What is Shared Care?
Shared Care is a formal, written agreement between an ADHD specialist and a General Practitioner (GP) to manage medication and day-to-day monitoring, where roles for prescribing and monitoring are clearly defined and accepted by both the specialist and the GP practice.
The specialist diagnoses ADHD, starts medication, and stabilises the patient, then initiates the agreement so the GP can take over prescribing and day-to-day monitoring. The specialist continues to conduct regular reviews and provides ongoing advice to the GP to ensure continued, safe management of the medication.
Key Principles
- Voluntary Agreement: Shared care is voluntary for your GP practice. We may decline to enter a shared care agreement based on clinical reasons, capacity, or governance concerns. If we decline, your specialist remains responsible for your prescribing.
- Specialist Responsibility: When a specialist starts your treatment, they must initially start and monitor until you reach a stable dose then provide enough medication until a safe transfer of care is agreed upon in writing.
- Communication is Crucial: For your GP to accept shared care, there must be robust communication pathways. Your specialist team must regularly monitor you and be readily available to manage any medication-related issues. If this cannot be assured, your GP cannot safely prescribe medication.
- Controlled Medication: ADHD medications are controlled drugs. A GP can only issue one month’s supply at a time.
Right to Choose (RTC) Providers
An RTC provider is a healthcare provider chosen by an NHS patient in England under the Right to Choose (RTC) policy, allowing patients to select a private or independent specialist, rather than an NHS-run service, for their first appointment for certain conditions like autism and ADHD, provided the provider has an NHS contract and is commissioned by the NHS.
We will consider shared care with RTC providers if all general requirements are met and an ICB-endorsed shared care protocol is in place. However, acceptance remains voluntary. If declined, the RTC provider retains responsibility for ongoing prescribing and monitoring
Private Providers
A private provider is a non-NHS provider where care and prescriptions are privately funded. Many NHS GP surgeries are no longer entering shared care with private providers due to capacity, safety, and limited access to specialist support. Patients are often not fully informed about these challenges.
Shared care applies to NHS services. Combining private prescribing with NHS monitoring raises governance and equity concerns. We may review individual requests based on assurances of clear monitoring pathways, but this is decided on a case-by-case basis. If your GP does not feel competent or if adequate information/ support is not provided, we will decline, and prescribing/monitoring will remain with your private specialist.
Risks with Private/RTC Providers
If a private or RTC provider stops their services or becomes unreachable, we are unable to provide prescriptions. This means you would need to find medication directly from a private provider or seek a new NHS referral, which can lead to considerable delays and a break in your medication supply.
Our Recommendation
As a practice, we recommend the NHS pathway to minimise potential issues in the future, given the risks associated with private/RTC providers ceasing services, but acknowledge that many people may choose other pathways for assessment.
Transfers of Care
- New Patient Registrations: If you are moving to us from a different GP surgery, we cannot offer bridging prescriptions for ADHD medication. Your previous specialist remains responsible for supplying your medication until a formal transfer and new shared care agreement is accepted by a local specialist team.
- Private-to-NHS Transfers: These require a formal NHS referral and acceptance by an NHS ADHD service before GP prescribing is considered.
Changes to Medication
Any changes to your medication dose, strength, formulation, or type can only be made after clear written guidance is received from your specialist team. We cannot act on verbal instructions or copies of private prescriptions alone.
If You Are Going Abroad
If you are abroad for over one month, only a one month supply will be issued due to controlled drug monitoring requirements. You must arrange local supply at your destination for longer stays.
For more information on ADHD care, please visit Frequently Asked Questions (FAQs) :: West Yorkshire Health & Care Partnership