If you have received a private ADHD diagnosis and been recommended medication, one of the first practical hurdles you will face is how to actually get that medication prescribed. Most people cannot afford to continue buying private prescriptions indefinitely — and this is where a shared care agreement becomes essential. A shared care agreement (SCA) is a formal arrangement between your private specialist and your NHS GP that allows your GP to prescribe and monitor ADHD medication on behalf of the private clinic, typically at NHS prescription cost.
Key Takeaways
- A shared care agreement lets your NHS GP prescribe ADHD medication after a private diagnosis
- This reduces your medication cost from £80–£200/month private to the NHS prescription charge
- GPs cannot refuse shared care purely on cost grounds — NICE guidance supports GP involvement
- If your GP refuses, escalate via your ICB or PALS before considering private prescription services
What Is an ADHD Shared Care Agreement?
A shared care agreement (SCA) is a formal clinical document that outlines how responsibility for prescribing and monitoring a specialist medication will be shared between a hospital or specialist service and a patient's GP. In the context of ADHD, it typically means that after a private psychiatrist has diagnosed ADHD and initiated a medication titration, they ask your NHS GP to take over ongoing prescribing of that medication.
The agreement sets out clearly what the specialist is responsible for (initial assessment, diagnosis, selecting the appropriate medication, conducting the titration period) and what the GP is responsible for (issuing monthly prescriptions, monitoring blood pressure and weight, noting any side effects, and referring back to the specialist if the patient's condition changes significantly).
Once a SCA is in place, your ADHD medication will typically be available on a standard NHS prescription, costing you the standard prescription charge (currently £9.90 per item in England, or free if you have an NHS prepayment certificate).
Why Do You Need One After a Private Diagnosis?
When you receive a private ADHD diagnosis, the prescribing responsibility sits initially with the private clinic. The clinic's psychiatrist can provide private prescriptions, but these are significantly more expensive — private ADHD medications typically cost £80–£200 per month depending on the drug and dose. For medications that will be taken indefinitely, this cost is unsustainable for most people.
However, GPs are under no automatic obligation to prescribe medications initiated privately. Some GPs are comfortable doing so, particularly for well-understood medications like methylphenidate. Others are not, citing concerns about clinical responsibility, lack of training in ADHD, or local ICB policies that restrict prescribing of specialist medications.
How to Get Your GP to Accept Shared Care
The most important thing you can do is come to your GP appointment well-prepared and with a collaborative rather than confrontational approach. Book a dedicated appointment specifically to discuss shared care. Bring the following: your full written diagnostic report from the private clinic, the specific SCA document or template (most private clinics will provide this), information on the medication recommended including its licensed indication, dose, and monitoring requirements.
NICE guideline NG87 on ADHD and the accompanying Quality Standard QS39 make clear that GPs have a key role in maintaining ADHD medication for stable patients. Your local ICB should have a shared care protocol for ADHD — ask your GP whether their practice has signed up to it, as this often removes individual GPs' concerns about clinical responsibility.
What to Do If Your GP Refuses Shared Care
GP refusal of shared care is unfortunately more common than it should be, but it is not the end of the road. The first step is to request a second opinion within the same practice — ask to see a different GP who may be more familiar with ADHD or more open to the shared care model.
If the whole practice refuses, the next step is to contact your ICB directly. All ICBs have a patient advice team, and some have specific pathways for resolving shared care disputes. PALS (Patient Advice and Liaison Service) can also help you navigate this process and may be able to facilitate a conversation between the GP practice and the specialist clinic.
Frequently Asked Questions
Is my GP legally required to accept a shared care agreement for ADHD?
GPs cannot be forced to prescribe outside their clinical competence, but they cannot refuse on cost grounds alone. NHS and BMA guidance both support shared care as the appropriate model for stable ADHD medication. If refused, escalate to your ICB via PALS.
How long does it take to set up a shared care agreement?
Once your GP agrees in principle, setting up the formal agreement typically takes 2–6 weeks. Your private clinic should provide the SCA documentation; your GP then reviews and countersigns it, and prescribing can begin from the next prescription cycle.
Can I get ADHD medication without a shared care agreement?
Yes — your private clinic can issue private prescriptions directly, but these cost significantly more (£80–£200/month). This is a viable short-term solution while pursuing a shared care arrangement with your GP.