Shared Care Policy

This policy sets out the practice's position regarding requests to enter into Shared Care Agreements (SCAs) with private healthcare providers.

The purpose of this policy is to ensure a consistent, transparent and equitable approach for all patients and clinicians. It also provides a clear rationale for the practice's decision, enabling staff to explain the policy openly and consistently.

The practice recognises that this decision may be disappointing for some patients and appreciates the financial and personal implications. However, after careful consideration of the clinical, governance, legal and operational risks, the practice has determined that it will not enter into Shared Care Agreements with private providers.

This policy applies to all medications that would normally require specialist initiation and ongoing specialist oversight, including but not limited to:

• ADHD medication
• Gender-affirming hormone therapy
• Specialist psychiatric medication
• Other specialist medicines requiring shared care arrangements

What is a Shared Care Agreement?

A Shared Care Agreement is a formal arrangement between a specialist clinician, the patient's GP and the patient, whereby responsibility for prescribing and monitoring a specialist medication is shared.

Shared care is appropriate only when:

• the patient's condition is stable or predictable;
• there is clear communication between the specialist and the GP;
• responsibilities for prescribing and monitoring are clearly defined; and
• all parties, including the GP practice, agree to participate.

Participation in shared care is voluntary. A GP practice is under no contractual obligation to enter into a Shared Care Agreement.

Practice Position

The practice will not enter into Shared Care Agreements with private healthcare providers.

Patients who choose to receive specialist assessment and treatment privately remain responsible for obtaining ongoing prescriptions, monitoring and specialist review from their private provider unless and until their care has been formally transferred to an NHS specialist service and an NHS Shared Care Agreement is agreed.

Where appropriate, the practice will continue to provide routine NHS primary care and will refer patients to NHS specialist services if requested.

Rationale

1. Continuity and Patient Safety

Shared care relies upon ongoing specialist involvement.

There is a significant risk that patients may discontinue private treatment because of cost or because their medical insurance no longer covers their care. If this occurs, the specialist oversight that underpins safe prescribing immediately ceases.

The practice is not able to continue prescribing specialist medication without appropriate specialist supervision. This could result in treatment being interrupted whilst alternative arrangements are made, which may place patients at risk of deterioration or withdrawal effects.

2. Specialist Monitoring

Many specialist medications require ongoing clinical monitoring, including but not limited to:

• blood tests
• ECGs
• blood pressure monitoring
• physical health monitoring
• interpretation of investigation results
• dose adjustments based on specialist assessment

Although GP practices may be able to undertake certain investigations, responsibility for interpreting the results and making prescribing decisions remains with the specialist clinician.

The practice cannot safely assume responsibility for monitoring specialist medication when the prescribing specialist remains in the private sector.

3. Clinical Governance

The practice must be satisfied that diagnoses have been made by appropriately qualified specialists following accepted clinical standards.

Whilst many private providers deliver excellent care, there is considerable variation across the independent sector.

The practice cannot always be assured that:

• the clinician has the appropriate specialist expertise;
• NHS-recognised diagnostic standards have been followed;
• National clinical guidance has been adhered to; or
• Appropriate multidisciplinary assessment has taken place where required.

This creates potential risks of inaccurate diagnosis, inappropriate treatment and unnecessary exposure to medication.

4. Prescribing in Accordance with NHS Guidance

The practice has a responsibility to prescribe in accordance with NHS guidance, local formulary recommendations and national best practice.

There have been occasions where private providers have initiated:

• medicines that would not normally be commissioned within the NHS;
• third-line treatments before first- or second-line therapies have been adequately explored; or
• doses outside those ordinarily accepted within NHS prescribing guidance.

The practice cannot assume prescribing responsibility where treatment falls outside accepted NHS practice.

5. NHS Responsibility

The practice provides NHS primary care services.

Private healthcare providers are responsible for the investigations, prescribing, monitoring and follow-up associated with the treatment that they initiate.

The practice is neither commissioned nor funded to provide ongoing prescribing and monitoring in support of privately initiated specialist treatment.

Unlike many NHS Shared Care Agreements (for example, disease-modifying anti-rheumatic drugs), there is no commissioned funding or service specification supporting private shared care arrangements.

6. Equity and Consistency

To ensure fairness and avoid discrimination, the practice applies this policy consistently to all privately initiated specialist medications.

Applying a blanket policy ensures that all patients are treated equally regardless of diagnosis or the private provider involved.

7. Professional Responsibility and Indemnity

GPs remain professionally responsible for every prescription they sign.

The General Medical Council advises that prescribers should only prescribe where they have sufficient knowledge of the patient's condition and are satisfied that appropriate arrangements are in place for monitoring and follow-up.

Where specialist oversight remains within the private sector, the practice cannot be assured that these requirements are consistently met.

For this reason, accepting prescribing responsibility may place clinicians outside accepted professional practice and potentially outside NHS indemnity arrangements.

Transfer to NHS Care

Patients who have commenced treatment privately may request referral to the relevant NHS specialist service.

Once the patient has been assessed by the NHS specialist team and that team has agreed ongoing treatment, the practice will consider entering into an NHS Shared Care Agreement in accordance with local shared care guidance.

Until that point:

• prescribing remains the responsibility of the private specialist;
• monitoring remains the responsibility of the private specialist; and
• the patient remains responsible for funding any privately prescribed medication.

Medications Commonly Prescribed in Primary Care

Where a private specialist prescribes medication that would ordinarily be initiated and managed entirely within general practice (for example, antidepressants or antihypertensive medication), the practice may agree to continue prescribing on the NHS following appropriate GP review.

As a general principle, the initial prescription should be supplied by the private clinician. Once the patient has been reviewed by a GP and it is considered clinically appropriate, prescribing may transfer to the NHS in the same way as any medication initiated within primary care.

Policy Review

This policy will be reviewed annually or sooner if national guidance, commissioning arrangements or professional standards change.

This version is more aligned with NHS policy documents and references the key principles underpinning GMC prescribing guidance, NHS commissioning arrangements, equity, clinical governance and patient safety. It is written in a way that would withstand scrutiny if shared with patients or commissioners.