An ADHD shared care agreement is an arrangement where your GP takes over prescribing your ADHD medication, and doing routine health checks, once your dose is stable after titration. Your specialist stays involved, reviews you at least once a year and advises your GP. It’s voluntary: GPs can say no for any reason, and many decline requests from private providers.
In short
- NICE recommends that, once the dose is stable, prescribing and monitoring move to your GP under a shared care protocol.
- It can only start after titration, when your dose is settled. Agreements often build in about 3 months of stabilisation.
- GP practices don’t have to agree (BMA, updated April 2025), and local policies on private providers vary by area and nation.
- If your GP says no, a private specialist can keep prescribing, but you pay for each prescription and for the medicine.
- Either way, you still need a specialist review at least once a year.
What is an ADHD shared care agreement?
Shared care splits your ADHD treatment between two teams. A specialist, from an NHS ADHD service or a private clinic, diagnoses you, finds the right medicine and dose with you, and keeps overall oversight. Your GP practice then prescribes and does routine monitoring, so you get NHS prescriptions instead of private ones.
This is what the NICE guideline on ADHD (NG87) expects once treatment has settled: “After titration and dose stabilisation, prescribing and monitoring of ADHD medication should be carried out under Shared Care Protocol arrangements with primary care.” NG87 covers England, and Wales follows it. Northern Ireland’s Department of Health endorses NICE guidance. Scotland isn’t bound by NICE, and its health boards set their own arrangements.
You’ll hear two terms. The shared care protocol is the written document, often a local template from your integrated care board (ICB) in England or your health board, that says who does what. The agreement is when you, your GP and your specialist all sign up to it for you. GMC prescribing guidance says shared care “requires the agreement of all parties, including the patient”.
If you’re having treatment with us, our page on shared care with your GP at ADHD Health explains how our request works and what it costs. If your practice has already said no, read my GP won’t agree to ADHD shared care: what now?
When can shared care start?
Only after titration, when you and your specialist have found a dose that works and your health checks are stable. NICE doesn’t set a fixed length for titration. The BMA’s guidance on prescribing in general practice notes that shared care agreements commonly include a stabilisation period of about three months. Our guide to what to expect from ADHD titration explains that stage.
Before writing to your GP, a specialist will usually have:
- finished titration, with a stable dose
- your baseline and recent blood pressure, pulse and weight (and height for children)
- a written treatment and monitoring plan
- a named contact your GP can reach
- plans for your annual specialist review, and for taking prescribing back if needed
Keep getting prescriptions from your specialist while your GP decides, so your treatment doesn’t stop.
Who does what under shared care?
The exact split is set by the local protocol, but it usually looks like this.
| Your specialist | Your GP | You |
|---|---|---|
| Makes the diagnosis and finds the right medicine and dose | Prescribes at the dose agreed with the specialist | Agree to the arrangement and keep both teams informed |
| Writes to your GP with a treatment and monitoring plan | Does routine checks, such as blood pressure, pulse and weight (and height for children) | Go to your health checks, or send readings when asked |
| Reviews you at least once a year and advises your GP if anything changes | Contacts the specialist with any concerns | Tell your GP or specialist about side effects or changes in your health |
| Takes prescribing back if the arrangement ends | Arranges a safe handover if they can no longer prescribe | Book your annual review and order repeat prescriptions in good time |
What’s in a shared care protocol?
Protocols differ by area, but most cover how the diagnosis was made, the medicine and dose, baseline health checks, who does the monitoring and how often, side effects to look out for, when the specialist reviews you, and how the arrangement can end.
The monitoring usually follows NICE NG87:
| Check | Adults | Children and young people |
|---|---|---|
| Blood pressure and pulse | Every 6 months, and before and after each dose change | Every 6 months, and before and after each dose change |
| Weight | Every 6 months | Every 3 months for children aged 10 and under. For over 10s, at 3 and 6 months after starting, then every 6 months |
| Height | Not routinely | Every 6 months |
| Specialist medication review | At least once a year | At least once a year |
Does my GP have to agree to shared care?
No. The BMA’s guidance for practices in England says: “Shared care prescribing is non-core voluntary activity that can be declined by the GP practice for any reason.” In September 2025 the primary care minister said GPs “cannot be compelled” to enter a shared care agreement, as Pulse reported. Many practices decline requests from private providers.
