What Is an ADHD Shared Care Agreement in the UK?

This guide explains what an ADHD shared care agreement is, how it works, who's responsible for what, and how it can differ between NHS and private care.

ADHD medications are specialist medicines. In the UK, they should be started by a specialist, such as a psychiatrist, specialist nurse prescriber or paediatrician with expertise in ADHD.

Once medication is working well and the dose is stable, it doesn't always make sense for the specialist to keep writing every prescription. A shared care agreement allows the GP to take on day-to-day prescribing and some monitoring, while the specialist stays involved.

The agreement is a written document setting out who's responsible for what. It usually follows a local shared care protocol, agreed by the NHS in your area. In line with NICE guidelines, this is the usual way ADHD medication is managed once someone is stable.

Shared care usually happens in three stages.

1. Diagnosis

First, ADHD is diagnosed through a full specialist assessment. Medication is one option, alongside things like practical strategies, coaching and support at home, school or work.

2. Starting medication and titration

If you decide to try medication, a specialist prescriber starts it. They then go through a process called titration. This means:

• starting on a low dose
• increasing it gradually, usually every week or few weeks
• checking how well it's working, and any side effects
• monitoring heart rate, blood pressure and weight, and height in children

The aim is to find the dose that works best with the fewest side effects. Titration often takes a few months. During this time, prescriptions come from the specialist, not the GP.

3. Shared care

Once your dose is stable, usually for a set period, the specialist may ask your GP to take over prescribing under a shared care agreement. If your GP agrees, prescriptions then come from your GP surgery, while the specialist continues to review your care.

The exact details depend on the local protocol, but responsibilities usually look like this.

The specialist usually

• carries out the assessment and confirms the diagnosis
• discusses treatment options and starts medication
• manages titration until the dose is stable
• writes to the GP to request shared care, with clear information about the medicine and monitoring
• carries out regular reviews, usually at least once a year
• gives advice if problems come up, and takes back care if needed

The GP usually

• decides whether to accept the shared care request
• issues ongoing prescriptions
• carries out routine monitoring, such as heart rate, blood pressure and weight
• contacts the specialist about any concerns, side effects or changes

You, or your child's parent or carer, usually

• take the medication as prescribed
• attend monitoring and review appointments
• let your GP or specialist know about side effects or changes in health
• order prescriptions in good time

Many ADHD medicines are controlled drugs. This means prescriptions are usually limited to a set supply, often up to 30 days, so planning ahead helps avoid gaps.

No. Shared care is voluntary. A GP can decline if, for example:

• they don't feel confident managing the medication
• the local area doesn't have a shared care protocol for adults or children
• they have concerns about the information provided
• the specialist isn't part of an arrangement the local NHS recognises

If your GP declines, they should explain why. It doesn't mean you can't have medication, but you may need to continue getting prescriptions from your specialist, or look at other routes.

Through the NHS

If you're diagnosed and started on medication by an NHS ADHD service, shared care is usually more straightforward. Most local areas have agreed protocols between NHS specialists and GPs.

In England, some people use Right to Choose, which lets you choose an NHS-funded provider for your assessment and treatment. Because these providers are NHS-funded, GPs are often more likely to accept shared care, although it still isn't guaranteed.

Arrangements in Scotland, Wales and Northern Ireland can differ, so it's worth checking with your GP.

Through a private provider

Many people choose a private ADHD assessment to avoid long waiting lists. If you then start medication privately, you may ask your GP for shared care. Some GPs agree. Others don't, often because of local NHS policies about private providers.

If shared care isn't agreed, you'd usually need to continue paying for private prescriptions and reviews. This can be expensive over time, so it's worth thinking about before you start.

Whether you're going through the NHS or a private provider, it can help to ask:

• Does my GP practice accept shared care for ADHD medication?
• Is there a local shared care protocol for adults, children, or both?
• Does my GP accept shared care with this particular provider?
• What happens if my GP declines?
• How much will private prescriptions and reviews cost, if needed?

Your GP practice is usually the best place to start. They can tell you about their policy and any local arrangements.

Raiys doesn't currently prescribe ADHD medication, so we don't offer titration or shared care agreements ourselves.

After your assessment, you'll receive a detailed written report, usually within 14 days. If you'd like to explore medication, you can share your report with your GP to talk about next steps. Your GP may:

• refer you or your child to an NHS ADHD service for medication
• discuss other treatment and support options
• in some cases, ask for further information or their own assessment

Everyone diagnosed at Raiys can also use BeChange, our digital programme designed to help you understand ADHD and build practical, everyday strategies at your own pace.

Raiys works nationwide, offering online ADHD assessments for adults and for children and young people aged 5 to 17 across the UK. Our experienced, specialist ADHD team follows NICE guidelines and provides a clear, detailed report you can share with your GP.

If you're in crisis right now, call 999, go to A&E, or call Samaritans free on 116 123, any time of day or night.

Ready to take the next step? Find out more about our adult ADHD assessment or child ADHD assessment.

Shared care can feel complicated at first. But understanding how it works can help you plan ahead, ask the right questions, and find the route to treatment and support that suits you.