Questions about treatment
How do I get a shared care agreement for ADHD medication?
Shared care is an agreed arrangement between you, your specialist and your GP. It usually follows dose adjustment and stabilisation. A specialist’s request does not automatically mean your GP has accepted prescribing responsibility.
This is a UK overview. Local arrangements differ, including between the UK nations and between NHS and private care.
Written and clinically reviewed by Adam OdusholaADHD Advanced Practitioner and Clinical Prescribing Pharmacist
Last updated: Last reviewed: Next review:Key points
- Shared care is an agreed arrangement between you, your specialist and your GP.
- It usually follows dose adjustment and stabilisation.
- A specialist’s request does not automatically mean your GP has accepted prescribing responsibility.
- Your GP can refuse or later withdraw. Your specialist service is then responsible for prescribing until another arrangement is agreed.
Who does what under shared care?
| Person or team | Typical responsibility, confirmed in your agreement | What this means for you |
|---|---|---|
| Specialist | Diagnosis, treatment initiation, dose adjustment, specialist advice and ongoing specialist review | Your specialist service keeps looking after your ADHD: any side effects, questions or changes to your medication, and your ongoing reviews |
| GP | Prescriptions and agreed monitoring after accepting the arrangement | Your GP agrees to issue your prescriptions, which makes collecting your medication easier, and to carry out regular monitoring to check it is still suitable, such as your blood pressure, pulse and weight. What is checked, and how often, depends on the medication and your agreement |
| You | Taking treatment as agreed, attending monitoring and reporting problems | You agree to take the medication as prescribed, to attend your reviews, and to have the monitoring your medication needs |
| Pharmacist | Dispensing, checking the prescription and advising on taking the medicine | Your pharmacist checks the prescription is safe and correct, dispenses the medicine, and can help if a brand changes or supplies run short |
Sources: Good practice in prescribing and managing medicines and devices: shared care; Responsibility for prescribing between primary and secondary/tertiary care.
The agreement should state who acts on abnormal results and who to contact when treatment changes.
What are the steps?
- Ask your specialist whether your treatment is ready for shared care.
- Ask your GP practice what information and local arrangements are needed.
- Your specialist sends the assessment, current treatment plan, monitoring results and proposed responsibilities.
- Confirm whether the GP has accepted, and when the transfer starts.
- Confirm who will issue your next prescription and arrange your next checks.
Continue obtaining prescriptions through the existing arrangement until the transfer is explicitly confirmed.
What information should the specialist provide?
The handover should explain the diagnosis, treatment response, exact medicine and dose, relevant risks and recent monitoring.
It should include the review plan, contact details for specialist advice and what to do if side effects or abnormal results occur.
You should receive a clear explanation of your own responsibilities.
Source: Good practice in prescribing and managing medicines and devices: shared care.
What if my GP refuses or cannot accept shared care?
Ask for the reason, in writing if possible, and tell your specialist straight away. Shared care is voluntary for GP practices. A request from your specialist does not oblige the GP to prescribe.
A shared care request is not simply a request for your GP to write prescriptions because a specialist started the medicine. When a GP signs a prescription, they take on the clinical and legal responsibility for it, and for the monitoring that goes with it. So a practice can decline if its clinicians do not feel competent or confident with the medicine, if it is not satisfied with the specialist service’s clinical governance and quality assurance, or if it does not have the capacity or resources to do the monitoring. Practices should apply the same reasons to everyone, so that no group of patients is treated differently.
If the practice declines, your specialist service remains responsible for prescribing until a safe transfer is agreed. Contact them promptly if your supply is becoming uncertain.
Where treatment is private, clarify prescription and review costs while another arrangement is being discussed. A private diagnosis does not automatically establish NHS shared care, and many practices do not accept shared care from private providers.
Sources: Good practice in prescribing and managing medicines and devices: shared care; Responsibility for prescribing between primary and secondary/tertiary care; Principles for Shared Care Prescribing (updated 9 September 2026); Written question UIN 16572 (Prescription Drugs): shared care agreements are voluntary and the specialist keeps prescribing responsibility, answered by the Department of Health and Social Care on 16 July 2026.
