ADHD Shared Care Agreements in the UK
If you have been diagnosed with ADHD and are wondering how to get your medication from your GP instead of going back to a specialist every time — shared care is the answer. This guide explains how it works, how to request it, and what to do if your GP says no.
Short answer: Yes — once you have an ADHD diagnosis from a specialist (NHS or private), your GP can prescribe your ongoing ADHD medication through a shared care agreement. If your GP refuses, you have the right to request they reconsider, ask for a written explanation, or transfer to another GP surgery. Scroll down for the step-by-step process and a template for requesting shared care.
What is a Shared Care Agreement?
A shared care agreement is the standard NHS pathway for ongoing ADHD medication management. It splits responsibility between your specialist and your GP.
The specialist's role
- Conducts the ADHD assessment and confirms diagnosis
- Recommends medication and starts the titration process
- Monitors you until the right dose is found and you are stable
- Writes a shared care protocol letter to your GP
- Remains available for specialist advice if needed
Your GP's role
- Takes over routine prescribing once you are stabilised
- Monitors physical health (blood pressure, heart rate, weight)
- Arranges regular reviews (typically every 6-12 months)
- Refers back to the specialist if issues arise
- Issues NHS prescriptions — no private prescription costs
Why shared care matters
How to Request Shared Care
Getting a shared care agreement in place is a step-by-step process. Here is what to expect at each stage.
Get diagnosed by a specialist
You need a formal ADHD diagnosis from a qualified specialist — through the NHS, the Right to Choose pathway, or a private assessment. Your GP cannot diagnose ADHD or start medication without specialist input.
Ask your specialist for a shared care letter
After diagnosis and medication titration, ask your specialist to write a shared care protocol. This letter should include your diagnosis, medication details, dose, monitoring requirements, and when the GP should refer back. A good shared care letter makes it much easier for your GP to agree.
Take the letter to your GP
Book an appointment with your GP and bring the shared care protocol. Explain that your specialist has recommended shared care and that NICE guideline NG87 supports this arrangement. Be prepared for the GP to take time to review the protocol before agreeing.
GP reviews and responds
Your GP will review the shared care protocol and decide whether to accept. If they agree, they will begin prescribing your medication and arranging monitoring. If they decline, they should provide reasons — and you have options to escalate (see below).
Tip: If your specialist uses an NHS-approved Right to Choose provider, GPs are generally more willing to accept shared care because the assessment was NHS-funded.
If Your GP Refuses Shared Care
It can be deeply frustrating to finally get a diagnosis and then face resistance from your GP. You are not alone — this is a common experience, and there are things you can do.
Common reasons GPs decline
What you can do
Ask for the refusal in writing
Request that your GP documents their reasons for declining shared care. This creates a paper trail and sometimes prompts reconsideration.
Speak to the practice manager
The practice manager can clarify the surgery's policy on shared care and may be able to facilitate a conversation with a different GP at the same practice.
Contact your local ICB
Your Integrated Care Board (formerly CCG) can advise on local shared care protocols and may intervene if your GP is not following local or national guidance.
Ask your specialist to contact the GP directly
A clinician-to-clinician conversation can be more effective than a letter. Many specialists are willing to speak with GPs to address specific concerns.
Register with a different GP practice
If your current practice will not engage with shared care, you have the right to register elsewhere. Some GP practices are more experienced with ADHD shared care than others.
Make a formal complaint through PALS
The Patient Advice and Liaison Service can help you make a formal complaint if you believe the refusal is unjustified. This is a last resort but can be effective.
Private Diagnosis and Shared Care
Whether you were diagnosed through the NHS, Right to Choose, or a fully private assessment, shared care is possible — but the route matters.
NHS Diagnosis
Most straightforward route to shared care. The specialist writes directly to your GP as part of the NHS pathway. GPs are generally comfortable accepting shared care from NHS colleagues.
Right to Choose
NHS-funded assessment through an approved private provider. GPs are generally willing to accept shared care because the assessment was commissioned by the NHS, even though it was delivered privately.
Private Diagnosis
Can be more challenging. Your GP needs confidence that the assessment followed NICE guidelines. A detailed shared care protocol from your specialist — including medication, monitoring, and review schedule — is essential.
What your GP needs from the specialist
Regardless of how you were diagnosed, your GP will need a clear shared care protocol that includes:
ADHD Medications Under Shared Care
Several ADHD medications are available on the NHS and can be prescribed by your GP once shared care is in place. Here are the most commonly prescribed options.
Stimulant Medications
First-line treatment for most adults with ADHD
Available in immediate-release and extended-release forms. Most commonly prescribed first-line ADHD medication in the UK.
