Shared care for ADHD medication in Scotland

What shared care is, what the reality of it is in Scotland, and what to do if your GP refuses

Reviewed by ADHD Scot,

What is shared care?

Shared care is how your NHS GP takes over prescribing ADHD medication that a private specialist has recommended. Once a Shared Care Agreement (SCA) is in place, your GP issues regular prescriptions on the NHS, meaning you no longer pay privately for your medication each month.

The model exists because ADHD medication requires ongoing monitoring. It is a three-way arrangement: your private specialist retains clinical responsibility for oversight and dose adjustments, your GP handles the prescriptions, and you remain engaged with both. Regular reviews with your specialist continue; shared care is not a handover to the NHS, and your specialist does not step away once your GP starts prescribing.

All NHS prescriptions in Scotland are free at the point of dispensing, so shared care can mean a significant saving compared to private prescribing.

The reality of shared care in Scotland

NHS Scotland Right Decisions guidance supports shared care for ADHD medication where a private specialist has made a diagnosis and established a stable prescription. GPs are not required to accept every request, but they should not routinely refuse without clear clinical grounds.

In practice, acceptance varies enormously: between health boards, between practices within the same board, and even between individual GPs at the same practice. Many GPs are not accepting any shared care requests at all. Always speak with your GP before booking a private assessment. This is one of the most significant structural problems in ADHD care in Scotland.

One thing that surprises many people: a recommendation from a private specialist does not automatically entitle you to NHS prescriptions. The NAIT guidance (2022) is explicit on this: your GP has both the right and the responsibility to satisfy themselves that the private assessment was thorough (that appropriate checks were carried out, that other possible explanations for your symptoms were considered, and that there are clear arrangements for ongoing monitoring) before agreeing to prescribe. A brief assessment with a thin report and no monitoring plan gives your GP legitimate clinical grounds to hesitate. Understanding this from the start can help you choose a provider who makes the shared care process much more straightforward.

How clinical correspondence affects shared care decisions

GPs are often not ADHD specialists, and when considering a shared care request they rely heavily on the clinical letter or report they receive from the diagnosing provider. The quality and clarity of that letter can make the difference between a yes and a no.

Your GP will typically want that letter to show: that the assessment included information from someone who knows you well and evidence of your presentation in childhood (not just your own account at the time of assessment); that other possible explanations for your symptoms were considered and ruled out; that your cardiac history and current medications were reviewed before medication was recommended; and that there are clear arrangements for who monitors you ongoing and who holds clinical responsibility. A letter that addresses these points gives your GP the confidence to agree. One that doesn't can leave them in a genuinely difficult position, even when they want to help.

When choosing a provider, ask what their shared care letters typically include and whether they have experience supporting shared care with Scottish GPs.

What to do if your GP refuses

  1. Ask for their reasons in writing. This creates a record and sometimes prompts reconsideration
  2. Ask your private specialist to write directly to your GP. A detailed clinical letter explaining the diagnosis, the medication, and the monitoring arrangements often makes the difference. Many good providers do this proactively; others will do it if asked
  3. Ask another GP at the same practice. If one GP refuses, a colleague may be more familiar with ADHD shared care and willing to take it on
  4. Contact Patient Advice and Support Service (PASS)
  5. Ask your health board. Some Scottish health boards have formal pathways for NHS follow-up after private diagnosis; others do not. Ask directly
  6. Continue with private prescribing for now. If your GP continues to refuse without clinical grounds, your private specialist can continue prescribing while you work through the steps above

Shared care is not permanent by default

A shared care agreement does not automatically follow you to a new GP practice. These are the circumstances in which it can end:

  • Your GP leaves the practice. A new GP is not automatically bound by an agreement their predecessor entered into. If the practice does not have a clear protocol, it may not be renewed without prompting
  • You move to a new GP practice. Shared care does not transfer automatically. You will need to request it from your new practice, and they may decline. Starting the process early, before you move, gives you the best chance of a smooth transition
  • The practice changes its policy. Some practices have quietly moved away from new shared care arrangements, sometimes without informing existing patients until a prescription is due

If you are on shared care, keep a copy of the agreement letter and the contact details for your private specialist. If it lapses, you will need to re-establish it, potentially from scratch.

What to look for when choosing a provider

Not all private providers take an active role in supporting shared care, but most do, especially if they offer medication prescribing and titration. Before you commit, ask:

  • Will you write a personalised shared care letter to my GP, not a template?
  • Does your assessment include collateral information from someone who knows me, and evidence of childhood presentation?
  • Is my cardiac history and current medication reviewed before medication is recommended?
  • What are your ongoing monitoring arrangements, and who holds clinical responsibility for my care after diagnosis?
  • Do you have experience supporting shared care with Scottish GPs specifically?
  • If my GP declines, can you continue to prescribe, and at what cost?

Our Compare providers tool shows which providers include shared care support as part of their service.

If shared care is declined: what private prescribing costs

If you cannot access shared care, you will need to continue with private prescriptions if you wish to continue being prescribed medication. The cost has two components: the private prescription fee charged by your clinic or prescriber (costs vary; some Scottish providers charge from around £30, others more, as of 2026; check current rates with your provider) and the cost of the medication itself at a pharmacy.

Private prescriptions can be dispensed at any pharmacy, including standard high street pharmacies, not only specialist private ones. Medication costs vary between pharmacies, so shop around. You are not required to use a pharmacy your clinic recommends.

Useful contacts and further reading

ADHD Scot is an independent, non-clinical information project. Nothing here is medical advice. Always speak to your GP or specialist about your own prescribing arrangements.

Reviewed by ADHD Scot,