Shared Care, Specialist Prescribing and Private Treatment

What is shared care?

Shared care means that responsibility for your treatment is formally shared between a specialist service and your GP practice.

For example, a specialist may diagnose a condition, start a specialist medicine and adjust the dose until treatment is stable. They may then ask the GP practice to issue ongoing prescriptions and undertake specified monitoring, while the specialist continues to provide specialist review and advice.

Shared care is therefore more than simply asking your GP to issue a repeat prescription.

There needs to be a clear agreement about:

• which clinician is responsible for each part of your care;
• which medicines the GP is being asked to prescribe;
• what monitoring is required and who will arrange it;
• who reviews and acts on results;
• what ongoing specialist reviews are required;
• how the GP can obtain timely specialist advice;
• who makes changes to treatment; and
• what happens if your condition changes or the shared-care arrangement can no longer continue.

Current professional guidance describes shared-care prescribing as requiring agreement and effective communication between those involved. Current British Medical Association (BMA)  guidance also describes shared-care prescribing as voluntary, non-core activity for general practice.

Why doesn’t my GP automatically accept shared care?

When a GP agrees to prescribe a medicine, they take clinical responsibility for the prescriptions they issue.

Sharing care therefore cannot simply be decided by the specialist service or transferred to general practice by sending the practice a letter.

Before accepting responsibility, the practice needs to be satisfied that the arrangement is safe, appropriate and sustainable.

This includes considering whether:

• treatment has been appropriately initiated and stabilised;
• there is a clear and appropriate shared-care agreement;
• responsibilities between the specialist and GP are clearly defined;
• appropriate monitoring arrangements are in place;
• the practice has the necessary information and competence to prescribe safely;
• the specialist will continue to provide appropriate review;
• timely specialist advice is available if problems arise;
• there is a route for responsibility to return to the specialist where required; and
• there is an appropriate commissioned and resourced arrangement for additional work being undertaken by general practice.

These considerations are important because shared care transfers real clinical responsibility and workload to the practice. Current BMA guidance specifically identifies capacity, competence, specialist support, monitoring arrangements and commissioned pathways among the considerations relevant to shared-care prescribing. 

Does it matter whether my specialist is NHS, Right to Choose or private?

Yes, because these are different arrangements, although the same fundamental principles of safe prescribing apply.

NHS specialist services

There are established NHS pathways where responsibility for particular medicines can be shared between specialist services and general practice.

Where an appropriate local shared-care arrangement exists, this provides an agreed framework setting out the responsibilities of the specialist service and the GP practice.

However, being treated by an NHS service does not in itself mean that every medicine will automatically be prescribed by your GP. The practice still needs an appropriate and safe arrangement under which to accept that responsibility.

NHS Right to Choose

Right to Choose is also NHS-funded care, even where the service is provided by an independent organisation.

However, Right to Choose and shared care are separate arrangements.

Being referred to a provider through NHS Right to Choose does not automatically commit Jessop Medical Practice to taking over prescribing, investigations or monitoring requested by that provider.

We explain this in more detail on our NHS Right to Choose for ADHD page.

What if I choose to see a specialist privately?

Patients are, of course, entitled to access private healthcare alongside their NHS care.

However, choosing to see a specialist privately does not automatically transfer responsibility for the resulting treatment to the NHS GP practice.

If a private clinician recommends or starts a medicine, patients should therefore not assume that Jessop Medical Practice will subsequently issue the medicine on an NHS prescription.

Jessop Medical Practice does not routinely take over prescribing or shared care for treatment initiated privately.

If the practice cannot take over prescribing, the private provider remains responsible for making appropriate arrangements for the treatment that it has recommended or initiated.

Current BMA guidance recognises particular considerations around shared care with private providers, including the need for enduring specialist input and what happens if a patient’s private funding for specialist follow-up ceases.

“But my private specialist has told me my GP can prescribe it”

We appreciate that this situation can be frustrating.

A specialist can recommend that a GP takes over prescribing, but that recommendation does not in itself transfer clinical responsibility to the GP practice.

The practice still has to decide whether it is appropriate and safe for us to accept responsibility for prescribing and monitoring.

If we cannot accept the proposed arrangement, this does not mean that we are questioning your diagnosis or saying that the treatment recommended by your specialist is wrong. It means that responsibility for that treatment has not transferred to the practice.

What about blood tests, ECGs and other investigations requested by another provider?

A similar principle applies to investigations.

Where a specialist service requires an investigation as part of its assessment, initiation of treatment or ongoing specialist monitoring, we would normally expect that provider to arrange the investigation and remain responsible for reviewing and acting upon the result.

This may include, for example:

• blood tests;
• ECGs;
• blood pressure or pulse monitoring;
• physical observations; or
• other specialist investigations.

Requesting an investigation carries responsibilities beyond performing the test. Someone must review and interpret the result, identify abnormal findings, communicate appropriately with the patient and arrange any necessary action or follow-up.

For patient safety, responsibility for these steps needs to be clear.

Jessop Medical Practice therefore does not routinely undertake investigations solely because another provider requires them as part of that provider’s assessment or treatment pathway.

This applies whether the request comes from a private provider or another external service where there is no agreed arrangement for the practice to provide that work.

This does not prevent your GP from arranging investigations that they independently consider clinically appropriate as part of your NHS general-practice care.

Why does commissioning and practice capacity matter?

General practice is commissioned and resourced to provide particular NHS services to its registered population.

Some additional services, including some shared-care and monitoring arrangements, require additional clinical time, administrative work and ongoing responsibility.

Taking on work from another service where there is no agreed arrangement does not simply add another task. It uses the same clinical and administrative capacity that the practice needs to provide its existing services to patients.

This is why we consider both clinical safety and whether there is an appropriate commissioned and resourced pathway before accepting additional responsibility.

The BMA’s current advicesimilarly states that additional medication-monitoring work undertaken by general practice should be delivered through a funded, commissioned pathway. 

What happens if Jessop Medical Practice declines shared care?

Declining shared care does not mean that we stop being your GP or that we will not continue to provide your normal NHS general-practice care.

It means that the specific responsibility which the specialist has asked us to take on has not transferred to the practice.

The specialist/provider responsible for that treatment should therefore make appropriate arrangements for the elements of care that remain its responsibility.

Where clinically relevant, we will continue to take account of information provided by other healthcare professionals when caring for you.

Our approach

Our aim is not to create unnecessary barriers to specialist treatment.

We need to make sure that when Jessop Medical Practice takes responsibility for prescribing, monitoring or another element of specialist care:

• responsibility is clearly defined;
• prescribing can be undertaken safely;
• appropriate specialist support remains available;
• investigations and results have clear clinical ownership;
• appropriate commissioned arrangements are in place; and
• taking on additional services does not compromise our ability to provide safe general-practice care to our patients.

Shared care must therefore be agreed. It cannot be assumed simply because another clinician or provider has requested it.