Shared Care Prescribing
Shared Care agreements and Private Providers
Please note that we DO NOT participate in shared care prescribing arrangement with private providers. The statement below explains what shared care prescribing is, and the reasons why we are not able or willing to participate in it with private providers, and also the conditions of shared care prescribing with NHS services.
SHARED CARE MEDICATIONS
Shared care is a process whereby responsibility for a patient’s medication is shared between a GP and consultant. In such a situation, the consultant will assess a patient’s suitability for the medication, perform any necessary baseline 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 then writes 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 the duration of treatment. 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.
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.
We are only able to participate in shared care for patients receiving NHS care. We do not participate in shared care arrangements with private providers.
Additionally, we will not consider shared care arrangements if any of the following conditions apply (most of these describe situations that are, by definition, not shared care):
- There is no written shared care agreement (please a note a private provider cannot complete an NHS form if they are not providing NHS services)
- There is a shared care agreement, but it does not match the equivalent NHS shared care agreement for the same cohort of patients.
- The provider is an assessment or diagnosis only service, that is, it does not prescribe medication at all.
- The provider has not completed an appropriate assessment of patient’s suitability for the medication, performed baseline investigations or provided counselling for the medication (for example, information on side effects, interactions)
- The provider has not initiated the patient on medication and/or has not adjusted dosage accordingly and/or has not stabilised the patient on the medication.
- The provider has discharged the patient back to sole GP care. We are not able to supply shared care medications without the patient being under a consultant. With private care we do not know how long a patient will remain under their service and they are under no obligation to inform us if a patient stops seeing them.
- The medication being recommended is one that falls outside the GP’s knowledge, experience or competence to prescribe.
- The is recommending use of medication that falls outside its licensed indications (for instance, it is being used for a different age group or different reason from the manufacturer’s recommendations).
The reason why we do not consider prescribing medication in any of the above situations is that there is no guaranteed specialist oversight and consequently patient safety is potentially at risk. Whilst it may be more cheaper and/or more convenient to source a prescription from your GP, we will not enter into any arrangement that has the potential to put a patient at risk.
YOUR PRIVATE PROVIDER CAN PROVIDE YOU WITH WHAT YOU NEED
If you are concerned you might not get the investigations and medications you need as part of the care from your private provider, you are advised to purchase or negotiate a package with your private provider that includes all of this. If your private provider informs you that your GP will just do it, they are providing you with false assurance and factually incorrect information.
Ultimately, should patients require any tests or medications as part of the care given by a private provider, the private provider themselves can request tests or supply medication to the patient for the appropriate fee.
We respect the universal right of any patient to choose (and pay for) a private provider, however, it is not an NHS GP’s responsibility to request tests or prescribe medications on behalf of that provider purely for the purposes of reducing the cost burden of private care for the patient* or for the purposes of reducing waiting times to assessment and/or treatment, and due consideration must always be given towards proper clinical oversight and patient safety.
*NHS guidance states that private and NHS care should be kept as clearly separate as possible, so that funding, legal status, liability and accountability are appropriately defined, that the patient should bear the full costs of any private services, and that NHS resources should never be used to subsidise the use of private care.
We hope the above goes some way to explaining the situation regarding requests from private providers.
REQUEST BY PRIVATE PROVIDER TO REFER BACK TO THEIR OWN NHS CLINIC:
You may be asked by your private provider to ask your GP to do a referral to the private provider’s own NHS clinic, perhaps because you may not have the funds to proceed with private healthcare or if your insurance company does not cover you. This request represents unnecessary administration being inappropriately passed to the GP. The NHS referral can be achieved by the private consultant directly without the need for a further GP letter. This is in line with BMA and NHS England advice and if you are asked by a private provider to do this, please return the request back to them.
