Introduction
What is Shared Care?
Shared care is when a hospital or specialist clinic asks a GP practice to take on part of a patient’s prescribing and monitoring after they have been diagnosed and stabilised on treatment.
- The specialist remains responsible for the overall care plan and reviews.
- The GP may agree to prescribe medicines and arrange monitoring tests under the specialist’s guidance.
- A formal shared care agreement sets out the responsibilities of the patient, the specialist, and the GP.
- Shared care exists across many specialties including rheumatology, gastroenterology, ADHD, and gender dysphoria.
Important: Shared care is not automatic. GPs are not obliged to enter into any shared care agreement, and patient safety and equitable access remain our top priorities.
NHS Shared Care Agreements (SCA)
Hospital NHS departments (Secondary Care) sometimes ask General Practitioners (Primary Care) to “share care” of patients, once a health condition has been diagnosed and the relevant medication prescribed at a dose that is stable and unlikely to change.
Shared care in the NHS is a formal local agreement that allows General Practitioners (GPs) to take responsibility for prescribing and monitoring specialist medicines. It involves a partnership between patients, their families, and healthcare professionals, enabling informed health choices.
Shared care requires the consent of the specialist, GP, and patient. The specialist must provide advice to the GP if this is asked for and review the medicine at regular intervals to make sure it is still safe and effective.
To take on prescribing and monitoring, the GP must be satisfied they have sufficient information, experience and knowledge of the patient and the medicine, treatment or device in order to prescribe. GP’s must feel competent to exercise their share of clinical responsibility and feel they will be able to access timely support from secondary care when needed.
Patients must also agree to:
- Request repeat prescriptions from the GP in enough time.
- Attend follow up monitoring appointments with the GP and the specialist (this may be blood tests or other health markers such as weight or blood pressure).
- If not able to attend an appointment with the GP or the specialist, inform them as soon as possible and make another appointment.
- Report suspected side effects to the specialist or GP.
We will consider shared care requests from NHS clinics, where patients have been fully assessed, diagnosed, and stabilised.
In order to agree to a shared care request, we will require a written request from the secondary care provider detailing the following:
- Medication name and indication for use
- Dosing regime
- Monitoring requirements
- Plan for follow up.
- If the practice accepts the SCA, the written document will be signed and returned to the provider.
- We reserve the right to cease prescribing the agreed medication if at any point monitoring is not completed, the agreed reviews are not carried out, or if any safety concerns arise. We will advise the secondary care provider and patient of our intention to cease prescribing if this is the case.
We reserve the right to decline shared care agreements with secondary care at our discretion and request the specialist to continue the management and prescribing.
We also reserve the right to withdraw our agreement to share care if specialist or patient do not meet their responsibilities.
Private Providers including some Right to Choose Providers (RTC)
We will not enter into any new shared care agreements with private providers. (This includes some private ADHD or Gender Clinics).
This decision was not reached lightly, as the implication for patients is clearly understood and sympathised with. However, the risks of providing this for medications initiated by private providers remains significant, and so the practice will not enter into shared care agreements with private providers.
This includes, but is not limited to, ADHD medication, Gender medication, DMARD medication. These are the three most common areas where private shared care agreements are requested and declined.
A Right to Choose provider is an organisation that holds a contract with an Integrated Care Board (ICB) and this qualifies them to operate nationally. We can only enter into agreements with RTC providers (ADHD) that have been approved by our ICB, a list can be found on the NHS Norfolk & Waveney website.
We are aware that patients may wish to engage with private provision of health care for many reasons (including but not exclusively) such as long waiting lists on the NHS. We recognise this frustration, and we ask our patients to please be aware of our policy regarding “shared care” before they engage with private specialists with a plan to subsequently transfer care to the GP surgery. This may be, for example, requests for ADHD assessments and medication, gender transition hormone prescriptions, and more.
Our practice policy is that we do not enter into shared care agreements with private providers. This usually covers both assessments/diagnoses of conditions and any specialist medication recommended by the private provider as a result.
We will not continue prescriptions initiated by private providers (unless care is subsequently taken over by the NHS and it becomes an NHS shared care agreement).
We cannot Support Shared Care with Private Providers for the following reasons:
- Many medications are to be issued and managed by specialist services only, whether they are NHS or private providers. The responsibility for prescribing medication rests on the prescribing doctor themselves.
- The BMA advises against shared care with private providers in order to keep NHS and private care clearly separate.
- Supporting only those who can self-fund creates unfairness and disadvantages patients who cannot afford private care.
- We cannot always be confident about the standards, safety, or governance of private clinics. In particular; we have clinical concerns that the rate of diagnosis and medication recommendation in some private clinics is far higher than in NHS ones.
- There has recently been an explosion in the number of private clinics offering assessments for conditions such as ADHD, and it is impossible for us to assess each of these providers and their individual shared care agreements.
- There is no guarantee that the private provider and the patient will continue their relationship, potentially leaving a patient without appropriate specialist support. This will then leave the prescribing doctor vulnerable to mistakes and potentially causing harm to the patient.
- If a private or RTC company ceases to operate in future in may leave patients and GP without the necessary support.
Patients already receiving medication through a private or RTC shared Care Agreement
- If a patient is joining our surgery where their previous GP had signed a SCA with a private provider, it does not automatically follow that our surgery will enter into a similar agreement.
Bridging Prescriptions
Plowright Medical Centre cannot provide” bridging prescriptions” for specialist medications started by a private provider that is no longer affordable, or where a patient is waiting on an NHS pathway.
The General Medical Council (GMC) are clear that responsibility for a medication lies with the prescriber, and a doctor should only prescribe within their range of competence. It is therefore not safe or ethical to provide such prescriptions.
We understand the current limitations of local NHS commissioning leave many patients in a difficult situation. In the meantime, Plowright Medical Centre must prioritise safe, equitable care within the NHS framework.
We will continue to review this policy if local or national guidance changes.
Last Reviewed : 26 / 01 / 2026