Trowbridge Health Centre

Shared Care Policy

 Jan 2025

Background 

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. 

• If care is transferred, then from this point the GP is responsible for the prescriptions they sign. They must also ensure adequate monitoring. This is a significant responsibility, and decisions must be made carefully bearing this in mind. Many GPs may not have the skills to undertake this specialist prescribing. 

• In shared care arrangements the prescribing Consultant or specialist team remain responsible for parts of the patient’s care, and available to support the GP. The presence of a specialist is 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 GPs may be deemed to operating outside of Good Medical Practice. 

• There are multiple issues that are affecting patient hospital waiting times 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. GPs should not be asked to work beyond their competences or over safety limits to cover long waiting times for other services. 

• 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. 

NHS Providers within BSW 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. 

If this adhered to, and we have the available expertise, Trowbridge Health Centre will engage with shared care arrangements with these specialists.  

Alternative NHS Providers (Right to Choose Providers) 

In the current climate it is understandable that some patients are exercising their ‘right to choose’ and requesting referral to alternative service providers. Some providers are advertising NHS assessment and shorter waiting times.

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

Under “Right to Choose”, the alternative provider can only provide the service which has been commissioned by the NHS elsewhere in the country. This may well mean that they are not able to offer or follow locally agreed shared care pathways, monitoring, follow up and prescribing. 

Many “Right to Choose” services will only diagnose and cannot prescribe or provide a shared care arrangement. 

Due to the uncertainty of the service being offered by an independent contractor who Trowbridge Health Centre have no knowledge of we DO NOT enter shared care arrangements with “Right to Choose” providers.

Private Providers 

NHS shared care protocols do not apply to private contractors. 

However, if the private provider is appropriately accredited, practicing in line with UK best practice and agrees to prescribe and monitor patients in line with locally agreed NHS protocols then Trowbridge Health Centre will consider entering into a shared care arrangement with them. 

If Trowbridge Health Centre 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.  

Appeals

If a patient has a shared care arrangement denied by Trowbridge Health Centre, and feels this is inappropriate,  then they can appeal this decision by writing to the practice manager.  The partnership (experienced GPs) will consider the appeal and then the practice manager will inform the patient of the final decision.