Shared Care Agreement – Patient Information Policy
- Purpose
This policy outlines the principles and expectations for patients receiving medications under a shared care agreement between specialist services and The Old Church Surgery. It supports safe, effective, and coordinated prescribing and monitoring.
- Scope
Applies to all patients prescribed medications under a shared care agreement initiated by a specialist team and continued by the GP practice.
- Definition of Shared Care
Shared care is a formal arrangement where prescribing and monitoring responsibilities are shared between a specialist and a GP. The specialist initiates and stabilises treatment; the GP may take over prescribing once the patient is stable, provided appropriate support is in place.
- Key Principles
4.1 Initiation by Specialist Team
- Medication is initiated and stabilised by the specialist team.
- The specialist is responsible for diagnosis, initial prescribing, and monitoring.
4.2 Transfer to GP Prescribing
- Prescribing may transfer to the GP once the patient is stable.
- This occurs only if the GP agrees and a formal shared care protocol is in place.
4.3 Monitoring Requirements
Patients must comply with all monitoring requirements, which may include:
- Regular blood tests
- Blood pressure, pulse, and weight checks
- Other condition-specific assessments
4.4 Ongoing Specialist Support
- The specialist team remains responsible for ongoing review and oversight.
- Support may be provided remotely if appropriate.
- Patient Responsibilities
To ensure safe continuation of treatment, patients must:
- Attend all scheduled monitoring appointments
- Report any side effects or concerns promptly
- Follow the treatment plan as advised
- Inform both GP and specialist of any health changes
Note: Failure to meet these responsibilities may result in discontinuation of the medication.
- GP Practice Responsibilities
Shared care is a voluntary activity for GP practices. A GP may decline participation if:
- The practice lacks capacity or resources
- The medication or condition falls outside the GP’s clinical competence
- There is insufficient support or communication from the specialist team
- Shared Care and Private Providers
Shared care procedures apply primarily to patients receiving treatment under the NHS. However, the practice may consider entering into a shared care arrangement with a private provider, provided that:
- All principles of the shared care agreement are fully adhered to
- The patient remains under the active care of a recognised specialist service
- Clear communication and clinical responsibility are maintained by the specialist team
Such requests will be considered on a case-by-case basis, taking into account the nature of the treatment, the availability of specialist support, and the clinical capacity of the practice.
- Medications and Conditions Commonly Covered by Shared Care
| Condition | Condition / Indication Medications Commonly Included |
| Rheumatological / Autoimmune Disorders Methotrexate, Sulfasalazine, Leflunomide, Azathioprine, Mycophenolate, Ciclosporin | Methotrexate, Sulfasalazine, Leflunomide, Azathioprine, Mycophenolate, Ciclosporin |
| ADHD | Methylphenidate, Lisdexamfetamine, Dexamfetamine, Atomoxetine, Guanfacine |
| Transgender Hormone Therapy | Testosterone (Nebido), Estradiol, Finasteride, Spironolactone |
| Osteoporosis | Denosumab (Prolia) |
| Mental Health / Bipolar Disorder | Lithium |
| Neurological Conditions | Riluzole (ALS), Hydroxycarbamide (sickle cell disease) |
| Cardiovascular / Arrhythmias Amiodarone, Dronedarone | Amiodarone, Dronedarone |
| Endocrine/calcium disorders | Cinacalcet |
| Organ Transplant / Immunosuppression | Tacrolimus, Mercaptopurine |
- References
- NHS England Shared Care Guidance: https://www.england.nhs.uk/publication/shared-care-guidance/
- British Medical Association (BMA) Guidance on Shared Care Prescribing
Addendum: Bridging Prescriptions for Transgender Patients
The Royal College of Psychiatrists has advised that, in certain circumstances, GPs may consider issuing bridging prescriptions for hormone therapy to transgender patients who are awaiting assessment by an NHS Gender Identity Service.
However, both the Royal College of Psychiatrists and NHS England emphasise that such prescribing decisions must be based on the individual GP’s clinical experience, competence, and confidence in managing gender-affirming hormone therapy. This is recognised as a highly specialised area of care that requires appropriate training and support.
At The Old Church Surgery, our GPs do not have specialist experience in initiating gender-affirming hormone therapy. Therefore:
- The practice will not initiate hormone treatment for transgender patients.
- The practice may consider taking over prescribing under a formal shared care agreement, provided:
- The patient has been assessed and stabilised by an NHS Gender Identity Service.
- A clear shared care protocol is in place.
- Ongoing specialist support and monitoring are available.
This position reflects national guidance and our commitment to safe, competent, and coordinated care.