Switching From Private to NHS ADHD Care: Shared Care Explained

If you've had a private ADHD assessment and started medication with a private prescriber, the logical next step is transferring your prescriptions to your GP. ADHD medication is a controlled substance, typically prescribed monthly, and private prescription costs (£100-200 per month) add up quickly. The mechanism for this transfer is called a shared care agreement, and understanding how it works (and what to do when it doesn't) is essential for anyone on the private-to-NHS pathway.

What a Shared Care Agreement Is

A shared care agreement is a formal arrangement between your private psychiatrist and your GP. The specialist retains clinical oversight of your ADHD treatment (reviewing your medication, adjusting doses, and managing any complications) while your GP handles routine prescribing and basic monitoring (blood pressure, heart rate, weight checks). NICE guideline NG87 recommends this transition: 'After titration and dose stabilisation, prescribing and monitoring of ADHD medication should be carried out under shared care arrangements with primary care.'

In practical terms, once a shared care agreement is in place, you receive your ADHD medication on NHS prescriptions (at standard costs or free if you have a prepayment certificate), your GP sees you for periodic monitoring, and your private psychiatrist conducts annual or six-monthly reviews. The financial difference is significant: NHS prescriptions cost £9.90 per item (or £31.25 for a three-month prepayment certificate) compared to £100-200 per month privately.

Why GPs Refuse

Shared care agreements are not legally binding on GPs. They're a professional courtesy, and GPs can decline them. A 2024 ADHD UK survey found refusal rates of 42% in England, 62% in Northern Ireland, 71% in Scotland, and 81% in Wales. The reasons GPs give typically fall into several categories.

1. 1

   Lack of confidence with ADHD medication. ADHD stimulants are controlled substances (Schedule 2 under the Misuse of Drugs Regulations), and some GPs feel uncomfortable prescribing them without specialist training. This is a training and support issue, not a valid reason to refuse care, but it's the most commonly cited concern.

2. 2

   Local Integrated Care Board (ICB) policy. Some ICBs have policies restricting shared care agreements with private providers, or requiring additional verification steps. Your GP may be willing in principle but blocked by local policy.

3. 3

   Concerns about the private assessment quality. Some GPs are sceptical of private ADHD diagnoses, particularly from less well-known providers. Choosing a reputable, CQC-regulated provider reduces this risk.

4. 4

   Practice-wide policy. Some practices have a blanket policy of not entering shared care agreements with any private providers, regardless of the condition or the quality of the private service.

How to Maximise Your Chances

The most effective step is the simplest: speak to your GP practice before you pay for a private assessment. Ask specifically whether they accept shared care agreements from private ADHD providers, and whether there are any conditions (such as the provider being CQC-registered or using specific assessment tools). Getting this information upfront avoids the situation where you've spent £500-1,200 on an assessment only to discover your GP won't prescribe.

When choosing a private provider, look for CQC registration, GMC-registered clinicians, and a track record of successful shared care transitions. Some providers (like Psychiatry-UK) have established shared care protocols with many GP practices, which can smooth the process. Ask the provider what their shared care acceptance rate is with local GPs; reputable providers will know this figure.

If Your GP Refuses

If your GP declines shared care, you have several options. Ask them to put the refusal in writing and explain their reasoning. This creates a record and sometimes prompts reconsideration. Ask whether the refusal is a personal clinical decision or a practice/ICB policy; these require different responses.

You can register with a different GP practice. In England, you have the right to register with any practice that's accepting new patients in your area. Before transferring, call the new practice and ask about their shared care policy. Some practices are significantly more receptive than others.

You can also ask your GP to refer you to the NHS ADHD service for a confirmatory assessment. This approach uses your private diagnosis as supporting evidence while creating an NHS clinical pathway. Once the NHS service confirms the diagnosis and stabilises your medication, the transfer to GP prescribing follows the standard NHS route, which GPs rarely refuse.

The Titration Phase

Shared care typically begins after titration is complete and your medication is stable. During titration (8-16 weeks), your private psychiatrist adjusts your medication dose through regular reviews. Once the right medication and dose are established, the psychiatrist writes to your GP with the shared care request, including the diagnosis, treatment plan, monitoring requirements, and their commitment to ongoing specialist oversight.

Some GPs accept shared care from the start of titration (particularly if they're comfortable with the medication), while others prefer to wait until the dose is stable. Clarifying this with your GP early prevents surprises during the transition.

Sources

NICE: ADHD guideline NG87 · ADHD UK · Care Quality Commission · Psychiatry-UK · NHS: ADHD · Misuse of Drugs Regulations 2001