Shared Care Prescribing as an NHS service where specialists ask GPs if they are willing to agree to share the responsibility of prescribing and monitoring of specialist medication. For any prescriber, entering into any shared care arrangement has implications around governance and quality assurance.
NHS shared care
GPs can enter into shared care prescribing agreements with services commissioned by the NHS. There are local policies for this, agreed between specialists and GPs.
The NHS specialist ensures that the patient is properly started and stabilised on the medication, before asking for the GP to take over prescribing responsibility. There is a system in place to ensure that the patient continues to get specialist reviews in the hospital, and the GP is able to get advice as needed.
Common health conditions where shared care prescribing is used include rheumatoid arthritis, ADHD, inflammatory eye disease, gender dysphoria, Parkinson’s disease and IBD.
Private providers
There has been a significant increase in patients going privately, and then asking the GP to prescribe specialist medication as an NHS prescription on behalf of the private provider. This is not the same as NHS shared care.
Historically, we have been an outlier in prescribing on behalf of private providers. However this is no longer safe or sustainable, and we have reviewed our policy on this.
We cannot issue any new specialist medication prescriptions on behalf of private specialists. You will need to obtain your prescription from your specialist.
Patient safety
Private providers may not adhere to the same safety standards as NHS providers. Patient safety is our priority, and we need to be as certain as we can that we are prescribing safely.
Problems often arise when patients no longer pay to see the private specialist, leaving the GP to prescribe the medication without access to any specialist input. This is risky for patients and GPs are not insured for this.
Commissioning
GPs are not funded to carry out non-NHS work. Undertaking significant amounts of private work can lead to GPs subsidising the cost of private healthcare. At a time of ever increasing demands on primary care, this takes away significant resources from other patients, and promotes health inequality.
British Medical Association Guidance
The BMA has clear guidance on responding to private healthcare, which can be seen here. Therefore, going forward, we are no longer able to prescribe new specialist medication on behalf of private services.
The private clinic will remain responsible for prescribing the medication for you and making sure it is safely monitored.
We can refer you to NHS services and will be able to enter into shared care prescribing with them, once an appropriate agreement is in place.
To ensure this policy is fair and non-discriminatory, this will apply to specialist prescribing on behalf of all private providers, not for specific patient groups or health conditions.
We know this may be a disappointment. The policy has been agreed with all the local practices in our area so that we are all taking the same approach.
September 2024