ADHD shared care: what it is and who decides

ADHD shared care is an arrangement in which a GP may take over prescribing ADHD medication that a specialist started. The Department of Health and Social Care (DHSC) describes shared care within the NHS as “a voluntary arrangement”, and the General Medical Council (GMC) says it “requires the agreement of all parties, including the patient”. NHS England and the British Medical Association (BMA), for practices in England, also say a GP need not agree.

This is general information, not medical advice. It cannot tell you whether a particular GP practice will agree.

What is an ADHD shared care agreement?

The NHS website for England (the review date shown on its ADHD pages is 19 March 2025) says ADHD medicines “must be started and monitored by an ADHD specialist”. It says a GP “may be able to take over prescribing ADHD medicines, but only if there is a ‘shared care agreement’” between the GP and the ADHD specialist. These sentences appear on its pages for adults and for children and young people, and on the matching NHS 111 Wales pages (last updated 04/07/2025), which say they were adapted from the NHS website.

NICE’s ADHD guideline, NG87 (published March 2018, last updated September 2019), recommends that “After titration and dose stabilisation, prescribing and monitoring of ADHD medication should be carried out under Shared Care Protocol arrangements with primary care.” NICE says its guidelines are for “health and care in England and Wales”.

NHS England’s 2018 guidance on prescribing responsibility between primary and secondary care describes shared care as “a particular form of the transfer of clinical responsibility from a hospital or specialist service to general practice”. It says that when a specialist considers a patient’s condition “stable or predictable”, “they may seek the agreement of the GP concerned (and the patient) to share their care”. The guidance does not mention ADHD (we searched its text on 10 October 2026).

NHS England also publishes national template shared care protocols (SCPs). Its page (updated 29 July 2025) says: “There is no legal obligation nor mandatory requirement to use the SCPs.” It also says there are “currently no plans for NHS England to update these shared care protocols” and, because the review date (January 2025) has passed, advises that “before use, organisations review them through their local medicines governance processes”.

We read five of the protocols, each for a medicine used for ADHD in adult services; all five are dated 4 July 2022. Each lists responsibilities for the specialist, for primary care and for the patient, and these lines appear in all five:

Who decides whether shared care goes ahead?

The GMC’s guidance on prescribing says: “Shared care requires the agreement of all parties, including the patient.” For a doctor who prescribes on another healthcare professional’s proposal, it says the doctor “must be satisfied the prescription is needed, appropriate for the patient, within the limits of your competence” and have “enough information to safely proceed”. It adds: “you will be responsible for the steps you take to make sure that the prescription is appropriate, necessary and safe”.

The GMC says its work supports “good, safe patient care across the UK”; the shared care section itself names no nation, and its endnote says “see resources published by NHS England, Welsh Medicines Information Centre, NHS Scotland health boards and Health and Social Care in Northern Ireland”. The guidance came into effect on 5 April 2021, and its landing page lists updates on 15 March 2022 and 13 December 2024.

The DHSC gave a written answer on 17 March 2026 to a parliamentary question headed “ADHD: Drugs”. It said “Decisions regarding shared care agreements are made locally”, and that the GMC “has made it clear that GPs are not contractually obliged to enter shared care agreements and may decline requests on clinical or capacity grounds”. The second statement is the Department’s description of the GMC’s position, and the answer does not say which nations it covers.

NHS England’s 2018 guidance says the provision of shared care prescribing guidelines “does not necessarily mean that the GP has to agree to and accept clinical and legal responsibility for prescribing”, and that a GP “should only do so if they feel clinically confident in managing that condition”. It says “Referral to the GP should only take place once the GP has agreed to this in each individual case”, and that “the hospital or specialist will continue to provide prescriptions until a successful transfer of responsibilities”.

The BMA’s guidance for GP practices in England (updated 9 September 2026) says: “Shared care prescribing is non-core voluntary activity that can be declined by the GP practice for any reason.” It says this includes “Inadequate capacity within the practice”, “Inadequate competency about the specialist medication, despite training” and “Lack of assurance to provide the ongoing specialist support required for shared care.” It adds: “you should ensure any refusal is consistent and framed by a set of principles so it is not discriminatory to specific patient groups.”

The same page lists principles that it says “should apply to all shared care prescribing”. One is that “The GP practice is satisfied with the quality assurance and clinical governance of the specialist provider”, which it says “will be more challenging if the provider is not commissioned by the NHS”. It also says the local commissioner or Local Medical Committee (LMC) “may have a policy on shared care with private providers”.

Does a private diagnosis lead to shared care?

Not automatically: two decisions are involved. The specialist, which may be a private provider, decides whether to ask the GP practice, as NHS England’s 2018 guidance describes. The GP practice then decides whether to accept. A request going out is not an agreement.

The BMA’s guidance for practices in England on responding to private healthcare (GPC England; updated 31 August 2023) says shared care with private providers “is not recommended due to the general NHS constitution principle of keeping as clear a separation as possible between private and NHS care”. It adds: “A private patient seeking access to shared care should therefore have their care completely transferred to the NHS.”

The same BMA page says: “Shared care may be appropriate where private providers are providing commissioned NHS services and where appropriate shared care arrangements are in place.” The two BMA pages we read do not use the phrase “Right to Choose” (we searched both on 10 October 2026).

A page from Norfolk and Suffolk integrated care board (ICB) for people in Suffolk considering a private assessment (no date shown on the page) says: “Your GP has the right to refuse to prescribe ADHD medication on the NHS if you paid for a private assessment and diagnosis.” It also says an NHS clinician “cannot be compelled to accept a diagnosis made following a privately funded assessment and may disagree with the diagnosis you have been given”.

The Royal College of Psychiatrists’ page for adults (published June 2023) says specialist NHS adult ADHD services “will check that your report includes all of the detail [listed on its page] before accepting you into the NHS service”, and advises that “before getting an assessment from an alternative provider you should make sure that it will be accepted by your local NHS service”.

The ADHD Taskforce that NHS England commissioned says in Part 2 of its report (November 2025) that there are “anecdotal reports of low-quality ADHD assessment and inaccurate diagnosis provided by some ADHD services”. It says this mistrust “poses further challenges for people with ADHD”, including “having to seek additional assessments when they move geographical areas, change provider or require GP shared care”. The sentences quoted here do not say whether those services are private or NHS. The report also says shared care protocols for ADHD “have been available for many years but these have become more problematic in recent years with many arrangements no longer in place”.

The evidence summary in Part 2 of the Taskforce report (Annex 3, updated June 2025) says data “suggest that support for GPs to prescribe ADHD medication is patchy”, citing two 2024 papers. That sentence is about the support available to GPs; it gives no figure for how many GPs agree to shared care.

One of the two papers, by Price and colleagues in the British Journal of General Practice, reported surveys in England from October 2022, including convenience samples of health professionals and of people with lived experience of ADHD. Its abstract concludes: “Elements supporting appropriate shared-care prescribing of ADHD medication via primary care are not universally available in England.” The authors say the convenience sample “is likely to have been biased towards responders with high levels of interest in ADHD and/or those experiencing challenges”.