Ask for the decision in writing
Formal explanations are useful if policies are unclear or inconsistent.
Ask whether the refusal is practice policy, an individual GP decision, ICB policy, or a temporary restriction.
These are not the same thing.
ADHD Shared Care Agreements Explained
Plain English help with ADHD shared care agreements, GP refusals, Right to Choose, NHS prescribing and private diagnosis.
ADHD shared care in plain English
If you have ADHD and are trying to understand what “shared care” actually means, you are not alone.
A lot of people only discover how important shared care is after diagnosis, when medication starts helping and suddenly there are problems with prescriptions, GP policies, or NHS systems.
The whole thing can feel confusing and inconsistent.
This page explains
- what ADHD shared care agreements are
- how they are supposed to work
- why some GPs refuse them
- how Right to Choose fits into the picture
- what happens after private diagnosis
- why so many people in the UK are struggling with ADHD prescribing
What Is an ADHD Shared Care Agreement?
An ADHD shared care agreement is an arrangement between an ADHD specialist service and your GP.
Usually this means:
- the specialist diagnoses ADHD and manages medication titration
- the GP takes over repeat prescribing once medication is stable
- both services share responsibility for ongoing monitoring
The idea is simple.
ADHD specialists handle the complex parts of diagnosis and medication adjustment.
GPs provide ongoing prescriptions locally once things are settled.
Without shared care, many people would need to continue paying private prescription and monitoring costs indefinitely.
Why ADHD Shared Care Matters
Shared care is often the point where ADHD treatment becomes sustainable long term.
Without it, people may face:
- ongoing private prescription costs
- private review appointments
- delays accessing medication
- uncertainty around treatment continuation
- additional admin and paperwork
For many people, medication is not about becoming “perfect” or “high performing.”
It is about reducing friction.
Being able to start tasks.
Thinking more clearly.
Managing overwhelm more consistently.
Keeping access to treatment stable matters.
Especially after long NHS waiting lists or years spent struggling without support.
Can a GP Refuse ADHD Shared Care?
Yes.
This is one of the biggest sources of confusion and frustration.
GPs are not automatically required to accept ADHD shared care agreements.
Some GP practices accept them routinely.
Some refuse all ADHD shared care.
Others only accept agreements from specific providers.
Policies can vary between:
- GP practices
- NHS areas
- Integrated Care Boards, often called ICBs
- individual clinicians
That means people can receive completely different outcomes depending on where they live or which surgery they are registered with.
This is why many people describe ADHD support in the UK as a postcode lottery.
ADHD Right to Choose and Shared Care
Right to Choose is an NHS pathway in England that allows patients to choose certain alternative providers for ADHD assessment and treatment.
It has helped many people access diagnosis faster than local NHS waiting lists.
Right to Choose does not automatically guarantee shared care afterwards.
This is where many people become confused.
Someone may:
- receive an NHS-funded ADHD diagnosis through Right to Choose
- complete titration correctly
- become stable on medication
- still experience problems with GP prescribing afterwards
You can read more about this in my guide to ADHD support in the UK and my update on NHS Right to Choose changes.
Shared Care After a Private ADHD Diagnosis
Private ADHD diagnosis and shared care is another area where policies vary significantly.
Some GP practices:
- accept private ADHD shared care agreements
- accept some clinics but not others
- require additional NHS review first
- refuse all private-provider shared care
This inconsistency creates a lot of uncertainty for patients.
Many people assume there is one clear national rule around ADHD prescribing.
In reality, local interpretation and policy differences often shape what happens.
I have written more about this in My Shared Care Update December 2024 and ADHD Medication Management and Shared Care Agreements.
Why Are ADHD Shared Care Agreements Becoming More Difficult?
There is no single reason.
Several pressures appear to be contributing:
- increased ADHD referrals
- pressure on GP services
- medication shortages
- inconsistent NHS guidance
- local funding pressures
- concerns around prescribing responsibility
- variation in ADHD knowledge and confidence
Patients often end up caught between systems that interpret guidance differently.
That uncertainty can become stressful very quickly, particularly for people already managing burnout, overwhelm, executive dysfunction or anxiety.
What Can You Do If ADHD Shared Care Is Refused?
Speak to your ADHD provider
Many providers are now familiar with shared care difficulties and may be able to advise.
Consider another GP practice
Some surgeries are significantly more supportive of ADHD treatment than others.
Keep copies of everything
Assessment letters, medication reviews, agreements and email communication can become important later.
ADHD Shared Care and the Wider NHS System
Some GPs are highly supportive of ADHD patients.
Others are working under enormous pressure inside fragmented systems.
The bigger issue is consistency.
Right now, access to ADHD medication support in the UK can depend heavily on:
- location
- local NHS policies
- GP practice interpretation
- provider relationships
- commissioning arrangements
That instability is difficult for patients who are simply trying to maintain treatment and function day to day.
For wider context, you may also find these useful: ADHD NHS Backlog Investigation and The ADHD NHS Taskforce Report Review.
Related ADHD Support Resources
Frequently Asked Questions
Is ADHD shared care guaranteed after diagnosis?
No. GP practices can refuse ADHD shared care agreements.
Can a GP refuse shared care from a private ADHD clinic?
Yes. Some GP practices refuse all private-provider shared care arrangements.
Does Right to Choose guarantee shared care?
No. Right to Choose helps with access to ADHD assessment and treatment, but local GP prescribing decisions may still vary.
Why are people struggling more with ADHD shared care recently?
Pressure on NHS services, medication shortages, increased referrals and inconsistent local policies all appear to be contributing.
Can changing GP practice help?
Sometimes. Different surgeries can have very different approaches to ADHD prescribing and shared care agreements.
Need help making sense of ADHD support?
If you want to talk through ADHD support, workplace pressure, Access to Work, coaching or what might help next, you can send me a message.