Guidance

July 2026 Update (Shared Care – BMA Collective Action)

Wessex LMCs have consistently advocated there should be a shared care locally commissioned service in place that enables practices to consider whether they feel able to enter into a shared care agreement with a specialist.

Within the Wessex LMCs area we have worked hard to negotiate shared care agreements that recognise the high volume shared care drugs, with adequate resource for practices.

Our local approach therefore supports this month’s BMA collective action, with this webpage providing guidance for practices to consider on this topic.

Understanding Shared Care – NHS, Right to Choose and Private Providers

Page Contents

Key Points

NHS providers within your ICB

Alternative NHS providers (Right to choose providers)

Private providers

Nature of the arrangement

Shared Care LCS

Practice approach

Key Points

Podcast: Shared Care – A guide from Wessex LMCs

Shared care is a term used within the NHS to describe the situation where a specialist doctor wishes to pass some of the patient’s care, such as prescription of medication, over to their general practitioner (GP). This is something that can be requested but the guidance for all medications is that this may only be done if the GP agrees. The GP will need to consider a number of factors to decide if this is safe.

The General Medical Council (GMC) mentions shared care in their guidance:

If care is transferred, then from this point the primary care prescriber will be responsible for the prescriptions they sign and they must be prepared to explain and justify their decisions and actions. They must also ensure adequate monitoring. This is a significant responsibility and decisions must be made carefully bearing this in mind.

The GMC states that when taking on prescribing, all clinicians must keep informed about the medications they prescribe. They need to be able to recognise serious and adverse side effects and ensure that appropriate clinical monitoring arrangements are in place.

In shared care arrangements then the prescribing Consultant or specialist team would still remain responsible for parts of the patient’s care. These should be defined in the shared care arrangement and usually include any changes to the medication regime or any complications related to the medication. The presence of a specialist is also essential for the GP to be deemed to be operating under ‘shared care’. Shared care is not ‘shared’ unless it is shared by the GP with someone else. Without this then GPs may be deemed to operating outside of Good Medical Practice.

We are aware that there are multiple issues that are affecting patient hospital waiting times and that ICBs and our secondary care colleagues are working hard to try to address these. It is recognised that General Practice is also struggling to meet patient needs. GPs need to be mindful of focussing on undertaking essential services to patients first and foremost before agreeing to take on extra work on top of this. They should not be asked to work beyond their competences or over safety limits in order to cover long waiting times for other services or commissioning gaps.

If GPs feel that it is not appropriate for any reason for them to take over this extra work then appropriate arrangements for their continuing care would be as a default that the prescribing should remain with the specialist service. This may not be what the specialist service expects to happen. If there is any difficulty then please let the LMC know.

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NHS providers within your ICB

We would expect the provider to be appropriately accredited and practising in line with UK best practice and willing to follow locally agreed protocols for shared care.

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Alternative NHS providers (Right to choose providers)

Many alternative NHS providers are actually independent private providers holding an NHS commissioned contract from an ICB elsewhere in the country

If a GP needs to refer an NHS patient for a physical or mental health condition, in most cases patients have the legal right to choose the hospital, service or team they would like to go to for elective care. The GP firstly has to decide if it is clinically appropriate to make a referral.

The local ICB does not need to have its own contract with the alternative provider. If the choice criteria are met and a service is commissioned anywhere in England under an NHS commissioning contract (and no other exceptions to the legal right to choice of provider and team apply to the referral), then the legal right to choose applies, regardless of whether the responsible commissioner directly contracts the chosen service/provider or provides similar services locally. However, under “Right to Choose”, the alternative provider is only allowed to provide the service which has been commissioned by the NHS under the terms of the original NHS contract. This may well mean that they are not able to offer or follow locally agreed shared care pathways, monitoring, follow up and prescribing.

No prior local commissioner approval is required for referrals where the patient has exercised choice of provider under their legal rights. However, GPs are expected to comply with any ICB commissioning policies and only refer in line with these and will need to understand exactly what NHS service the patient will receive before they refer into the service. ( If in doubt about ICB commissioning policy, we suggest that you contact your local ICB for advice).

If a GP is asked to refer to an alternative NHS provider, we would expect the provider to be appropriately accredited and practising in line with UK best practice and willing to follow your locally agreed protocols for shared care, monitoring, prescribing and follow up. If they are unable to give this assurance then you will need to warn the patient that you may not be in a position to provide shared care, monitoring, prescribing or follow up if it is outside of your competence, capacity or not in line with agreed local guidelines.

In the current climate it is understandable that some patients are exercising their ‘right to choose’ and requesting referral to independent providers who hold an NHS contract with ICBs outside of Wessex. Some providers are advertising NHS assessment and shorter waiting times.

Patients choosing such services and their GPs should be mindful that some services will only diagnose and will not prescribe or provide the secondary care part of a shared care arrangement. This should be taken into account by the GP and the patient when making their decision of whether it is appropriate to refer to these providers as it may not meet the outcome that the patient is hoping for.