Extended-release prodrug stimulant. Often prescribed when methylphenidate is not effective or not tolerated. Smooth, long-acting effect.
Short-acting stimulant. Sometimes used as an adjunct to extended-release medication for end-of-day coverage.
Non-Stimulant Medications
Used when stimulants are not suitable or not tolerated
Non-stimulant SNRI. Takes 4-6 weeks for full effect. Good option for people with anxiety, tics, or substance use history.
Non-stimulant alpha-2 agonist. More commonly prescribed for children but sometimes used in adults. Can help with emotional regulation.
Availability may vary depending on your local NHS formulary. Your specialist will recommend the most appropriate medication based on your symptoms, health history, and response during titration.
Free Screening Tools
Whether you are preparing for an ADHD assessment or managing the emotional impact of your diagnosis journey, these free screening tools can help you understand your experiences. They are not a diagnosis, but they can be useful preparation for conversations with your GP or specialist.
Quick ADHD Screener
Based on the WHO Adult ADHD Self-Report Scale. A short screening tool to help you understand whether your experiences align with common ADHD symptoms.
Free · 2 minutes · No sign-up requiredAutism Screening (AQ-10)
ADHD and autism commonly co-occur. If you are being assessed for ADHD, screening for autism traits can provide useful context for your clinician.
Free · 3 minutes · No sign-up requiredAnxiety Screening (GAD-7)
Anxiety is one of the most common conditions alongside ADHD. Understanding your anxiety levels helps build a fuller picture for your GP.
Free · 2 minutes · No sign-up requiredDepression Screening (PHQ-9)
ADHD and depression frequently co-occur. If you are feeling low while navigating your diagnosis journey, this screening may be helpful.
Free · 3 minutes · No sign-up requiredFrequently Asked Questions
What is a shared care agreement for ADHD?
A shared care agreement is a formal arrangement between a specialist (psychiatrist or ADHD clinician) and your GP to share responsibility for your ADHD treatment. The specialist diagnoses you, recommends medication, and handles the initial titration period. Once you are stable on the right dose, your GP takes over routine prescribing and monitoring, with the specialist remaining available for advice if needed.
Can my GP prescribe ADHD medication in the UK?
Yes, but only under a shared care arrangement. GPs cannot initiate ADHD medication themselves — this must be done by a specialist. However, once a specialist has diagnosed you, started medication, and written a shared care protocol, your GP can take over ongoing prescribing. This is the standard pathway recommended by NICE guideline NG87.
What if my GP refuses shared care?
Shared care is voluntary — GPs are not legally obligated to accept it. If your GP refuses, ask for their reasons in writing. You can then escalate to the practice manager, contact your local Integrated Care Board (ICB), seek a second opinion from another GP at the same practice, register with a different GP practice, or make a formal complaint through PALS (Patient Advice and Liaison Service). NICE guidance supports shared care for ADHD, so a refusal without clinical justification can be challenged.
How do I request a shared care agreement?
After your ADHD diagnosis, ask your specialist to write a shared care letter or protocol addressed to your GP. This letter should include your diagnosis, the medication prescribed, the dose, monitoring requirements, and when the GP should refer back to the specialist. Take this letter to your GP and request that they accept shared care. Many GPs will agree once they have clear guidance from the specialist.
Does shared care work with private ADHD diagnoses?
Yes, but it can be more challenging. GPs are more likely to accept shared care from NHS or Right to Choose providers because those assessments are NHS-funded. For private diagnoses, your GP needs to be satisfied that the assessment followed NICE guidelines and was conducted by a qualified professional. A clear, detailed shared care protocol from your private clinician significantly increases the chance of your GP agreeing.
What ADHD medications can be prescribed under shared care?
The most commonly prescribed ADHD medications under shared care include methylphenidate (brand names Ritalin, Concerta, Equasym), lisdexamfetamine (Elvanse), dexamfetamine, and atomoxetine (Strattera). All of these are available on the NHS formulary. The specific medication prescribed depends on your specialist’s recommendation, your response during titration, and local formulary preferences. Both stimulant and non-stimulant options can be prescribed under shared care.
Sources & Further Reading
- NICE Guideline NG87 (opens in new tab) — Attention deficit hyperactivity disorder: diagnosis and management (includes shared care recommendations)
- British Medical Association (opens in new tab) — Shared care guidance for GPs, including responsibilities and limitations
- NHS England (opens in new tab) — Right to Choose policy, shared care frameworks, and ICB guidance
- Royal College of Psychiatrists (opens in new tab) — Position statements on ADHD shared care and GP prescribing
. Information is general guidance only and does not constitute medical advice. Always consult a qualified healthcare professional for personal medical decisions.
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