Shared Care Agreements

This page explains what “shared care” means, when it may be used, and what our practice policy is – especially around private providers. It is designed to help patients understand how responsibilities are divided between GPs and hospital specialists.

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1. What is Shared Care? 🤝

Shared care is an arrangement where your care is jointly managed by:

• Your GP practice (primary care)
• A hospital or community specialist team (secondary care)

It is usually used when:

• A specialist starts a particular treatment (often a more complex or “specialist” medicine), and
• It is agreed that your GP can safely continue prescribing and monitoring this treatment, with ongoing support and oversight from the specialist.

Shared care is not automatic. All parties must agree:

• The specialist must feel it is appropriate
• The GP must feel it is safe and manageable

If a GP does not feel it is appropriate to enter into a shared care agreement (for example, due to capacity, safety concerns, or the complexity of the medicine), they can decline. In that case, the specialist remains fully responsible for prescribing and monitoring.

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2. When Shared Care May Be Considered ✅ / ❌

At Sherburn and Rillington Practice:

• We will only consider shared care agreements with NHS providers 🏥
• We do not enter into shared care agreements with any private providers (including right to choose providers) for any medication or any condition
• Any decision to accept shared care is based on:
  • Your clinical needs and
  • Whether both the specialist and the GP practice can safely meet the responsibilities in the agreement

Your GP may decline a shared care request if, for example:

• The medicine is highly specialised or outside normal general practice experience
• The monitoring required is too complex or intensive for primary care
• The practice does not have the capacity to take on the extra workload safely

If shared care is declined, the specialist (hospital or NHS service) must continue to:

• Prescribe the medication 💊
• Arrange and act on any necessary monitoring 🧪

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3. How a Shared Care Agreement Is Set Up 🛠

If a specialist feels shared care might be appropriate, the usual steps are:

1. Assessment by the specialist 🔍
   
   The specialist assesses whether your condition and treatment are suitable for shared care, following clinical guidelines.
   
2. Discussion with your GP 📞
   
   The specialist contacts the GP practice to ask if we are able to take on shared care. This is not guaranteed.
   
3. Formal agreement 📄
   
   If the GP agrees, a written shared care agreement is put in place. This sets out clearly:
   • What the specialist will do
   • What the GP will do
   • What is expected from you as the patient
4. Implementation ▶️
   • The specialist usually starts the medicine and adjusts the dose until it is stable
   • Only once the treatment is stable, and the GP has agreed, might the GP take over prescribing under shared care
5. Review and ongoing monitoring 🔄
   • The shared care arrangement is reviewed regularly
   • If you are discharged from the specialist, or if you stop attending specialist appointments or miss important monitoring, the shared care agreement will no longer be valid
   • In those situations, the GP may no longer be able to prescribe the specialist medication, and responsibility returns fully to the specialist service

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4. Who Is Responsible for What? 👥

Responsibilities are set out in each individual shared care agreement, but in general:

• Your GP practice
  • Looks after your overall health and routine primary care needs 🩺
  • May prescribe and monitor certain medicines if this has been agreed and is safe
  • Coordinates with the specialist and raises any concerns
• The specialist team
  • Provides expert advice and manages the specialist aspects of your condition 🎓
  • Initiates and stabilises specialist medicines
  • Advises the GP on monitoring and reviews, and remains available for advice
  • Retains overall responsibility where the GP cannot safely take this on
• You, as the patient
  • Attend appointments with both your GP and specialist as advised 📅
  • Have blood tests or other monitoring when requested 🧪
  • Take your medicines as prescribed and report any side effects or concerns
  • Keep us informed if you are unable to attend appointments

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5. New Patients on Shared Care Medications 💊

If you are joining the practice and already take medication under a shared care arrangement, but there is no formal local NHS shared care agreement, you will need to follow the process below before we can prescribe your medication.

This includes, for example, patients who have been diagnosed and started on ADHD medication by a Right to Choose provider and are currently receiving medication under an arrangement with another GP practice.

What We Can Do ✅

• We can refer you to an NHS medication titration service
• This service will:
  • Review your diagnosis and treatment
  • Stabilise your medication under NHS care
  • Consider whether shared care with our GP practice is appropriate

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