common reasons that a GP may deny a patient shared care. Most of them are about governance and responsibility.

1. The GP doesn’t feel they have enough information to safely prescribe.   ADHD medications are classed as controlled drugs and therefore they require appropriate monitoring and clear documentation (for example, baseline checks, titration plans, follow-up schedules, adverse side effects plans etc.) If any of that is missing or unclear, a GP may not feel confident assuming responsibility for issuing prescriptions.

2. The plan doesn’t match local NHS prescribing pathways or formularies.  Different areas have different local guidance. Some ICB/ICS documents set out scenarios where GP prescribing is supported and where it isn’t, particularly following a private diagnosis. It’s important to check and ask your GP at the point you are seeking an assessment.

3. The GP is being asked to take clinical responsibility without specialist backup.   Shared care only works if the specialist remains involved so, for example, annual reviews, access to that service for advice, and a clear re-referral process if needed. Where that isn’t in place, GPs may understandably decline.

4. System pressure and risk concerns are rising.  There has been increased scrutiny and pressure around ADHD pathways, especially where patients move between private providers and NHS care. This has been widely reported recently, including concerns about assessments that don’t align with NICE guidance and gaps in continuity.

What Does Good Shared Care Look Like?  

A strong shared-care-ready plan typically includes a few key things. First and foremost, it should include a clear diagnostic letter/report explaining the assessment methods and clinical rationale. Baseline physical measurements and relevant history at each stage of your journey should also be included, alongside medication titration notes, outcomes of each review, a stable dose statement, and ongoing monitoring schedule. A clear point of contact for the GP to query or escalate concerns is essential too.

What Can You Do if Your GP Says No? 

Here are sensible next steps that tend to help without escalating conflict:

1. Ask for the reason in writing.   A simple message like ‘Can you confirm what information you need to consider shared care?’ often turns a dead-end into a checklist.

2. Request a shared-care pack from your specialist clinic  This should include everything a GP needs to make a safe decision, although often the GP practice will have their own pack/process document.

3. Check local guidance.  Some areas publish clear patient-facing explanations of prescribing scenarios (NHS specialist vs private vs RTC).

4. Consider Right to Choose (England).  If you’re in England, Right to Choose may allow referral to an NHS-commissioned provider (where shared care pathways can be clearer). ADHD UK provides an overview of RTC and how to use it.

5. Protect continuity while the admin catches up.  If you are already on medication, do not stop suddenly unless advised by a clinician. If prescribing is disrupted, ask your specialist team urgently about interim options and a safe plan.

While your GP is not always obligated to accept shared care, getting a private ADHD diagnosis with complete documentation and with a treatment plan in accordance with NICE guidelines will maximise your chances of shared care being accepted. To further improve these chances, talk to your GP at the beginning of your journey, ask what their guidelines are, what that GP practice requires, EG complete assessment reports and titration reviews, titration outcome, stable dose confirmation, monitoring plan, and a clear route for GP specialist communication.