ADHD shared-care agreements: how they work and why they matter

ADHD medication needs careful initiation, with dose adjustments and checks of blood pressure, pulse and weight. Once stable, ongoing prescribing is routine. Shared care lets specialists use their expertise at the start and lets GPs provide long-term supervision close to home, with agreed responsibilities. NICE guidance (NG87) says that treatment should be started by a specialist and, when stable, may be continued under shared-care arrangements.

• The specialist assesses, diagnoses, explains risks and starts treatment.

• They titrate the dose and confirm that it is effective and tolerated.

• They then write to the GP with the diagnosis, dose, monitoring requirements and contact for queries.

• The GP prescribes repeats, records monitoring measurements and refers back if problems arise.

• The specialist remains available for advice and periodic review.

GPs may refuse for reasons such as local commissioning policies, lack of confidence in the diagnosing service, unclear monitoring protocols, concerns about workload or concerns about the diagnostic process. Some local health systems have issued guidance on how they treat diagnoses from certain providers. A GP is entitled to say no, but should explain their reason and, ideally, help you find a way forward.

Options include asking the GP what would make shared care possible, asking the diagnosing provider to continue prescribing, which may involve fees if private, requesting a local NHS service review, or asking your integrated care board how it handles such cases. If you are on a stable dose and prescribing is interrupted, do not stop or alter medication yourself without advice, and do not obtain it from unregulated sources.

Some providers offer ongoing private prescribing and monitoring for a fee. Costs vary and add up over time, so ask for full details before choosing this. A private prescriber should monitor blood pressure, pulse and weight regularly and communicate with the GP where you agree.

A written document naming the medicine and dose, monitoring tests and how often, who reviews, what to do if problems arise and contact details. Ask for a copy. Check that your GP has received it before the specialist stops prescribing.

Before you commit to a provider, ask whether they routinely arrange shared care, which local practices have agreed to it, what they do if a GP declines and what ongoing private prescribing would cost. Ask whether they will provide a clear written monitoring protocol for the GP. It is also reasonable to ask your own practice, in advance, whether they would accept shared care for a diagnosis made elsewhere. Knowing the answers early avoids the distress of being diagnosed and then unable to continue treatment.