ADHD Shared Care and What Happens if Your GP Refuses
Shared care is a voluntary arrangement in which your GP takes over prescribing your ADHD medication after a specialist has settled your dose. Your GP is not obliged to accept it and can decline. If yours declines, your specialist may continue prescribing, depending on your pathway.
This guide is for adults who already have an ADHD diagnosis and are on, or close to, a stable dose, as well as parents of a diagnosed child.
What a Shared Care Agreement Actually Is
1
Assessment
Your specialist assesses you and discusses whether medication is appropriate.
2
Titration
Medication is started and the dose is adjusted until a stable, effective dose is established.
3
Shared Care Request
Once your dose is settled, your specialist writes to your GP proposing shared care.
4
Ongoing Care
If accepted, your GP issues NHS prescriptions and carries out routine monitoring
Can Your GP Refuse? Yes, and Here Is the Actual Rule
Shared care is voluntary. Your GP can decline a shared care agreement on clinical or capacity grounds and should explain the reason for their decision.
Your GP Does Not Have to Accept
There is no NHS rule requiring your GP to enter a shared care arrangement.
A Reason Should Be Recorded
If your GP declines, the reason should be recorded and there should be clarity about who will prescribe next.
Why Shared Care Requests May Be Refused
Local Policies
Some practices may follow local policies about accepting shared care arrangements.
Clinical or Capacity Reasons
A GP may decide they cannot safely take on the prescribing or monitoring responsibilities.
Private and NHS Care Policies
Policies around shared care with private providers can vary between practices and local NHS systems.
Which Route Applies to You?
1
Your GP has accepted
2
The letter has gone but your GP has not replied
3
Your GP declined and you are a private patient
4
Your GP declined and your assessment was NHS-funded
5
You are not on a stable dose yet
The Five Shared Care Routes
01.
Your GP Has Accepted Shared Care
Your GP now issues NHS prescriptions. Your specialist remains involved, stays available to your GP for advice and carries out your annual review.
Shared care can later end if your dose changes, a new health concern arises, or the practice withdraws from the relevant protocol.
Who prescribes: GP
Your cost: NHS prescription charge or exemption
Next step: Continue routine monitoring and specialist reviews.
02.
Your GP Has Not Replied
If the shared care letter has been sent but your GP has not responded, first confirm that the clinic sent it to the correct address and ask your practice to log it.
The NHS Payment Scheme uses 21 days without a response as a relevant benchmark for NHS-commissioned providers, although this is not a legal deadline for your GP.
Who prescribes: Existing prescriber while unresolved
Next step: Confirm the letter, chase the practice and contact your prescriber before your medication runs low.
03.
Your GP Declined — Private Patient
If you are a private patient, continued prescribing may remain with your specialist where clinically appropriate.
Private ongoing care may involve:
- Repeat prescription fees
- Pharmacy medication costs
- Annual review
- Potential future shared care request
04.
Your GP Declined — NHS-Funded Patient
Your next route depends on the NHS-funded pathway through which you were assessed.
What happens next depends on the NHS-funded pathway through which you were assessed. If your GP declines shared care, contact your specialist or provider to confirm who will continue prescribing and how your medication will be managed. Arrangements can vary between NHS and Right to Choose pathways.
05.
You Are Not on a Stable Dose Yet
Shared care cannot begin while your dose is still being adjusted.
Complete titration first. Once a stable and effective dose has been established, your specialist can consider sending the shared care request.
Next step: Complete titration.
What the NHS Now Pays When Shared Care Is Refused
With Shared Care
Without Shared Care
Adult ADHD Annual Review (with medication)
£144.88
£247.61
Adult ADHD Annual Review (without medication)
£108.30
£175.06
Annual prescription item
£12.58
£21.55
Controlled drug allowance
£9.23
£9.23
What It Costs You, Either Way
Cost
GP Accepts Shared Care
GP Declines — Private
GP Declines — NHS-Funded
Shared care letter
Applicable
Applicable
Pathway dependent
Prescription
NHS
Private
Pathway dependent
Medication
NHS/private pharmacy cost
Private pharmacy cost
Pathway dependent
Annual review
Specialist review
Private review
Pathway dependent
Ongoing prescribing
GP
Specialist
Provider/pathway dependent
How the Shared Care Request Works
01.
Reach a Stable Dose
Your specialist completes titration and establishes a stable treatment plan.
02.
Specialist Prepares the Request
Your specialist prepares the shared care letter with your diagnosis, medication, dose and monitoring information.
03.
Letter Is Sent to Your GP
The request explains what responsibilities your GP is being asked to take on.
04.
Your GP Reviews the Request
Your GP decides whether they can accept shared care.
05.
Shared Care Begins or Prescribing Remains With the Specialist
The next step depends on whether your GP accepts or declines.
NHS & Right to Choose
Ask for the Reason in Writing
Find out whether the refusal is a practice-wide policy or something specific to your case.
Ask for a Fuller Shared Care Letter
Your specialist can provide clearer information about medication, monitoring and the responsibilities being requested.
Confirm Who Will Prescribe
Ask your specialist to clarify the prescribing arrangement while the shared care request remains unresolved.
Check Your NHS-Funded Pathway
If your assessment was NHS-funded, ask whether an ongoing medication pathway applies to you.
Escalate if Appropriate
You can speak to the practice first and then your ICB’s patient services team if necessary.
