Guide

Shared care agreement for ADHD: explainer and request letter

A shared care agreement moves routine ADHD prescribing and monitoring from the specialist who started your medication to your GP, on NHS prescriptions, under an agreed protocol. It is voluntary: the British Medical Association describes shared care as a non-core activity a practice can decline, so the letter on this page is a formal request, sent after titration is complete with your provider's paperwork attached. If the practice declines, prescribing stays with the initiating service. Information only, not medical advice.

Information only, not medical advice and not a diagnosis. Never start, stop or change prescription medication without advice from your prescriber. Whether to enter shared care is a clinical and practice decision.

What a shared care agreement actually is

After a private or NHS Right to Choose assessment, the specialist starts medication and adjusts the dose until it is stable (titration). A shared care agreement is the document that then hands routine prescribing and monitoring to your GP: it sets out the prescribing protocol, the checks required (typically blood pressure, pulse and weight at set intervals), and how the specialist stays available for advice and review. For you, the practical difference is NHS prescription charges instead of private prescription fees.

Why practices sometimes say no

Shared care is voluntary. Practices decline on grounds such as clinical governance, monitoring capacity, or local commissioning policy, and the BMA position is that the decision rests with the individual GP or practice. The full picture, including what happens to your prescription if the answer is no, is in can my GP refuse shared care?. If you moved practice recently, also see moving GP on ADHD medication.

The request letter

Replace everything in square brackets and attach your provider's shared care agreement or clinic letter; the request usually cannot be considered without it. Send it to the practice manager or your named GP, and keep a copy.

Dear [practice manager / Dr [GP surname]],

Re: request for shared care for my ADHD medication

I was assessed by [provider name] and diagnosed with ADHD on [date]. Since then I have completed titration and have been stable on [medication name, dose] since [month, year], with [no side effects / side effects noted and managed as set out in the enclosed letter].

[Provider name] has proposed a shared care arrangement and I enclose [their shared care agreement / their clinic letter setting out the proposed arrangement], which covers the prescribing protocol, the monitoring required, and how the specialist remains available for advice and review.

I would be grateful if the practice would consider entering this shared care arrangement so that my routine prescriptions can move to the NHS. I understand that shared care is voluntary and that this is a decision for the practice.

If the practice feels unable to agree, please could you let me know the reasons, and record in my notes that the request was made. I would also welcome any suggestion the practice can make, for example reviewing the decision once [e.g. the local shared care policy or capacity changes].

I am happy to attend any appointment needed, including for monitoring such as blood pressure and pulse checks.

Yours sincerely,
[Your full name]
[Date of birth]
[NHS number, if known]
[Address]
[Date]

Before you send it

• Timing. Practices normally expect titration complete and the dose stable (commonly around 3 months) before considering shared care. Check your provider's own threshold.
• The paperwork does the heavy lifting. A proper shared care agreement sets out who does what; your letter makes the request formally and creates a record.
• If declined. Ask for the reason in writing. Local policies differ by area (integrated care board), so a no in one area is not the rule everywhere, and some practices will review the decision if policy or capacity changes.
• Costs if declined. Ongoing prescribing stays with the provider that started the medication, which usually means continued private prescription and review fees if you went private. Estimate them with the medication cost estimator.

Frequently asked questions

This page is information only, not medical advice and not a diagnosis. Prescribing decisions are always for registered clinicians. If a dispute leaves you unable to get your medication, speak to your prescriber; do not stop suddenly without advice.