Why GPs may decline
- Workload. Shared care is extra work that isn’t part of the core GP contract.
- Governance. The BMA says practices should check a private provider’s governance, which is “more challenging if the provider is not commissioned by the NHS”. Practices should also apply the same principles to every request, so they don’t discriminate.
- Local policy. The 2025 UK conference of local medical committees (LMCs) adopted a policy that “any shared care prescribing arrangement with a private provider is unsafe, not enduring, and widens health inequalities”. Some ICBs and LMCs advise practices on private requests.
- Confidence and competence. A GP has to feel able to prescribe and monitor the medicine safely.
What GMC guidance says
The GMC’s guidance on shared care (paragraphs 73 to 81) works in both directions:
- Decisions about who takes responsibility for your care should be based on your best interests, not on convenience or the cost of the medicine and its monitoring (paragraph 73).
- Shared care needs the agreement of everyone involved, including you (paragraph 74).
- A GP who prescribes on a specialist’s recommendation must be satisfied the prescription is appropriate, within their competence, and backed by enough information to proceed safely (paragraphs 75 and 79).
- A GP who is still not satisfied should explain this to you and the specialist, and make arrangements for your continuing care (paragraph 81).
So cost alone shouldn’t decide it, but a GP who isn’t satisfied that prescribing is safe and within their competence should say no.
Do shared care rules differ by area and UK nation?
Yes. In England, ICBs and LMCs often publish their own policies. In Nottingham and Nottinghamshire, for example, July 2026 guidance on private ADHD requests says GPs aren’t obliged to agree even if every condition is met. Its conditions include a UK-registered, appropriately trained specialist, a diagnosis in line with NICE NG87, following the local protocol, and a private specialist review at least once a year. Children under 6 are excluded. If follow-up by the private provider isn’t assured, the patient is referred to the NHS, and private prescribing continues in the meantime.
| Nation | Shared care with private providers | NHS prescriptions |
|---|---|---|
| England | Voluntary for GP practices. ICB and LMC policies vary | £9.90 per item in 2026/27, unless you’re exempt |
| Scotland | Health boards set the rules. NHS Lothian says practices may share care with private providers but “there is no requirement to do so”, and expects a specialist re-evaluation at 12 months | Free |
| Wales | Varies by health board. Cwm Taf Morgannwg adds GP referrals with a private diagnosis to its ADHD waiting list for specialist review, where the longest adult wait was 225 weeks in May 2026 | Free |
| Northern Ireland | The Department of Health reports that people diagnosed privately are “often unable” to get GP prescriptions under shared care | Free |
More on the other nations in ADHD assessment in Scotland, Wales and Northern Ireland.
What happens to my prescriptions either way?
| If your GP agrees | If your GP declines | |
|---|---|---|
| Who prescribes | Your GP, on the NHS | Your private specialist |
| What you pay | In England, £9.90 per item in 2026/27 unless you’re exempt. Free in Scotland, Wales and Northern Ireland | A fee to the prescriber for each prescription, plus the pharmacy’s private price for the medicine |
| The prescription | A standard NHS prescription | A paper controlled drug form (FP10PCD in England, PPCD(1) in Scotland, WP10PCD in Wales, PCD1 in Northern Ireland). Each covers up to 30 days and must be dispensed within 28 days |
| Specialist reviews | At least once a year. A private specialist charges for these | At least once a year, plus the regular health checks |
In England, under 16s and 16 to 18 year olds in full-time education are among those who don’t pay for NHS prescriptions. If you do pay, a prescription prepayment certificate costs £32.05 for 3 months or £114.50 for 12 months in 2026/27 and covers all your NHS prescriptions. NHS charges and certificates don’t apply to private prescriptions.
How does a shared care request work with ADHD Health?
With us, shared care is a request, not an appointment, and it costs £200 as a one-off. You can make it after three completed titration appointments, once your dose is stable and your blood pressure, pulse and weight checks are up to date. You need to be registered with a UK GP. If you live in Northern Ireland, contact us first about prescribing.
The request form asks for your date of birth, your NHS number if you know it (CHI number in Scotland, H&C number in Northern Ireland), your current medication, dose and when you take it, your GP’s name, practice address and email, and the date of your third titration appointment.
A clinician then reviews your records and prepares a GP request pack: your diagnosis, dose history, monitoring plan and prescribing guidance. We send it to your practice, usually within a few working days of the clinical review. After that the decision is your GP’s.
