A practice in the East Riding of Yorkshire area

4. Miss A complains about the care and decision-making by the Practice from April 2025 regarding her son’s access to NHS treatment for ADHD. She complains about the Practice’s: • refusal to enter into a shared care agreement for her son’s ADHD medication • lack of support to access further NHS care, including referral for a heart specialist assessment.

5. Miss A says these matters have resulted in her son being unable to access NHS-funded treatment for a diagnosed long-term condition. She reports this has led to ongoing private healthcare costs and avoidable distress.

6. To resolve the complaint, Miss A seeks: • a clear explanation of the Practice’s decision-making • access to appropriate NHS prescribing or shared care arrangements for her son • service improvements in the handling of shared care requests • a financial remedy of £5,000 to reflect the private costs she says she has incurred.

7. Miss A’s son was placed on an NHS waiting list for possible ADHD assessment in September 2023.

8. Due to concerns about delays in accessing NHS assessment and treatment, Miss A arranged a private assessment and treatment for her son. The private specialist commenced ADHD medication and arranged monitoring.

9. The records show on 30 September 2024, the Practice assessed Miss A’s son, including undertaking an examination, and did not identify any cardiac abnormality requiring further investigation.

10. In April 2025, Miss A contacted the Practice requesting shared care prescribing arrangements. The Practice advised that it would not enter into shared care agreements with private providers, in line with a policy introduced in December 2024.

11. Miss A complained to the Practice about this decision. The Practice provided written responses explaining that shared care prescribing is discretionary and confirmed that it would not change its decision.

Refusal to enter into a shared care agreement

15. Miss A said in April 2025 the Practice refused to enter into a shared care agreement after her son’s ADHD medication had been stabilised by a private specialist.

16. Miss A considered this unfair because she understood the Practice had previously accepted shared care arrangements for other patients.

17. The Practice explained that it introduced a policy in December 2024 not to enter into shared care agreements with private providers.

18. The NICE guidance says that, after ADHD medication has been titrated and stabilised by a specialist, prescribing and monitoring would usually continue under shared care arrangements with primary care.

19. However, the BMA shared care guidance explains that shared care prescribing is a non-core voluntary activity and may be declined by GP practices for reasons including capacity, competence, and lack of specialist support.

20. The GMC prescribing guidance also states that clinicians must be satisfied they have sufficient knowledge and support to prescribe safely and take responsibility for prescribing decisions.

21. Our adviser explained that shared care prescribing is an area of clinical and organisational discretion. Our adviser confirmed that GP practices are not required to accept shared care arrangements and may decline them in line with BMA guidance.

22. Our adviser further explained that shared care is not part of core GP contractual responsibilities, meaning practices are not required to provide it.

23. The BMA private healthcare guidance also explains that where care is being provided privately, associated investigations and prescribing would usually remain within the private pathway unless responsibility is formally transferred to NHS services. It also explains that shared care arrangements with private providers are voluntary and may be declined.

24. The NHS England prescribing guidance says GPs should only take on prescribing responsibilities where they are satisfied this is clinically appropriate, within their competence, and responsibilities are clearly defined between services.

25. The records show that Miss A requested shared care prescribing in April 2025 and the Practice declined this request in line with its own policy.

26. We appreciate Miss A’s concern that the Practice had previously accepted shared care arrangements for other patients. However, we have seen that the Practice changed its policy in December 2024 to state it would not enter into any shared care agreements with private providers and applied this policy to new requests.

27. Our adviser confirmed it was clinically reasonable for the Practice to refuse shared care in these circumstances, including where medication had been initiated privately.

28. While NICE guidance supports shared care arrangements in principle, it does not require GP practices to accept them. Both the BMA prescribing guidance and the private healthcare guidance are clear that GP’s do not have to take on shared care agreements and can decline them.

29. Based on this, we consider the Practice acted in line with all of the above guidance and have not seen any indication of failings with the Practice refusing the shared care agreement.

30. We recognise this caused distress and frustration for Miss A, particularly given the ongoing private costs involved. We have not identified any failing by the Practice in relation to this issue.

Access to further NHS care and cardiac assessment

31. Miss A also complains that the Practice did not support access to further NHS care, including referral for a cardiac assessment.

32. Miss A says she arranged a private cardiac assessment for her son following advice from the private provider before commencing ADHD medication.

33. The GMC guidance says in providing clinical care you must adequately assess a patient’s condition, taking account of their history, including symptoms and carry out a physical examination where necessary. It also says you should promptly provide (or arrange) suitable advice, investigation or treatment where necessary.

34. The records show that on 30 September 2024 Miss A attended an appointment at the Practice with her son as she wanted to have his heart checked before he started his ADHD treatment. The Practice took a history from Miss A and asked about her son’s symptoms. The Practice also examined Miss A’s son, including listening to his heart and chest. It did not identify any cardiac symptoms or abnormality requiring further investigation.

35. The records also show that Miss A contacted the Practice again on 29 January 2025 asking for the Practice to refer her son for an echocardiogram as the private ADHD clinic had requested this before prescribing ADHD medication. The Practice declined this request.

36. Our adviser explained that where ADHD treatment is initiated privately, associated investigations, such as cardiac assessment before medication, would usually form part of the private care pathway.

37. Our adviser explained that a GP would be expected to assess the patient and determine whether there is an independent clinical need for NHS referral. Our adviser said that if no such need is identified, it is reasonable not to arrange NHS investigations requested as part of private care.

38. Our adviser said based on the information in the records, there was no clinical indication for a referral.

39. We have seen that in line with the GMC guidance the Practice did assess Miss A’s son in September, took his history, symptoms and carried out a physical examination. It did not identify a need for any further investigations so did not refer Miss A’s son for a cardiac assessment or an echocardiogram. This is in line with the GMC guidance.

40. As above, the BMA private healthcare guidance also explains that where care is being provided privately, associated investigations would usually remain within the private pathway unless responsibility is formally transferred to NHS services.

41. Therefore, in line with this, we consider it was appropriate for the Practice to refuse to refer Miss A’s son for an echocardiogram as this was requested as part of his private care.

42. As such, we have not seen any indications of failings in how the Practice dealt with Miss A’s son’s cardiac assessment request or ongoing management of his care.

43. We recognise that Miss A incurred private costs and experienced distress in arranging private care. We recognise this has been a difficult and frustrating experience for Miss A and her family.

44. After considering the available evidence, relevant guidance, and independent clinical advice, we have not seen any indications of failings in the Practice’s decision-making or management of Miss A’s son’s care. Therefore, we will not be taking any further action on this complaint.

1. We have carefully considered Miss A’s complaint about the Practice. We are sorry to hear about her experience and recognise the distress and frustration caused by the difficulties she experienced in accessing NHS prescribing arrangements for her son’s ADHD medication.

2. We thank Miss A for taking the time to bring her concerns to us. After reviewing the available records, guidance, and independent clinical advice, we have seen no indication of failings with the care provided by the Practice.

3. We appreciate Miss A’s concerns about the ongoing private costs of treatment and the impact this situation has had on her family. We have not seen any indication that these difficulties resulted from failings by the Practice. Therefore, we will not be taking any further action.