My GP Refused a Shared Care Agreement — What to Do Next

What Is a Shared Care Agreement?

A shared care agreement (SCA) is a formal arrangement between a specialist — such as a private ADHD psychiatrist, clinic, or nurse prescriber — and your NHS GP. The specialist initiates your ADHD medication and finds your optimal dose (a process called titration). Once you are stable, they write to your GP requesting that ongoing prescribing be taken over on the NHS.

In theory, this makes private diagnosis affordable long-term: you pay once for assessment and titration, then receive NHS prescriptions from your GP. In practice, GP refusals have become a serious crisis in UK ADHD care.

Why GPs Refuse Shared Care Agreements

GP refusals are rarely personal — they typically stem from systemic pressures. Understanding the actual reason your GP is refusing is the key to finding the right solution.

• Indemnity concerns: GPs worry about prescribing controlled drugs (stimulants) they did not initiate, particularly from a private provider.
• Unfunded workload: SCAs carry ongoing administrative responsibilities that are not separately funded by the NHS.
• ICB-level policies: Some Integrated Care Boards have issued guidance discouraging or restricting SCA acceptance from certain private providers.
• "Diagnosis mill" concerns: GPs may have received warnings about specific providers they consider to have insufficient diagnostic rigour.
• Lack of familiarity: GPs who rarely see ADHD SCAs may not know their obligations or how to process them.
• Practice policy: Some practices have blanket policies against accepting SCAs from any private provider — despite this being discouraged by NHS England.

Your Rights When a GP Refuses

The legal and regulatory position on GP SCA refusals is clear, even if GPs sometimes claim otherwise:

• NHS England guidance states GPs should not unreasonably refuse to prescribe medication recommended by a specialist.
• GMC Good Medical Practice guidance requires GPs to act in patients' best interests.
• NICE guidelines for ADHD recommend GPs accept shared care from accredited specialists.
• If a GP refuses, they must explain their reasoning — you have the right to request this in writing.

Step-by-Step: What to Do After a Refusal

1. 1

   Get the refusal in writing

   Ask your GP surgery to provide the specific reason for refusal in writing. A vague verbal refusal is very hard to challenge. A written reason tells you exactly which route to take next.

2. 2

   Ask your specialist to liaise directly

   Contact your ADHD specialist and inform them of the refusal. Many experienced specialists have established relationships with GP networks and can advocate on your behalf or clarify concerns about their diagnostic process.

3. 3

   Contact your ICB Patient Advice and Liaison Service (PALS)

   Your ICB's PALS service exists specifically to help patients navigate this kind of situation. They can clarify local SCA policies, escalate formally on your behalf, and facilitate a meeting between your GP and specialist.

4. 4

   Consider changing GP surgery

   You have the right to register with any NHS GP practice that is accepting new patients. Before registering, ask explicitly: "Do you accept shared care agreements from ADHD specialists?" Use our GP Checker to see which surgeries in your area have a track record of accepting SCAs.

5. 5

   Explore pharmacist independent prescriber (PIP) routes

   Pharmacist Independent Prescribers are qualified specialists who can legally prescribe controlled drugs including Elvanse, Ritalin, and Concerta without requiring a GP agreement. This bypasses the shared care problem entirely.

Pharmacist Independent Prescribers: The Alternative Route

Pharmacist Independent Prescribers (PIPs) with ADHD specialisation are the most significant alternative for patients whose GPs refuse shared care. They are registered with the General Pharmaceutical Council (GPhC) and hold independent prescribing authority for controlled drugs under Schedule 2 — which includes most ADHD stimulants.

PIPs can conduct their own assessment (or accept an existing specialist diagnosis), manage titration, and issue prescriptions directly without any GP agreement. In many cases, their appointment fees are lower than psychiatrist-led services, and waiting times are shorter.

How to Find a GP That Accepts Shared Care

Our GP Shared Care Checker lets you look up specific GP surgeries and see whether patients have reported successful or refused shared care agreements — and which ADHD providers those outcomes relate to.

When choosing a new GP surgery, these factors suggest a practice is more likely to accept shared care:

• The practice has a GP with a special interest (GPwSI) in mental health or ADHD.
• The practice is part of a Primary Care Network with an established ADHD shared care protocol.
• Patient reports on our platform show accepted SCAs from your specific specialist.
• The surgery is in an ICB area with an active (not restricted) shared care framework.

Frequently Asked Questions