Shared Care Agreements for ADHD Medication: Understanding Your Rights and Options

Shared Care Agreements for ADHD Medication: Understanding Your Rights and Options

NICE Guidance on Shared Care for ADHD

The National Institute for Health and Care Excellence (NICE) issued guidance in 2018 regarding the diagnosis and management of ADHD in adults. It states:

"After titration and dose stabilisation, prescribing and monitoring of ADHD medication should be carried out under Shared Care Protocol arrangements with primary care."

This means that once an individual's ADHD medication has been adjusted to the correct dose and is stable, their care can be shared between a psychiatrist (specialist) and a GP (primary care provider) under an agreed framework.

What Is Shared Care?

A Shared Care Agreement (SCA) is a formal arrangement between a patient, their GP, and their psychiatrist. It enables a GP to continue prescribing ADHD medication and monitor a patient's condition, while the psychiatrist remains involved for specialist oversight when necessary.

For an SCA to be implemented:

• The patient must have a stable dose of medication.
• The psychiatrist must agree that shared care is appropriate.
• The GP must be willing to participate in the agreement.

Are GPs Obliged to Accept Shared Care?

GPs are not legally required to sign a Shared Care Agreement. It is considered a professional courtesy rather than an obligation. A GP may refuse to sign if they feel:

• They do not have sufficient expertise in ADHD management.
• The agreement places an excessive burden of responsibility on them.
• They have ethical or procedural concerns about prescribing ADHD medication.

If a GP refuses shared care, the responsibility for prescribing and monitoring remains with the psychiatrist or specialist service.

What Happens If Shared Care Is Refused?

If a GP declines to enter into a Shared Care Agreement, alternative arrangements need to be made. This could include:

• Continuing treatment under the psychiatric team that diagnosed the condition.
• Seeking private prescriptions if NHS prescribing is not an option.
• Using NHS schemes like 'Right to Choose' to access an alternative provider.

Addressing a GP’s Refusal of Shared Care

If your GP refuses shared care, you may consider the following steps:

1. Request a Meeting – Discuss your case directly with your GP. Explain the impact that being unable to access medication will have on your life and daily functioning.
2. Refer to NHS Guidance – NHS England states that:
   • "The NHS should not withdraw NHS care because a patient chooses to buy private care."
   • "Patients who access private care should not be placed at an advantage or disadvantage in relation to NHS care."
   • "Where the same diagnostic, monitoring, or other procedure is needed for both NHS and private care, the NHS should provide this free of charge and share the results with the private provider."
   You can ask your GP or their practice manager to clarify how refusing shared care aligns with these principles.
3. Ask for an NHS Referral – If your GP is hesitant about accepting a private diagnosis, request a referral to an NHS ADHD service while continuing private treatment.
4. Consider Changing GP – If your GP refuses shared care and is unwilling to discuss options, switching to a more accommodating GP may be beneficial. Ensure the new practice accepts shared care agreements before transferring.

What If There Is No ADHD Service in Your Area?

NICE guidelines state that ADHD assessments should be accessible to all individuals who need them. If your GP claims there is no ADHD service in your area, you still have options:

• England: You can use the ‘Right to Choose’ scheme to access an assessment with an alternative provider or request an Individual Funding Request (IFR) for specialist care.
• Wales & Northern Ireland: The Right to Choose scheme is not available, but you can apply for an IFR through your local health board.
• Scotland: Scotland does not follow NICE guidelines, so ADHD services are not guaranteed. The Royal College of Psychiatrists in Scotland has issued best practice guidelines, and an alternative to the IFR scheme, the Peer Approved Clinical System, exists. However, this primarily applies to medication rather than diagnostic assessments.

Final Thoughts

Navigating ADHD treatment under the NHS can be challenging, particularly when dealing with shared care refusals. Understanding your rights, advocating for yourself, and exploring all available NHS pathways can help ensure continued access to essential medication and support.

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