Shared care with your GP

What shared care means

Shared care is an arrangement between a specialist and a GP. The specialist (in this case, Dr David Crocker) initiates your medication, adjusts the dose until it is working well, and confirms that it is safe and effective. Once you are stable, your GP takes over routine prescribing and physical health monitoring, while Dr Crocker continues to provide specialist reviews at regular intervals.

This is the standard model for how private psychiatric care transitions to the NHS. It exists because GPs are well placed to manage routine prescriptions and monitoring alongside your other healthcare, while the specialist retains oversight of the clinical plan. For most patients, shared care means that the ongoing cost of medication falls dramatically or disappears entirely.

While you are receiving private prescriptions, you pay £25–£30 per prescription depending on medication type (£30 for controlled medications such as ADHD stimulants, £25 for non-controlled medications) plus the cost of the medication at your pharmacy. Moving to shared care removes both of these costs for patients in Scotland, Northern Ireland and Wales. See our medication cost guide for typical private pharmacy prices.

Why shared care matters

Shared care is not just about saving money, although the cost difference is significant. It also means your GP has full visibility of your medication alongside everything else they manage for you. Routine prescriptions and blood pressure checks happen at your local practice rather than through a private service. And because your GP holds your complete medical record, they are better placed to spot interactions with other treatments or flag new health concerns.

For these reasons, establishing shared care is one of the core goals of ongoing treatment at Caledonian Psychiatry. Your psychiatrist will raise the question of shared care with you early and will submit a formal request to your GP as soon as it is clinically appropriate to do so.

The cost of waiting

A decision to wait for an NHS assessment rather than pursue a private route is entirely reasonable and understandable, particularly on financial grounds. We would never suggest otherwise. But it is worth being honest about what waiting can cost beyond money. Months or years without a diagnosis often mean continued difficulty at work, in relationships and in day to day functioning, problems that could be improving during that time. The opportunity cost is different for every person, but it is real, and it is worth weighing alongside the financial calculation.

It is also worth knowing that a private diagnosis does not close the door on NHS services. If and when an NHS assessment does come through, an existing diagnosis and a period of established treatment may allow that assessment to focus more on maintaining what is already working rather than starting from scratch, although some services will still carry out their own assessment regardless. The two pathways are not mutually exclusive.

What private care can offer during that time is the ability to explore diagnosis and treatment options more quickly, with more frequent appointments and more flexibility to try different approaches if the first one is not the right fit. NHS services do excellent work, but they are stretched, and the reality is that appointment frequency and the time available within each consultation are often limited by demand. Private care does not replace the NHS, but it can complement it by giving you a head start on understanding your difficulties and finding what works for you.

What we send to your GP

One of the most important things we can do to support a successful shared care arrangement is to make the GP’s decision as straightforward as possible. Every shared care application includes comprehensive clinical documentation.

• Clinic letters after every appointment: sent to your GP (with your consent) so they are kept informed of your diagnosis, treatment plan and progress throughout.
• Formal shared care request: a structured letter setting out the diagnosis, the medication and dose, the monitoring schedule, clear criteria for when to refer back to the specialist, and confirmation that titration is complete and the patient is stable.
• Pre-treatment baselines: before any stimulant medication is started, your psychiatrist records a cardiac and family cardiac history, blood pressure, pulse, weight and height, in line with NICE guideline NG87; an ECG is arranged only where clinically indicated. Baseline values are included in the shared care documentation, so your GP can see the starting point for all ongoing monitoring. Blood pressure and weight can usually be measured at home with a validated monitor or at a local pharmacy; where an in-person baseline is clinically needed, we ask your GP practice to assist, or arrange a private check as a last resort.
• Monitoring protocol: a summary of the physical health checks the GP will need to carry out (typically blood pressure, pulse and weight at agreed intervals), with reference to the relevant NICE guidance.
• Ongoing specialist review plan: confirmation that your psychiatrist will continue to see you at regular intervals (usually every six months) and will remain available to the GP for advice between appointments.

The aim is to give your GP everything they need to say yes with confidence, without having to chase additional information or interpret an incomplete request.

Sample document

Shared care application: prescribing agreement

This is an example of the shared care application we send to your GP once you have been stabilised on medication. You do not need to send this yourself.

It is at your GP’s discretion

Shared care is a voluntary arrangement. GPs are not obliged to accept, and some practices or health board areas have local policies that limit or delay shared care with independent providers. Despite our best efforts and yours, shared care is not always possible, and we would rather be honest about that from the outset than set expectations we cannot guarantee. The national guidance behind this discretion (and the quality bar it sets for private assessments) is explained in our guide to NHS prescribing after a private ADHD diagnosis.

That said, most GPs are supportive when they receive a clear, well-structured request and have been kept informed from the start. Our commitment is to do everything we can on our side: producing thorough, well-structured clinical documentation that gives your GP the best possible basis on which to agree. The quality of the shared care application matters, and it is something we invest considerable time in getting right.

What you can do to help

Patients who involve their GP early tend to have the smoothest path to shared care. There are several things you can do that genuinely make a difference.

• Let your GP know you are being seen privately as early as possible, ideally before or shortly after your first appointment with us. This avoids the shared care request arriving as a surprise.
• Consent to us copying your GP into clinic letters from the start. This builds a paper trail that makes the eventual shared care request feel like a natural next step rather than a cold approach.
• Attend your GP practice for physical health monitoring (blood pressure, pulse, weight) when we ask you to. This demonstrates to your GP that the monitoring framework is already working.
• If your GP raises concerns or asks questions, let us know. We are happy to speak with your GP directly or provide additional written information to address specific issues.

What happens if your GP declines

If your GP is not willing to enter into shared care, you are not left without options. You can continue to receive prescriptions from Caledonian Psychiatry at £25–£30 per prescription depending on medication type, plus the cost of the medication at your pharmacy. Our medication cost guide sets out typical prices by drug and dose so that you can estimate your ongoing costs.

Beyond continuing privately, there are other possibilities worth exploring. You can ask your GP to reconsider after a period of demonstrated stability. If your GP has specific concerns, we can write a more detailed letter addressing those points directly. If you move to a different GP practice or a different area, the new practice may have a different policy. And if your circumstances change and you can no longer afford private prescriptions, we will always prioritise writing a handover letter to your GP with clear guidance for ongoing monitoring, so that your care is not simply dropped.

We will never leave you without a plan. If shared care is not possible at a given point in time, we will work with you to find the most sustainable way forward.

If shared care ends after it has begun

A shared care agreement with Caledonian Psychiatry is never a one-way door for your GP. If a practice needs to withdraw from the arrangement at any point (a change in practice policy, a clinical concern, or any other reason), your psychiatrist resumes full prescribing responsibility promptly and at no new assessment cost. Because shared care includes regular specialist reviews, patients remain under specialist oversight throughout; where someone has been outside specialist review for a protracted period, an extended review may be needed before prescribing resumes, decided case by case. And if a patient stops attending their specialist reviews, we tell the GP rather than leave them prescribing unsupported.

Shared care is one part of a bigger decision. For the full picture of how a private assessment works in Scotland (costs, timescales and what happens afterwards), see the guide to private ADHD assessment in Scotland, or book an appointment when you are ready.