Understanding the Partnership Between You, Your GP, and Your Psychiatrist

When you’re diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) as an adult, the next crucial step often involves finding the right balance between ongoing treatment, medication management, and consistent support. This is where a Shared Care Agreement (SCA) comes into play a system designed to make ADHD care more accessible, collaborative, and sustainable.

Under the NICE guidance (2018) on the diagnosis and management of ADHD in adults, once your treatment and dosage have been stabilised by a specialist, your prescribing and monitoring can be transferred to your General Practitioner (GP) but only under a Shared Care Protocol.

In simple terms, shared care is about ensuring that you continue to receive high-quality, safe, and consistent treatment with both your psychiatrist and your GP sharing responsibilities appropriately.

What Is a Shared Care Agreement?

A Shared Care Agreement is a formal understanding between you, your GP, and your psychiatrist that allows your ADHD medication and treatment to be managed jointly. Your psychiatrist remains responsible for diagnosis, initial titration, and ongoing specialist input, while your GP helps by continuing prescriptions and conducting regular monitoring once the medication is stable.

It’s important to note that this is not a legal obligation for your GP. Instead, it’s a professional arrangement based on mutual trust and clinical confidence. GPs may choose to accept shared care if they are comfortable with the medication, guidance, and support provided by the psychiatrist.

The goal of shared care is to reduce fragmentation in ADHD management making it easier for you to receive prescriptions locally while maintaining specialist oversight.

How Does a Shared Care Agreement Work?

The shared care process usually begins after your ADHD medication has been titrated (that is, your dosage has been adjusted until it’s safe and effective). Once your psychiatrist is confident that your dose is stable, they can write to your GP to propose a Shared Care Agreement.

Here’s how it typically unfolds:

1. Initial Assessment and Titration
   Your psychiatrist performs a comprehensive assessment, confirms your ADHD diagnosis, and starts your medication. During the titration phase, your specialist monitors your response, side effects, and progress.
2. Stabilisation Phase
   Once your medication and dosage are stable meaning your symptoms are well-managed and you’re tolerating the medicine your psychiatrist may recommend transferring prescribing responsibilities to your GP under a shared care arrangement.
3. Shared Care Request
   Your specialist sends a written request to your GP, including detailed clinical information such as diagnosis, medication type, dosage, and monitoring requirements.
4. GP’s Decision
   Your GP reviews the request and decides whether to accept it. They are under no legal obligation to do so. Acceptance often depends on the GP’s familiarity with ADHD medications, capacity, and confidence in the shared care process.
5. Ongoing Monitoring
   Once the agreement is signed, your GP issues repeat prescriptions and conducts necessary health checks (for example, blood pressure, pulse, and weight). Your psychiatrist remains available for specialist advice and follow-ups.

Why Shared Care Agreements Exist

Shared Care Agreements bridge the gap between specialist and primary care. They are designed to:

• Ensure continuity of care after diagnosis and titration.
• Reduce the need for patients to travel to specialist clinics for repeat prescriptions.
• Enable GPs to support long-term medication management with input from a specialist.
• Improve patient safety through shared monitoring and clear communication.
• Enhance accessibility and reduce NHS waiting times for follow-up care.

When a shared care agreement works smoothly, patients benefit from consistent support and easier access to medication while remaining under specialist guidance.

What If Your GP Refuses Shared Care?

A GP is fully entitled to refuse to enter a Shared Care Agreement if they feel uncomfortable with the level of responsibility, lack of resources, or clinical confidence in prescribing ADHD medication.

If this happens, your psychiatrist must continue managing your care — including issuing private prescriptions or arranging ongoing NHS follow-ups. However, this can sometimes increase costs or waiting times.