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Private providers

Regarding GPs accepting diagnosis and shared care agreements with private providers we believe that the same principles of the GP being satisfied that the provider is appropriately accredited, practicing in line with UK best practice and will prescribe and monitor patients in line with locally agreed pathways apply. We would expect the private provider to provide evidence to assure GPs that they are meeting all the parameters in our checklist as part of good shared care.

NHS shared care protocols do not apply to private contractors, but a GP may consider extrapolating the principles of such an agreement to share care with a private provider if they choose to. GPs can therefore agree if they feel competent and confident in the private provider.

If the private provider does not provide such evidence or it is not clear of what systems are in place then the Practice should take this into account when making their decision of whether or not it is appropriate to enter a shared care arrangement with a provider.

If the GP does agree to take on prescribing there would need to be agreement with the patient about what would happen should they cease to have regular follow up with their private provider for whatever reason. The patient would need to understand that the GP would need to stop prescribing and would refer the patient to the NHS with understanding that prescribing would not resume until seen and approved by this service. GPs are not in control of waiting times for NHS services.

Ultimately the decision to accept the transfer of prescribing and monitoring care rests with the GP.

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Nature of the arrangement

It is also important to remember that formal shared care arrangements, be they NHS or Private, are voluntary on the part of the GP and the GP should be mindful of their own clinical competence and workload capacity when considering agreeing to enter into such an arrangement. Workload requested for an individual patients will need to be considered in balance with the reasonable needs of the practice population and whether further workload can be absorbed by the practice team safely.

Specialist services should only transfer care to primary care if the GP agrees to do so. This step is often forgotten and taken for granted as a fait accompli by secondary care. It should not be. A practitioner’s requirement to work safely within their own competences should be respected to keep patients safe. Specialist services are unlikely to be aware of other demands on the GPs or practice’s time. Specialists should not therefore prejudge decisions on behalf of the practice or express these to patients. Practice capacity to safely take on the associated workload of both prescribing and monitoring requirements should also be taken into account. These are both vital aspects of safe patient care.

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Shared Care LCS

It is also worth noting that some areas have a Local Enhanced service or an incentive scheme to fund practices to provide this shared care work. Shared care work is not core GMS and by offering it as part of a locally commissioned service there is recognition of the additional workload and training involved. Each drug accepted will need its own process around monitoring, prescribing and education of the practice team. As an LMC we do not believe that taking part in a locally commissioned service should override the practice’s need to regulate workload within safe limits.

If practices are signing up to such a locally commissioned service they will need to consider if the resource offered matches the requirements to undertake the work safely and whether there is the recognition in the contract around safe limits. If ICBs are not recognising the need to work within safe limits in this area then please contact the LMC office.

Managing Requests to Prescribe from Non-Prescribing Private Clinics

If a patient has engaged with a private  service that does not itself prescribe and has asked the GP to initiate and continue prescribing, there is no service/prescriber to formally share care with. In this situation, the practice should normally decline—unless a GP within the practice has the necessary specialist knowledge and capacity to prescribe and monitor safely.

The patient can:

• Seek an alternative private provider that offers prescribing, or
• Be referred to an NHS service (noting that waits are long and outside practice control).

It is not possible for the LMC or practices to advise on which private providers offer prescribing. Patients may not realise the level of specialist knowledge and monitoring required, but prescribing without competence or capacity is unsafe—even if this leads to patient dissatisfaction.

National difficulties around gender incongruence have been recognised in numerous reports. Concerns about NHS gender incongruence services should be directed to NHSE (the commissioner), and concerns about the lack of a locally commissioned prescribing service should be raised with the ICB. Some ICBs have started commissioning services to support locally with gender incongruence prescribing and monitoring.

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Practice approach

In the interests of fairness, consistency and patient safety it may be useful for practices to have an agreed practice policy and review process for assessing requests for shared care with NHS or private providers.

The LMC suggests that practices may wish to consider including the following factors in their decision making when reviewing requests. The LMC would suggest that this is done at a practice level rather than individual practitioner level as these medications often involve a number of members of the team to be involved and therefore they all need to have capacity to take on the extra workload for the processes to be safe. You may also wish to discuss this as a PCN so there is a consistent approach between practices.

• Has the specialist sought agreement of the GP before transferring any care or prescribing?
• Are you signed up to an LCS that includes this medicine? (if yes this would only apply to NHS providers).
• Do you feel that the prescribing and awareness of all side effects and complications falls within the scope of your medical practitioners’ professional competence and their workload capacity?
• Are there adequate resources, training and sufficient capacity for the work of managing safe systems for monitoring and prescribing for this medication in your practice before care is transferred?
• For NHS providers, are they locally commissioned or approved by your ICB as working in line with UK best practice and local prescribing guidelines/shared care protocols?
• For private providers are you satisfied that the provider has demonstrated to you that it is appropriately accredited, practicing in line with UK best practice and will prescribe and monitor patients in line with locally agreed pathways apply?
• How would you manage prescribing if a patient, for whatever reason, is unable to continue follow up with a private provider?

Example Checklist for Practices to consider using:

If the answer to all of these are satisfactory or positive then a GP Practice would be likely to approve the request for the sharing of care. If one or more of these considerations is not met then it would seem sensible to decline the transfer.

In this case then the specialist will need to continue to prescribe and monitor.

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