Navigating the Shared Care Agreement for ADHD in the UK
- Dor Cohen
- Jan 12
- 5 min read
Updated: Jul 15
For many adults with ADHD in the UK, accessing a diagnosis and ongoing medication management can feel like a labyrinth. A critical component of this journey, especially when seeking private care, is the Shared Care Agreement (SCA). This article aims to provide an up-to-date, comprehensive overview of shared care, its current challenges, and how Mentalwell strives to provide the best possible support for our patients.
What is a Shared Care Agreement (SCA) for ADHD?
A Shared Care Agreement represents a collaborative approach to ADHD medication management, formalising a partnership between your General Practitioner (GP) and an ADHD clinician (such as the expert psychiatrists at Mentalwell). In this model, your clinician conducts your initial ADHD assessment, develops a comprehensive treatment plan, and initiates your medication titration – the crucial process of carefully adjusting your dosage until the optimal balance of benefits and side effects is achieved.
Crucially, the transfer to your GP for shared care takes place only after you have been stable on your medication, following a period of close monitoring through several follow-up titration appointments with your clinician. Once your medication is stabilised, the SCA allows your GP to take over the day-to-day prescribing and routine physical health monitoring. However, it's important to note that most GPs cannot change your prescription (e.g., dosage or medication type) if needed after being transferred; any such adjustments typically require re-engagement with your clinician.
Your clinician maintains an ongoing oversight role, providing expert guidance and reviewing your care as needed, ensuring continuity and expert management. This model is designed to integrate private care with NHS care, ideally simplifying long-term medication access and reducing costs.
The Reality of Shared Care: Challenges and Subjectivity
While the concept of shared care is designed for seamless transitions, the reality in the UK can often be more nuanced. At Mentalwell, patients are required to provide confirmation of their GP's agreement to a Shared Care transfer before the protocol can commence. This proactive step addresses common inquiries about the likelihood of GP acceptance, and it's essential for understanding the current landscape.
Prevalence of GP Refusal: Recent data and patient experiences highlight a concerning trend: a growing prevalence of GPs refusing to enter into shared care agreements for privately initiated ADHD medication.
Anecdotal evidence from patient forums and support groups indicates that this figure might be even higher in some areas, leaving many feeling stranded after investing in private assessments.
Why the Reluctance?
GP refusal is rarely personal but often stems from various factors:
Subjective Discretion: Critically, accepting an SCA is ultimately at the GP's discretion. They are not legally obligated to take over prescribing from a private provider.
Lack of Familiarity/Training: Some GPs may feel they lack sufficient experience in ADHD medication management, particularly with stimulant medications.
Workload Pressures: GPs are under immense pressure, and taking on complex shared care arrangements can add to their already heavy workload.
NHS Funding/Commissioning: Local Integrated Care Boards (ICBs) vary in their approach to funding and supporting shared care for privately initiated prescriptions, leading to inconsistencies across the country.
Liability Concerns: Some GPs may have concerns about clinical responsibility and liability when taking over prescriptions initiated by a private specialist.
Mentalwell's Proactive Approach to Shared Care Success
At Mentalwell, we are keenly aware of these challenges and are dedicated to giving our patients the best possible chance of a successful Shared Care Agreement. Our approach is designed to be as supportive and robust as possible, but we remain transparent that the final decision rests with the individual GP.
Comprehensive & Recognised Assessments: Our online ADHD assessments are conducted by highly qualified psychiatrists and strictly follow NHS best practice guidelines and standardised formats. This rigorous approach ensures that your diagnosis and initial treatment plan are clinically robust and presented in a format that GPs are familiar with and can readily understand. This enhances the likelihood of NHS acceptance.
Detailed Shared Care Request Packs: We provide your GP with a meticulously prepared Shared Care Agreement request pack. This includes your full diagnostic report, detailed titration notes, recommended medication and dosage, and monitoring parameters. We strive to anticipate and address common GP concerns proactively.
Expert Communication & Collaboration: Our clinicians are committed to open communication and collaboration with GPs. We believe in building bridges, not walls. Should your GP have questions or require further clarification, our team is available to provide the necessary information to facilitate a smooth transition.
Dedicated Support for Patients: We guide you through the process of requesting an SCA from your GP. We equip you with the information and understanding needed to have informed conversations with your GP, helping you navigate this often-complex step.
What to Do If Your GP Refuses Shared Care
While Mentalwell provides the strongest possible foundation for an SCA, it's vital to be prepared for potential refusal. If your GP does not agree to a Shared Care Agreement, here are your options:
Understand the Reasons: Request a clear explanation from your GP for their refusal. This can help you address specific concerns or explore alternative solutions.
Escalate Within the Practice: You can ask to speak with another GP within the practice or the practice manager to discuss your situation. Sometimes, different GPs may have different policies or levels of comfort with shared care.
Refer to Guidelines: You can politely refer your GP to NICE Guideline NG87 on ADHD (specifically sections on diagnosis and management), which supports integrated care models. Also, reference the GMC's "Good medical practice" guidance on shared care.
Consider Changing GPs: If repeated attempts are unsuccessful, and you are able to, considering registering with a different GP practice in your area might be an option. Researching practices that are known to be more supportive of shared care for ADHD can be helpful.
Long-Term Private Management: If an SCA isn't feasible, Mentalwell can continue to provide ongoing private medication management and monitoring. While this incurs continued costs, it ensures you maintain access to essential medication and expert psychiatric oversight without interruption.
Key Considerations for Your ADHD Journey
Ongoing Consultant Oversight: Even with a Shared Care Agreement, an annual check-up with your clinician is required to ensure the continued efficacy and safety of your medication, as well as to review your overall ADHD management plan.
Timely Diagnosis: Long NHS waiting lists for ADHD assessments remain a significant barrier. Private assessments, like those offered by Mentalwell, provide a faster pathway to diagnosis and appropriate care, allowing you to begin your treatment journey without unnecessary delay.
Medication Management: Effective ADHD medication requires careful monitoring and adjustment (titration). Ensuring consistent oversight by an experienced professional is paramount for optimal outcomes.
Individualised Approach: The best approach to ADHD management is always highly individualised. Your Mentalwell psychiatrist will work with you to find a solution that best fits your needs, circumstances, and preferences.
At Mentalwell, we are committed to supporting you throughout your ADHD journey, navigating the complexities of the healthcare system to ensure you receive the clarity and care you deserve. We strive to make the path to managing your ADHD as clear and effective as possible, every step of the way.
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