Here’s what you can do if your GP declines to sign a shared care agreement:

1. Request a Meeting
   Schedule a calm discussion with your GP. Explain how the medication impacts your daily life and how lack of access could affect your work, relationships, and wellbeing.
2. Refer to NHS Guidance
   The NHS states that care should not be withdrawn or restricted because a patient seeks private treatment. You can ask your GP or practice manager to explain how their decision aligns with this guidance.
3. Ask for an NHS Referral
   If your GP does not accept your private diagnosis, ask whether they can refer you through the NHS pathway and take on shared care after your medication has stabilised through that route.
4. Consider Changing GP Practice
   If all else fails, you may choose to move to a GP who is open to shared care. Before switching, confirm in advance that the new practice supports shared care for adult ADHD.

Shared Care in Private and NHS Pathways

Shared Care Agreements are more straightforward when the ADHD diagnosis and treatment come from within the NHS system, as communication and protocols are standardised.

However, many adults receive ADHD assessments privately often through recognised clinics that follow NHS standards. In such cases, some GPs may be reluctant to sign SCAs because they feel they were not directly involved in the diagnosis or titration process.

That said, shared care between private clinics and NHS GPs is common, especially when the private clinic provides care on behalf of the NHS through schemes such as Right to Choose (RTC).

If your diagnosis was through RTC, your GP is usually expected to participate in shared care as part of NHS provision.

The Role of the General Medical Council (GMC)

The GMC’s ethical guidance on shared care emphasises that doctors must work collaboratively in the best interests of patients. It states that when care is shared between professionals, clear communication and documentation are essential to ensure safe prescribing and consistent treatment.

This means your psychiatrist must provide full clinical details, and your GP must feel confident in their ability to continue care. The GMC does not require GPs to accept shared care but encourages cooperation wherever it benefits the patient.

What If Your GP Says “There’s No ADHD Service in Your Area”?

In England and Wales, NICE guidance ensures that all adults are entitled to an ADHD assessment. If your GP tells you there are no services available locally, you can:

• Ask to be referred under the Right to Choose scheme in England.
• Submit an Individual Funding Request (IFR) if Right to Choose is not applicable.
• Patients in Wales or Northern Ireland can follow local IFR processes specific to their region.
• Patients in Scotland can refer to the Royal College of Psychiatrists’ good practice guidelines, as Scotland does not directly follow NICE guidance.

Key Benefits of a Shared Care Agreement

1. Continuity of Care – You stay connected to both specialist and primary care providers.
2. Local Access to Medication – Prescriptions are managed conveniently through your GP.
3. Shared Responsibility – Your psychiatrist oversees treatment, while your GP handles practical prescribing and monitoring.
4. Improved Safety – Regular communication ensures side effects and dosage changes are closely tracked.
5. Reduced Costs – For NHS patients, shared care can eliminate the need for private prescriptions.

Challenges in Shared Care

While shared care offers many benefits, challenges do exist. These include:

• GP reluctance due to unfamiliarity with ADHD medication.
• Lack of resources in busy primary care settings.
• Limited communication between private clinics and NHS systems.
• Inconsistent regional policies across NHS trusts.

However, ongoing education, national awareness, and advocacy from ADHD organisations are helping bridge these gaps.

Moving Forward: Empowering Patients and Practitioners

Shared care works best when all parties patient, GP, and psychiatrist collaborate openly. As an adult with ADHD, it’s essential to stay informed about your rights, understand your treatment plan, and communicate regularly with your healthcare providers.

Many GPs are becoming more receptive to shared care as awareness of adult ADHD grows. Likewise, private clinics are improving coordination and documentation to make shared care easier and safer for everyone involved.

Ultimately, shared care is about empowering patients to live healthier, more balanced lives with consistent access to medication and a multidisciplinary support system.

Conclusion

A Shared Care Agreement isn’t just a piece of paperwork; it’s a partnership built on communication, trust, and shared responsibility. It ensures that adults with ADHD receive continuous, safe, and affordable care that bridges specialist expertise and local accessibility.

If your GP refuses shared care, don’t lose hope. There are still pathways to continue treatment, including NHS referrals, Right to Choose, and advocacy through patient rights. With the right information and persistence, shared care can help you maintain stability, access treatment easily, and move forward confidently with your ADHD management plan.