ADHD Shared Care Agreement: What to Expect

A private ADHD diagnosis can bring clarity, but many adults quickly have a practical question: can their GP take over prescribing? An ADHD shared care agreement may make this possible once treatment is established, but it is not automatic and it is not simply an administrative form. It is a clinical arrangement designed to ensure that medication remains safe, monitored and appropriately reviewed.

For people paying privately for assessment and titration, shared care can reduce the ongoing cost of prescriptions. More importantly, when it is suitable and accepted, it can create a clearer long-term pathway involving both your GP and your specialist psychiatrist.

A specialist psychiatrist can set up a Shared Care Agreement with your GP to prescribe ADHD medication if they are agreeable.

What is an ADHD shared care agreement?

An ADHD shared care agreement is a written plan that sets out how prescribing, monitoring and clinical responsibility will be divided between a specialist and a GP practice. Usually, the specialist begins treatment, adjusts the dose during titration and confirms that the medication is effective and tolerated. Once the dose is stable, the GP may agree to issue repeat prescriptions under the shared-care arrangement.

The specialist does not simply step away. They remain responsible for specialist oversight, including planned reviews, advice on medication changes and reassessment if symptoms, side effects or circumstances change. The GP supports routine prescribing and may carry out agreed physical-health monitoring, such as blood pressure, pulse and weight.

This model can work well because ADHD medication requires continuity. Treatment should be based on more than whether a prescription is due. It should take account of attention, impulsivity, sleep, appetite, mood, work demands, physical health and any other medicines you take.

Shared care is not guaranteed

A GP is not obliged to accept an ADHD shared care agreement from a private provider. Each practice makes its own decision, often guided by local policies, clinical capacity and whether the specialist documentation gives them enough information to prescribe safely.

This can feel frustrating, particularly when you have invested time and money in a detailed assessment. However, it is best to think of shared care as a request for a collaborative clinical arrangement, rather than an entitlement that follows every private diagnosis.

A GP may be more likely to consider shared care where the assessment is comprehensive, the diagnosis is clearly documented, medication titration has been completed, and the specialist offers ongoing review and direct advice when needed. Practices may also have requirements about the information they need before making a decision.

For this reason, it is sensible to speak with your GP practice before starting medication if shared care is an important part of your plan. Ask whether they consider shared care for adult ADHD medication initiated privately, what documents they require and whether they follow a local protocol. A receptionist may be able to explain the practice process, but a prescribing clinician will usually make the final decision.

Reasons a GP may decline

A refusal does not necessarily mean that your diagnosis is doubted or that treatment is inappropriate. The practice may not have the capacity to undertake the monitoring required, may have a policy limiting arrangements with private providers, or may need more detail about the specialist’s follow-up plan.

Some GPs are also cautious because ADHD medicines are controlled drugs and require careful prescribing. They need confidence that doses have been properly stabilised, relevant risks have been assessed and a specialist remains available to review you.

If your GP declines, private prescribing and follow-up can continue with your psychiatrist. It may be disappointing, but continuity of safe treatment should take priority over rushing an arrangement that does not meet the needs of either practice or patient.

What needs to happen before shared care?

An ADHD shared care agreement is normally considered after a full diagnostic assessment and a period of medication titration. Titration means starting medication carefully and adjusting the dose, where clinically appropriate, to find a balance between meaningful benefit and manageable side effects.

There is no fixed number of weeks that suits everyone. Some people respond well to the first medication and stable dose relatively quickly. Others need slower adjustments, a change in medicine or further consideration of anxiety, depression, sleep difficulties, cardiovascular health or substance use. These are not failures of treatment. They are reasons for personalised care.

Before requesting shared care, your specialist should be able to provide a clear clinical report. This will usually include the diagnostic assessment, relevant medical and psychiatric history, medication trial and current dose, response to treatment, side effects, physical observations, monitoring recommendations and a plan for future specialist review.

The report should also make clear who to contact if the GP has a clinical question. Shared care is safer when responsibilities are specific rather than assumed.

What each clinician usually does

The exact division of responsibilities varies between practices and local protocols. In many arrangements, the psychiatrist retains responsibility for diagnosis, medication initiation, dose adjustments, annual or otherwise scheduled specialist reviews, and advice about complex clinical changes.

The GP may issue repeat prescriptions at the agreed stable dose and arrange routine checks. These can include blood pressure, pulse, weight and discussion of side effects. If there are new concerns - for example, persistent palpitations, a marked mood change, troublesome appetite suppression or reduced medication benefit - the GP may ask the specialist to review treatment before prescribing continues.

You also have an essential role. Take medication exactly as prescribed, attend monitoring and review appointments, request repeat prescriptions in good time, and tell your clinician about changes to your health or other medicines. ADHD medication should not be shared with anyone else, and doses should not be altered without medical advice.

Questions to ask before you begin

Private ADHD treatment is easier to plan when the likely prescribing route is discussed openly from the start. Ask your specialist whether they provide shared-care documentation, when they consider a patient ready for it, and what follow-up reviews are required after the agreement begins.

Ask your GP whether they will consider the proposal before assuming that NHS prescriptions will be available. It is also reasonable to ask what happens if the practice changes its policy, if you move surgery or if your medication needs to change later. A new medicine or dose adjustment may require private prescribing again until the treatment is stable.

You may also want to clarify practical costs. Even where a GP accepts shared care and issues NHS prescriptions, specialist follow-up appointments are usually still required and may remain private. The cost of assessment, titration, letters, reviews and prescriptions should be explained clearly before you proceed.

How specialist follow-up protects your treatment

ADHD does not stay separate from the rest of life. A medication that worked well during a settled period may need reviewing after a new job, pregnancy planning, a significant illness, worsening anxiety, poor sleep or a change in other medication. Sometimes the answer is a dose adjustment; sometimes it is not. Psychological support, workplace adjustments, sleep treatment and strategies for organisation may be equally relevant.

At IamPsychiatry, adult ADHD care is consultant-led and considers the wider biopsychosocial picture alongside medication. A shared-care request is prepared with the aim of giving your GP clear, clinically useful information, while maintaining access to specialist review when your treatment needs attention.

If shared care is not available

If your GP cannot accept shared care, you still have options. Your psychiatrist can continue private prescribing, provided that appropriate appointments and monitoring take place. You can also ask your GP whether their decision relates to missing information that the specialist could provide, although this will not always change the outcome.

Avoid stopping ADHD medication suddenly or seeking prescriptions from unregulated sources because of uncertainty about costs or access. Speak to your prescriber first. They can explain safe options, whether a planned reduction is appropriate, and what support is needed while a longer-term arrangement is considered.

The most useful starting point is a straightforward conversation with both your GP and specialist. When expectations, responsibilities and costs are clear early on, an ADHD shared care agreement has the best chance of supporting treatment that is safe, sustainable and centred on your life.