Shared care with your GP - what it is and what to do if they refuse

After an adult ADHD diagnosis in the UK, the intention under NICE guidance is that once your medication dose is stable, your ongoing prescribing moves from the specialist clinic to your NHS GP under a shared care agreement. The specialist retains clinical oversight and does the annual reviews. The GP issues the monthly prescriptions. The patient gets NHS-funded medication instead of paying privately for each dispense.

When shared care works, it is the most cost-effective arrangement in UK adult ADHD care. When it does not, patients can find themselves paying for private prescriptions indefinitely. Here is what the arrangement actually involves and what your realistic options are if your GP declines.

What a shared care agreement is

A shared care agreement (SCA) is a formal written document between three parties: the patient, the specialist ADHD clinic, and the patient's NHS GP practice. It sets out who does what. The specialist takes responsibility for the initial diagnosis, titration, annual reviews, and any dose changes. The GP takes responsibility for issuing the routine monthly prescriptions at NHS cost and monitoring for side effects between reviews.

The specific template used varies by Integrated Care Board (ICB). Most ICBs publish their own ADHD shared care guideline. Well-drafted ones are explicit about who to contact if the patient's symptoms change, how to handle dose adjustments, and what monitoring is required (typically blood pressure, weight, and sometimes heart rate every three to six months).

Why GPs can refuse, and why they sometimes do

A shared care agreement is not a legal obligation. A GP practice can decline to enter into one, and their decision cannot be overturned by the specialist clinic or by the patient's ICB.

There are three main reasons GPs decline.

The first is legitimate clinical governance. ADHD medications are Schedule 2 and 3 controlled drugs. A GP who accepts shared care is accepting personal prescribing liability for a controlled drug whose dose has been set by a specialist the GP has never met. If the practice does not feel confident in its own training on ADHD medication, it may decline until training is in place.

The second is capacity. A typical GP practice has eight to ten minutes per patient. Adding a routine monthly controlled-drug prescription to a list of 2,000 patients per GP is real clinical workload, and many practices are at capacity.

The third, honestly, is cultural. Some practices have a blanket policy of declining ADHD shared care regardless of who the specialist is. This is more common with private specialist diagnoses than with NHS or RTC diagnoses, because some practices view a private diagnosis as a lower-evidence route. This view is not supported by NICE or by the BMA, but it is not illegal.

What to do if your GP refuses

Do not take the refusal personally and do not give up in the first five minutes. There are three productive responses.

First, ask for the reason in writing. Sometimes what looks like a flat refusal is actually "we do not currently have capacity for a new shared care patient, but we could reconsider in six months" or "we accept shared care for NHS-route diagnoses but not for private ones". Knowing which it is tells you what to do next.

Second, if the objection is about private diagnoses specifically, consider Right to Choose as a free NHS-funded route to a second diagnostic confirmation. Some patients end up being assessed privately, then referred back through Right to Choose to get an NHS diagnosis that their GP will accept for shared care. This is not efficient, but it can be the path of least resistance.

Third, if your GP is genuinely unable to take shared care and all other options have been exhausted, private prescribing is the fallback. We continue to prescribe for our patients whose GPs decline shared care. At LoveMyLife your monthly prescription is included in the £149 monthly care subscription and your medication is dispensed by our own pharmacy. The financial impact compared with NHS-funded prescriptions is roughly £1,200 to £1,700 per year in medication cost differential, though it depends which drug you are on and at what dose.

How we help the shared care process

Every patient we diagnose gets a written diagnostic report that is designed to support a shared care request. It contains the full DIVA-5 findings, the DSM-5 criteria-by-criteria reasoning, the titration record, the current stable dose, and a clinical summary written in language NHS GPs are used to reading. We also copy in a standard shared care information pack with the current North Central London SCG template as a starting point, which most ICBs will accept with minor amendments.

If your GP has specific questions or concerns, our clinicians will speak to them directly. This is not a service we charge for. We want your care transitioned successfully, because that is what is best for you.

A final honest note

Shared care is an excellent arrangement when it works, and in the majority of cases it does. If it does not, we are not going to pretend it is not a real financial issue. We will continue to provide your care privately and we will keep the cost as transparent as possible.

Ready to start?

If this article has made you think it is time to find out, the next step is a short consultation with one of our ADHD-trained GPs.

Begin your consultation at this link. Online in 30 minutes, or in person at Westfield London.