ADHD Treatment & Shared Care

Shared care means a specialist establishes the diagnosis and stabilises treatment, then a GP continues prescribing and monitoring under an agreed protocol with the specialist remaining involved.

This service is for you if

• You have a documented ADHD diagnosis from a specialist service
• You are established on a stable dose
• You have, or can obtain, a shared care agreement
• You are able to attend monitoring appointments

This service is NOT for you if

• You are seeking an ADHD diagnosis. We do not diagnose ADHD. See assessment referral.
• You want a first prescription. We do not initiate stimulant medication under any circumstances.
• You have no documentation of a specialist diagnosis
• Your dose is still being titrated by a specialist

Why the boundary is firm

ADHD diagnosis requires structured specialist assessment drawing on developmental history, usually over several hours. Stimulants are controlled drugs with cardiovascular effects and diversion risk. Neither diagnosis nor initiation can be done safely in a 20-minute remote consultation, and any service offering to do so should concern you.

If shared care turns out not to be appropriate, we will tell you why and what is needed instead. The consultation fee covers that assessment.

We review your documentation first. If shared care is appropriate, monitoring covers blood pressure, pulse, weight, sleep and side effects at agreed intervals, with the specialist informed.

If shared care is not appropriate, we will say so and explain what is needed instead — the consultation fee covers that assessment.

Monitoring is a condition of prescribing

Stimulant medication affects appetite, sleep, blood pressure and heart rate. Monitoring is not an optional extra — where it is not attended, prescribing does not continue, and that is said at the outset rather than discovered later.

What is checked, and how often

• Blood pressure and pulse at every review — stimulants raise both, and this is the main reason for the schedule
• Weight, and height in anyone still growing — appetite suppression is common and can be significant
• Sleep, which is affected by dose and timing
• Mood, anxiety and any tics
• Effectiveness — in function rather than in feeling: work, study, relationships, driving
• Every six months at minimum once stable, and more often after any change

Practical things that come up

• Appetite: eat before the dose takes effect and again in the evening as it wears off. Weight loss is worth reporting rather than accepting
• Sleep: usually about the timing of the last dose
• The rebound as medication wears off — irritability and low mood late in the day — which is a dosing conversation rather than a sign of failure
• Medication breaks, sometimes considered, and a decision to make with your specialist rather than alone

Report promptly

• Chest pain, palpitations or fainting — stop and seek urgent assessment
• Significantly raised blood pressure
• New or worsening low mood, or thoughts of self-harm
• Marked weight loss, or growth concerns
• New tics, or symptoms of psychosis

The legal and practical parts

• Stimulants are controlled drugs. Prescriptions have shorter validity, quantities are limited, and lost or stolen prescriptions cannot simply be replaced
• Travelling abroad requires planning. Several countries restrict or prohibit ADHD medication — check with the embassy, carry it in labelled boxes with a copy of the prescription, and allow time for any licence needed
• Untreated ADHD affects driving, and so can starting or changing medication. There are DVLA implications worth being clear about

What we do not do here

Diagnose ADHD. Initiate stimulant medication. Titrate a dose that a specialist is still adjusting. All three sit with the specialist service, and none can be done safely in a twenty-minute remote appointment.

If you are seeking a diagnosis

This service cannot help with that, and the honest routes are these:

• NHS assessment through your own GP. Free, and the waits in many areas are long — sometimes years, which is a genuine problem rather than something to gloss over
• Right to Choose, in England — you can ask your GP to refer you to any provider with an NHS contract, which is frequently much faster and still free. It is markedly under-used because most people do not know it exists
• Private assessment, which is quicker and costs a substantial sum. Check the assessor is a psychiatrist or specialist ADHD clinician, that the report is detailed enough for shared care, and ask directly whether NHS practices in your area accept their reports — some do not, which leaves people with a diagnosis and no route to ongoing prescribing

Non-medication approaches that genuinely help

• ADHD coaching and CBT adapted for ADHD, which have real evidence, particularly for the organisational and emotional side that medication does not touch
• Workplace and university adjustments under the Equality Act — and Access to Work, a government grant covering coaching, software and support that is not means-tested and is badly under-claimed. Disabled Students' Allowance for students
• Structure, externalised — written lists, timers, alarms, one calendar. Unglamorous and effective
• Sleep and exercise, both of which measurably affect symptoms

Non-stimulant medication

Atomoxetine and guanfacine are non-stimulant options, not controlled drugs, and sometimes preferable — where stimulants are not tolerated, where there is a cardiac concern, or where substance misuse is a factor. Initiation still sits with a specialist.

What frequently sits alongside it

Anxiety, depression and sleep problems are common in ADHD, and treating them is often what makes the biggest difference to day-to-day life. Those are things we can help with — see anxiety and depression.

In women, ADHD symptoms frequently worsen around perimenopause as oestrogen falls, and it is a common point of late diagnosis or of previously stable treatment stopping working.

