England only · Last updated August 2026
You waited years or you paid four figures. You got assessed, titrated, and settled on a dose that works. Then your GP said no to shared care — and now you're funding private prescriptions indefinitely for a condition you've already proved you have.
Here's what's actually going on, and which bits you can push on.
What shared care actually is
A shared care agreement is where your specialist stays responsible for diagnosis and reviews, and your GP takes over routine prescribing. It's the normal arrangement for stable, licensed treatment of a diagnosed condition.
It is voluntary for GP practices. That's the uncomfortable fact at the centre of all this, and any guide that hides it is lying to you.
But voluntary doesn't mean arbitrary — and it doesn't mean blanket.
The four refusals, and which are weak
1. "We don't accept private diagnoses"
The most common, and the most beatable. What actually matters is whether your assessment met NICE standards — most reputable private assessments do — and whether they considered your case or applied a rule.
Ask two things in writing: is this practice policy or a decision about my individual case? And what evidence would change your mind? The second usually gets you "a NICE-compliant assessment report", which you can simply request from your provider.
2. "Not until you've been stable for 12 months"
There's no national rule that says 12 months. Ask where the requirement comes from — local ICB guidance, or practice policy — and ask for it in writing. If your specialist has already confirmed you're stable, ask what they'd need beyond that.
3. "We don't do shared care for ADHD"
A blanket policy, and blanket policies are the weakest ground they can stand on. Shared care decisions are expected to be made on an individual patient basis. Get it in writing and it becomes an ICB matter.
4. Silence
Not a refusal — a gap. Nothing has been decided, so you're not appealing, you're prompting. A written request with a 14-day deadline turns an ignorable conversation into something the practice has to log and answer.
The one question that does most of the work
Most refusals soften here. "We don't do that" is easy to say and awkward to write down and sign — especially when the honest answer is that nobody looked at your file.
If they hold firm
- Written reasons from the practice manager
- Formal complaint to your ICB — use the phrase "patient choice complaint"
- Free NHS Complaints Advocacy, funded by your ICB and almost unknown
- Parliamentary and Health Service Ombudsman, within 12 months
- Change practice — the fastest practical fix, and no shame in it
The route that ends the argument entirely
If the objection is specifically that your diagnosis was private, there's a way to remove it rather than win it: NHS Right to Choose. Get re-assessed on an NHS pathway, free, and "it's private" stops being a sentence anyone can say to you.
Some providers even accept titration-only referrals if you're already diagnosed. It's the single most useful thing most people in this situation don't know exists.
Sources
- NICE guideline NG87 — ADHD diagnosis and management
- Health and Care Act 2022 — ICB structure
- NHS Constitution; Patient Choice Regulations 2023 (SI 2023/635)
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