Check Waiting Times in Your Area
NHS ADHD and autism waiting times can vary depending on the Integrated Care Board covering your GP practice.
Check your wait time
Enter your postcode below to see the current estimated waiting times for Harley Street Mental Health services in your area.
Wait times shown from completion of all required forms. Medication from positive diagnosis.
Private assessments are self-funded and not dependent on your ICB.
Frequently Asked Questions
(FAQs)
If you can’t find what you’re looking for, our team is here to help. Contact us for personalized guidance.
It is an arrangement between your specialist and GP about ongoing prescribing and monitoring. The specialist assesses you, starts medication and adjusts the dose during titration. Once your dose is stable, the specialist can propose shared care. If your GP accepts, the GP takes over NHS prescribing and routine monitoring while the specialist remains involved.
Yes. Shared care is a voluntary arrangement, and a GP is not obliged to accept it. Shared care is not automatic and is not a legal entitlement.
No. Right to Choose allows eligible patients in England to choose an NHS provider for their assessment, but it does not require their GP to accept shared care afterwards. A GP referral is also required to access the Right to Choose route.
Yes. A refusal does not necessarily have to be permanent. Practice policies, staffing and local commissioning arrangements can change. Ask why your GP declined first. If circumstances later change, your specialist may be able to send another shared care request.
If your GP accepts shared care, prescribing moves to the NHS and the usual NHS prescription arrangements apply. If your GP declines and you remain a private patient, you may continue paying private repeat-prescription and pharmacy medication costs. Check the clinic’s current pricing before making decisions based on specific figures.
Not automatically. Recognising a private ADHD diagnosis and agreeing to take over prescribing are two separate decisions. Some GP practices have their own policies on medication initiated privately, so your GP may recognise your diagnosis but still decline the shared care request.
A GP refusing shared care does not automatically mean your medication has to stop. Your specialist may continue prescribing. For private patients, this can mean continuing with private prescriptions and associated costs. The exact position for NHS-funded patients depends on the applicable commissioned pathway.
There is no legal deadline. The page notes that NHS England’s 2026/27 ADHD and autism payment guidance treats 21 days without a response as equivalent to a refusal for the purpose of an NHS-commissioned provider continuing to prescribe. This does not create a 21-day legal obligation for your GP, but it is a reasonable point at which to follow up.
What makes you different to other clinics?
We hand pick all of our clinicians to ensure that they have the same values as us.
This ensures that our service users are actually listened to and are the heart of our treatment plans.
We recognise that diagnosis and treatment plans cannot simply be “one size fits all” and our personalised down to earth approach aims to keep the process as easy as possible.
We will try to keep your costs low where possible. Once you are on the right dose and feeling settled (you may need one or two medication titration appointments to achieve this), you can order your medication through the repeat medication process.
Following two months of being on the same dose, with no further changes, we will consider returning your care to your GP.
Can I see you on the NHS?
We are a private clinic, and therefore you cannot be seen by us as part of the NHS. <br><br>We can write to your GP once you are stable on your treatment to ask them to take over prescribing as part of a Shared Care Agreement, however they are under no obligation to accept this agreement.
Do I need a referral?
Our clinicians can see you directly without a referral, however a condition of all appointments is that you agree for Harley Street Mental Health to copy your GP into all assessment and treatment plans.
We are happy to accept referrals from other clinicians, however this is not necessary to use our service.
What happens during an appointment?
If you have booked a virtual appointment, you will be sent an invitation through our clinic software known as “Semble”. On the day of your appointment, you click the link and will enter into a video interview with one of our clinicians.
If you have booked an in-person appointment you will be greeted by your clinician in the waiting room.
Do you accept insurance?
Currently we do not accept insurance, and all of our assessments and treatment plans are self funded, and therefore we encourage you to look at the “fees” page prior to booking.
Do you prescribe medication?
Our team are able to prescribe medication as part of your treatment plan if this is required. Our prescriptions are private, and therefore you will be liable for the cost of the prescription and the medication.
Hod do I know if the treatment will be beneficial?
Unfortunately, there are no guarantees with psychiatry. All of our clinicians are extremely experienced and prescribe based on the most up to date evidence base. You will be involved in your treatment plans at all stages.
I have a complaint?
We are sorry to hear that you have a complaint. Please see the complaints section of our website or email complaints@hsmh.co.uk where we will endeavour to resolve your complaint in a timely manner.
What are the fees associated with ADHD Assessments?
Please see the fees section on the website. It is important that you are aware of all costs prior to starting treatment. An ADHD assessment costs £715 and lasts approximately 1.5 hours and will include a detailed written report and treatment plan (includes a prescription which will posted to your chosen pharmacy, if medication is considered suitable for you).
The cost of medication will be in addition to this and paid directly to your chosen pharmacy.
We then require service users to attend titration appointments at £150 each where your medication is adjusted until most effective. Once you move on to repeat prescriptions, they will cost £48 for a monthly prescription.
Once you are stable on your medication (around two months of being on the same dose, with no further changes and you feel much better) you can ask us to write to your GP and enter into a shared care agreement which costs £125. Your GP is under no obligation to accept a shared care agreement, and therefore we encourage all service users to discuss this with their GP prior to using our service.
Are you registered with the CQC?
Yes, we have been approved for registration with the Care Quality Commission
I have another question
Please email us on contact@hsmh.co.uk and we will get back to you shortly