Shared Care and ADHD: Why It Matters and Why It Sometimes Breaks Down

Shared care is the arrangement by which an NHS GP takes over ongoing prescribing of a medication initiated by a specialist. For ADHD, it is the route most adults hope for after private or Right to Choose assessment: a long-term prescription that fits into the existing NHS relationship rather than continuing to pay privately. It is also the most variable part of the UK ADHD pathway and the one most likely to break down. This article explains what shared care is, what shapes it, and what to do when it does not happen.

What shared care is

Shared care is a formal arrangement between a specialist (the initiating clinician) and a GP (the long-term prescriber) where the GP takes over routine prescribing of a medication that has been stabilised by the specialist. The specialist remains responsible for the diagnosis, treatment plan, and any significant clinical decisions; the GP handles the day-to-day prescribing, repeat scripts and dispensing-side issues, with referral back to the specialist if anything changes ^{[1, 4]}.

Shared care is not unique to ADHD. It applies to other medications where the initiating decision is specialist (lithium, biological agents, several immunosuppressants and other complex prescriptions). The legal and clinical framework is the same across these areas.

A shared care agreement is signed by the GP and the specialist, with a clear allocation of responsibilities. It has three components:

• The diagnosis and treatment plan from the specialist
• The agreement of the GP to take on routine prescribing
• The agreement of the local Integrated Care Board (ICB) that this medication and this pathway are within the scope of shared care in that area

All three need to hold for shared care to work.

Why shared care matters to patients

The practical implications of being on or off shared care are substantial:

• Cost. NHS prescribing means standard NHS prescription charges in England (or free prescriptions in Scotland, Wales and Northern Ireland). Private prescribing means the medication is paid for at private cost, which for ADHD stimulants is typically much higher.
• Continuity. A GP-prescribed long-term medication sits inside the patient's existing NHS record, with the GP managing repeat scripts and reviewing alongside other medications.
• Travel and supply. The 28-day quantity rules on Schedule 2 controlled drugs are the same on NHS or private prescription, but the practical supply chain is often smoother on NHS prescription via familiar pharmacies.
• Continued care if circumstances change. A patient moving area, losing income, or facing other disruption is more resilient on NHS shared care than on private prescribing alone.

This is why shared care is the usual goal after private or Right to Choose assessment and titration.

Why shared care sometimes does not happen

Several reasons account for shared care being declined ^{[1, 4, 5]}:

The ICB has not commissioned shared care for ADHD medication initiated privately

This is the most common cause. ICBs (the new commissioning bodies, replacing CCGs) decide locally whether to commission shared care for specific medications and specific initiating routes. Some ICBs accept shared care for ADHD medication regardless of where the diagnosis was made; others accept it only after NHS assessment; others decline entirely.

The result is a postcode lottery. Two patients with identical diagnoses and identical medication plans, from the same private clinic, can have very different shared care outcomes depending on which ICB area they live in.

The GP practice declines individually

Even within an ICB that has commissioned shared care, individual GP practices can decline a specific request. This is more common where the GP is unfamiliar with ADHD prescribing, where the practice has concerns about controlled drug responsibilities, or where the practice has decided not to take on shared care for ADHD at all. NICE NG87 explicitly addresses this: shared care for ADHD is part of the recognised pathway, but the GP's individual willingness to take on the responsibility cannot be compelled ^[1].

The specialist report does not meet expectations

GPs accepting shared care need a specialist report that meets a clear standard: a documented diagnosis using recognised criteria, a clear treatment plan, baseline and monitoring data, and a named specialist available for ongoing input. A report that lacks these is unlikely to be accepted, regardless of the ICB position. What a good ADHD diagnosis looks like and whether the NHS accepts a private one covers this in detail.

The patient is not yet stable

Shared care is for the long-term steady state. A patient still in active titration is not ready for shared care. Most clinicians wait at least three months on a specific medication and dose before initiating a shared care request.

How NeuroFX approaches shared care

NeuroFX's standard approach to ADHD medication after diagnosis runs as follows:

• Specialist titration over approximately three months, with the structured reviews described in the titration article in this library
• Once a working dose is stable, a formal shared care request is sent to the patient's NHS GP
• If the GP and the local ICB accept, ongoing prescribing transfers to NHS shared care
• If shared care is declined, NeuroFX offers continued private prescribing through the ADHD medication and prescribing with NeuroFX pathway

The handover, where it happens, is a real handover: the specialist remains available for ongoing input, but the GP takes on the routine prescribing. Where shared care is declined, the patient keeps the same specialist relationship and continues to be reviewed at the specialist level.

What patients can do where shared care is uncertain

Several practical points help ^{[1, 5]}:

• Check the local ICB's position before starting private assessment. ICBs publish prescribing policies and shared care guidance. Some clearly accept ADHD shared care from private assessment; others do not. NeuroFX clinicians can advise on the local picture.
• Choose a specialist whose reports meet recognised standards. The diagnosis report is the document a GP and ICB will judge. A diagnosis from a CQC-registered provider, made using NICE-aligned methodology, with clear baseline monitoring data, is more likely to be accepted.
• Stay in active treatment. Shared care is not a one-off event. It depends on continued specialist availability and patient stability. A patient who stops engaging with reviews can find shared care withdrawn.
• Plan for the possibility of declined shared care. Continued private prescribing is a real option and many patients use it; the cost is significant but is the trade-off for faster assessment and continued specialist care.

Where the system is heading

Shared care variability has been recognised by NHS England and the Royal College of Psychiatrists as a problem for ADHD specifically ^[4]. National-level work is in progress to standardise the position across ICBs, but progress is gradual and the postcode lottery remains the day-to-day reality.

In the meantime, the practical picture is that some patients move smoothly onto NHS shared care and others continue on private prescribing. Neither outcome is a clinical failure; both are common.

What this means in practice

• Shared care is the long-term goal after private or Right to Choose ADHD assessment and titration, where the local ICB and GP accept it.
• Whether shared care is accepted depends on ICB policy, individual GP willingness, the quality of the specialist report and patient stability.
• A postcode lottery is the current reality across UK ICBs.
• Where shared care is declined, continued private prescribing is a routine option, not a failure of the diagnosis.
• The diagnosis report is the document on which a shared care request will be judged. A clear, NICE-aligned report from a CQC-registered provider is more likely to be accepted.

When to speak to a professional

Speak to your GP, your prescriber or NHS 111 if you experience any clinical concern about your ADHD medication. Speak to your specialist prescriber about shared care plans and timing, particularly if your local ICB position is unclear. NeuroFX provides private adult ADHD assessment, specialist titration and ongoing prescribing where shared care is not available.

Sources

1. NICE. Attention deficit hyperactivity disorder: diagnosis and management. NG87. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ng87
2. British National Formulary. Methylphenidate hydrochloride. https://bnf.nice.org.uk/drugs/methylphenidate-hydrochloride/
3. British National Formulary. Lisdexamfetamine mesilate. https://bnf.nice.org.uk/drugs/lisdexamfetamine-mesilate/
4. Royal College of Psychiatrists. Shared care guidance for ADHD. https://www.rcpsych.ac.uk/
5. NHS England. Integrated Care Boards. https://www.england.nhs.uk/integratedcare/