- If your GP agrees, routine prescribing moves to the NHS. You can still book a medication review with us, a titration appointment at £199.
- If your GP declines, which any practice can do, you can carry on with our repeat prescription service at £60 per prescription, about 12 a year.
The fee pays for our review and pack, not for a result. Once the review has started or the pack has been sent, the request can’t be refunded, whatever your GP decides. See all our fees.
How can you improve your chances of shared care?
Nothing makes a GP agree, but you can give your practice what it needs to make a fair decision.
- Ask early. Before you start treatment, ask your practice whether it shares care with private ADHD providers, and whether there’s a local protocol.
- Choose your specialist carefully. Look for a UK-registered specialist who works to NICE NG87, writes a full report, follows local protocols, and commits to annual reviews and to taking prescribing back if needed.
- Agree to information sharing. Your GP can’t judge a request without your report, your dose and your recent results.
- Keep up with monitoring. Recent blood pressure, pulse and weight readings show your treatment is stable.
- If the answer is no, ask why. A question about your diagnosis can often be answered by your specialist. A fixed practice or local policy usually won’t change because you push.
- Plan for both outcomes. Work out what private prescriptions would cost you in a year, so a no doesn’t leave you stuck.
Tip from our clinicians
Ask your practice manager, not only your GP, how the practice handles shared care requests from private ADHD providers. Some practices have a written policy, and knowing it before you start treatment helps you plan.
Can shared care stop or change later?
Yes. A GP may stop if specialist reviews or health checks aren’t happening, if the specialist is no longer involved, or if they no longer feel they can prescribe safely. GMC guidance expects them to arrange your continuing care, and the specialist takes prescribing back. If you move to a new practice, it decides for itself whether to continue. For children, the arrangement usually needs agreeing again when their care moves to adult services at 18.
Next step
Want your GP to take over prescribing?
After three titration appointments, once your dose is stable, we can send your GP a full shared care request. The request costs £200. Your GP can say no; if they do, you can carry on with repeat prescriptions from us.
Common questions
How long does a GP take to reply to a shared care request?
There’s no national deadline, and practices work at different speeds. Ask your practice how it handles requests. Keep ordering private prescriptions in good time while you wait: each covers up to 30 days and must be dispensed within 28 days of the date on it.
Can my GP change my dose under shared care?
Usually the GP prescribes the dose your specialist recommended and asks the specialist for advice if a change might be needed. GMC guidance says a specialist proposing shared care should give the GP enough information to manage your treatment safely. Your local protocol sets out who can change what.
Does shared care work for children?
Yes, in a similar way, with more frequent height and weight checks. Some areas exclude younger children: Nottinghamshire’s guidance excludes under 6s, for example. Plan the move to adult care well before your child turns 18, so prescribing carries on smoothly.
I was assessed through Right to Choose. Is shared care different?
Right to Choose providers are NHS-funded, but shared care is still voluntary for your GP. LMC guidance says GPs should warn patients if a Right to Choose provider can’t commit to local shared care protocols, so check before you choose. Read NHS Right to Choose for ADHD or a private assessment?
Sources
- NICE. Attention deficit hyperactivity disorder: diagnosis and management (NG87), sections 1.8 to 1.10 on medication, monitoring and review. Last updated January 2025.
- British Medical Association. Prescribing in general practice. Updated 28 April 2025.
- General Medical Council. Good practice in prescribing and managing medicines and devices: shared care, paragraphs 73 to 81. 2021. Accessed October 2026.
- Pulse. Care minister defends GP practices’ right to decline ADHD shared care arrangements. September 2025.
- North West LMCs. Guidance for practices: Right to Choose and shared care. 2026.
- Nottingham and Nottinghamshire Medicines Optimisation Steering Group. Guidance on the management of shared care prescribing requests following a self-funded assessment and diagnosis of ADHD by a private clinician. Version 2, July 2026.
- NHS Lothian. Freedom of information response 11738. 2026.
- Cwm Taf Morgannwg University Health Board. Freedom of information response. 26 May 2026.
- Department of Health (Northern Ireland). ADHD needs assessment. February 2026.
- Community Pharmacy England. NHS prescription charges frozen for the second year running. 21 November 2025.
- Community Pharmacy England. Dispensing controlled drugs. Accessed October 2026.
