Prescribing

Shared care is an NHS arrangement in which a specialist clinician requests that responsibility for ongoing prescribing of a medication is transferred to a patient’s GP practice. This is a request and transfer must be agreed by the GP practice.

The GP must be satisfied that prescribing the medication is safe, appropriate, and within the competence of the practice, considering available specialist support, monitoring requirements, and resourcing.

Prescribing responsibility — including the acceptance of clinical risk — lies with the clinician issuing the prescription. It is therefore essential that all clinicians involved are sufficiently trained, experienced, and supported to prescribe and monitor the medication safely.

Some medications initiated or recommended by NHS specialist services are considered specialist medications. These may:

• Be complex to dose
• Be prescribed outside their licensed indications
• Require regular or intensive monitoring (e.g. blood tests, physical observations)
• Require specialist clinical oversight

Some specialist medications do not have an agreed NHS Shared Care Agreement in place. In these circumstances, prescribing and monitoring must remain the responsibility of the specialist team.

Our practice does not undertake specialist prescribing (including specialist medications or specialist indications) outside the context of a formal NHS Shared Care Agreement that includes appropriate specialist support, monitoring arrangements, and funding or resourcing.

We have updated our position on Shared Care Agreements for:

• Specialist medications
• Medications initiated or requested by private or Right to Choose providers
• NHS organisations that do not provide adequate prescribing or monitoring support

This approach is consistent with Local Medical Committee (LMC) advice and the policies of many local GP practices.

Patient safety is our highest priority. We believe there is a significant risk in prescribing specialist medications without robust specialist oversight, monitoring, and follow-up arrangements.

Where we believe there are unacceptable risks due to insufficient monitoring, unclear responsibilities, or lack of specialist support, we will decline to prescribe. We do not consider it safe to initiate or continue specialist medications under these circumstances.

Each GP practice sets its own shared care policy based on staff expertise, capacity, and funding.

We continue to work with our local Integrated Care Board (ICB) and NHS organisations to encourage the development of safe, well-resourced pathways. Patients should be:

• Initiated on treatment by a specialist team
• Stabilised on an appropriate dose
• Offered regular or annual specialist follow-up
• Transferred to primary care only under a clear NHS Shared Care Agreement

Our aim is to ensure patients with complex conditions receive care through properly funded and supported services.

The practice will not take over prescribing under a Shared Care Agreement requested by a private or Right to Choose provider.

Where appropriate, we are happy to refer patients to locally commissioned NHS services if a private provider is unable to initiate or continue specialist medication.

Patients considering private or Right to Choose assessments should be aware of this policy before proceeding.

This policy is informed by national guidance, including:

• GMC Guidance on Shared Care: https://www.gmc-uk.org/professional-standards/the-professional-standards/good-practice-in-prescribing-and-managing-medicines-and-devices/shared-care