What if my GP wants to stop an existing shared care arrangement?
Some practices are withdrawing from shared care for ADHD, especially for people diagnosed privately. A practice can do this, but it should tell you and your specialist in writing and give notice, so that prescribing can pass back without a gap. Some local medical committees have advised practices to give three months’ notice, but there is no national rule.
- Ask the practice for the reason and the date prescribing will stop.
- Contact your specialist service straight away. It is responsible for continued prescribing until another arrangement is agreed.
- In England, ask your local integrated care board (ICB) what ADHD prescribing it has arranged in your area. Some have set up alternative prescribing services.
- Do not let your supply run out while this is sorted. Tell whoever is prescribing if you take guanfacine, because an abrupt interruption needs particular attention.
Sources: Principles for Shared Care Prescribing (updated 9 September 2026); Responsibility for prescribing between primary and secondary/tertiary care; GPs asked to pull out of ADHD shared-care agreements as part of collective action (25 November 2024).
Does shared care mean I no longer need reviews?
No. Prescriptions still need appropriate monitoring and specialist review.
Ask who will check pulse, blood pressure, weight and, for children, growth. Guanfacine has additional monitoring requirements, particularly during dose adjustment.
NICE recommends a medication review at least yearly by a professional with ADHD expertise. Your individual agreement may require more frequent appointments.
Sources: NICE guideline NG87: Attention deficit hyperactivity disorder: diagnosis and management, recommendations; Intuniv (guanfacine): Summary of Product Characteristics.
What if I might run out?
Contact the clinician currently responsible for prescribing as soon as possible. Do not assume the GP, specialist or pharmacist knows a transfer is incomplete.
Tell them if you take guanfacine because an abrupt interruption needs particular attention. Do not ration, stop or restart treatment without advice.
Common questions
Can my GP refuse shared care for ADHD?
Yes. Shared care is voluntary for GP practices, and a practice can decline for reasons such as capacity, competence with the medicine, or concerns about the specialist service’s governance. If it declines, your specialist service remains responsible for your prescriptions until another arrangement is agreed.
Does NICE guidance guarantee that my GP must accept?
No. NICE recommends shared-care arrangements after stabilisation, but the clinicians and patient still need to agree a safe arrangement.
Can shared care be arranged after private treatment?
It may be possible, but it depends on clinical information, local arrangements and acceptance by the professionals involved. In England, an NHS Right to Choose provider holds an NHS contract, so it is not the same as a private clinic: ask which one assessed you, because practices treat them differently. Even then, your GP does not have to accept shared care. Confirm the position before assuming prescriptions will transfer.
Can I stop specialist appointments once the GP prescribes?
Not unless a new care arrangement explicitly says so. Shared care normally continues to involve specialist review and access to advice.
Sources
- NICE guideline NG87: Attention deficit hyperactivity disorder: diagnosis and management, recommendations. NICE
- Good practice in prescribing and managing medicines and devices: shared care. General Medical Council
- Responsibility for prescribing between primary and secondary/tertiary care. NHS England
- Principles for Shared Care Prescribing (updated 9 September 2026). British Medical Association
- The NHS Choice Framework: what choices are available to you in your NHS care. Department of Health and Social Care
- GPs asked to pull out of ADHD shared-care agreements as part of collective action (25 November 2024). Pulse
- Written question UIN 16572 (Prescription Drugs): shared care agreements are voluntary and the specialist keeps prescribing responsibility, answered by the Department of Health and Social Care on 16 July 2026. UK Parliament
- Intuniv (guanfacine): Summary of Product Characteristics. eMC
This page is written for educational purposes and does not constitute medical advice. Always follow the guidance of your prescriber or pharmacist. If you have concerns about your medication, contact your clinical team.
About this page
- Written and clinically reviewed by
- Adam OdusholaADHD Advanced Practitioner and Clinical Prescribing Pharmacist
- First published
- Last updated
- Last reviewed
- Next review
“Last updated” is when the content last changed. “Last reviewed” is when it was last checked against current sources.
How this content is written, sourced and checked: editorial policy
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