Shared care is a process whereby responsibility for a patient’s medication is shared between a GP and a consultant or specialist. In such a situation the consultant will assess a patient’s suitability for medication, perform any necessary investigations and counsel the patient fully on the medication, before prescribing the medication and adjusting the dose until the patient is stable. Once the patient is stable, the consultant will write to the GP to ask them to consider shared care. If the GP accepts, they then take over the prescribing and monitoring of the patient, notifying the consultant should any problems arise. The patient must remain under the care of the consultant. For shared care to be valid, there must also be a written agreement on the duties and responsibilities of each party.
The whole process of shared care is to facilitate appropriate clinical oversight and to maintain patient safety, all in the patient’s best interests. Shared care agreements are a specific approach to the seamless prescribing and monitoring of medicines which enables patients to receive care in an integrated and convenient manner. Shared care agreements play a key role in enabling primary care prescribers to prescribe medicines with which they may not initially be familiar.
Having said the above, it must be noted that shared care is entirely voluntary for GPs and GPs are not obliged to enter into shared care, for whatever reason.
It is the policy of Holderness Health to agree to shared care arrangements with NHS and NHS-funded providers as long as there is a suitable shared care protocol provided which includes information on risks and potential side effects, and an expected monitoring schedule, with clear contact details of how to access the clinic or consultant for timely advice if needed. In cases where the information provided by the consultant or specialist service does not include sufficiently detailed prescribing recommendations for the GP to feel confident in prescribing, the GP will refer back to the service to provide support and advice.
Holderness Health will not participate in shared care arrangements with private providers whose services are not locally commissioned, that is, not funded by the NHS.
Due to patient choice and the long waiting times for some NHS services, many patients choose to receive their care from a private provider. Many private clinics will initiate medication but then request that further prescriptions and monitoring are provided by the patient’s GP. Holderness Health does not support the prescribing and monitoring of medications from private clinics. This is because it is difficult to assure the quality and governance aspects of private clinics, and because the practice does not enter into shared prescribing arrangements with private providers. The General Medical Council (GMC) states that if there is uncertainty whether a specialist working outside the NHS is suitably qualified, the clinician is not obliged to follow their recommendations. Good Medical Practice states a clinician must only prescribe drugs or treatment if they are satisfied that they serve the patient’s needs.
If you are being cared for by a private provider and they wish to have a shared care agreement with us for a medication you are being prescribed, it is with regret that we will decline this offer. You will need to have your full care with your private consultant/specialist, or you can ask them to refer you to an NHS service so we will then consider accepting shared care depending on a suitable agreement being available.
Sometimes we receive requests from private providers to arrange tests or investigations, for patients that they have seen privately. We appreciate that this may be to save you the cost of these investigations, however complying with this request is outside the scope of NHS general practice work and NHS guidance above.
Our contract states that a GP should only carry out investigations for a patient where the GP is the responsible doctor and it is necessary for the care of the patient. This means that the GP has had the full consultation with the patient themselves and has agreed, with the patient, the investigations that are needed.
The reason for this is not only because we are not contracted (and therefore not paid) to do this work, we also may not have the knowledge, resource or capacity to be able to perform these tests on behalf of private providers. When we get these requests will advise you and the private provider that these services do not fall within our contract and suggest they make alternative arrangements to get the investigations done.
November 2024