What to be wary of

Any service offering same-day online ADHD diagnosis, or a first stimulant prescription after a brief remote appointment. Proper assessment takes hours and draws on developmental history and, ideally, informant accounts. Buying stimulants online without a prescription is dangerous and illegal — counterfeit tablets circulate widely.

What you pay us

• £40 for the consultation, which covers assessing whether shared care is appropriate — and the fee applies whether the answer is yes or no
• £40 for each monitoring appointment, at least six-monthly once stable

Please bring your specialist diagnostic report, current prescription details, your specialist's contact details, and any existing shared care agreement. Without those, shared care cannot be assessed and the appointment cannot achieve anything — which is a wasted £40 we would rather you did not spend.

What you pay the pharmacy

ADHD medication varies considerably in price, and modified-release preparations cost more than immediate-release. We earn nothing from what is prescribed.

Ring pharmacies before handing over the prescription — differences are substantial, and note that controlled drug prescriptions are valid for 28 days rather than six months.

The NHS routes, which matter more here than usual

• NHS assessment is free. Waits are long in many areas, and that is a real problem
• Right to Choose in England lets you request referral to any provider with an NHS contract — often far faster, and still free. Badly under-used
• Shared care through your own NHS GP is free, and prescriptions are free in Scotland, Wales and Northern Ireland, or at the standard charge in England. If your NHS practice will take on shared care, that is cheaper than us

Before paying for a private assessment

Ask three questions first, because people spend a great deal and then find themselves stuck:

• Is the assessor a psychiatrist or specialist ADHD clinician?
• Will the report be detailed enough to support shared care?
• Do NHS practices in your area accept that provider's reports? Some do not, and a diagnosis with no route to ongoing prescribing is an expensive dead end

What we will not do at any price

Diagnose ADHD, or issue a first stimulant prescription. Not for any fee, and not however urgent it feels.

Any service that will do either after a brief remote appointment should concern you — proper assessment takes hours, and stimulants are controlled drugs with cardiovascular effects and diversion risk.

Can you diagnose ADHD?

No, and we would be wary of anyone who offers to do it remotely and quickly.

Diagnosis requires structured specialist assessment drawing on developmental history, usually over several hours and ideally with an informant account. That cannot be done in a twenty-minute video consultation.

Can you start me on medication?

No. We do not initiate stimulant medication under any circumstances.

Stimulants are controlled drugs with cardiovascular effects and diversion risk, and initiation involves careful titration with specialist oversight. Any service offering a first prescription after a brief remote appointment should concern you.

What is shared care, exactly?

A specialist establishes the diagnosis and stabilises the treatment; a GP then continues prescribing and monitoring under an agreed protocol, with the specialist remaining involved.

It only works when everyone agrees to it in writing — which is why we ask for the documentation before anything else.

What do I need to bring?

Your specialist diagnostic report, current prescription details including dose and duration, your specialist's contact details, and any existing shared care agreement.

Without these, shared care cannot be assessed. Please do not book without them — the appointment cannot achieve anything.

My NHS wait is years. What can I do?

Ask your GP about Right to Choose. In England you can request referral to any provider holding an NHS contract, which is frequently far faster and still free.

It is markedly under-used, mostly because people do not know it exists. It is the first thing to try before paying for a private assessment.

I have a private diagnosis. Will my NHS GP take over prescribing?

Sometimes, and sometimes not — and it is worth knowing before you pay for an assessment.

Some NHS practices decline shared care with particular private providers, or with private providers generally. That leaves people holding a diagnosis with no route to ongoing prescribing, which is a genuinely difficult position.

Ask the private provider directly whether local NHS practices accept their reports, before booking.

Why does monitoring have to happen?

Because stimulants affect blood pressure, heart rate, appetite, weight and sleep. Blood pressure and pulse are checked at every review for a reason.

Where monitoring is not attended, prescribing does not continue. That is a safety position rather than an administrative one.

Are there options that are not stimulants?

Yes — atomoxetine and guanfacine, which are not controlled drugs and are sometimes preferable, particularly where stimulants are not tolerated or there is a cardiac concern.

Initiation still sits with a specialist.

Can I take my medication abroad?

It needs planning, and it catches people out. Several countries restrict or prohibit ADHD medication entirely, and possession can be a criminal matter rather than an administrative one.

Check with that country's embassy well in advance, carry it in original labelled boxes with a copy of your prescription, and allow time for any export licence required.

Does ADHD affect driving?

Yes, in both directions — untreated symptoms affect driving, and starting or changing medication can too. There are DVLA notification requirements depending on circumstances, and it is worth being clear about them rather than guessing.

I am a woman, diagnosed late, and my medication has stopped working around perimenopause.

A recognised and under-discussed pattern. ADHD symptoms frequently worsen as oestrogen falls in perimenopause, and previously stable treatment can stop being adequate.

It is worth raising with your specialist rather than assuming you have got worse — and the menopause side of it is something we can help with.

Can you treat my anxiety and low mood alongside it?

Yes — that we can do. Anxiety, depression and sleep problems are common in ADHD, and treating them often makes more day-to-day difference than anything else.

See anxiety and depression.