What is Shared Care?
A shared care agreement (SCA) is an agreement between you, your GP, and your specialist. It enables the care and treatment you receive to be shared between the specialist and your GP. This will only occur with your agreement and the agreement of the GP and when your medication is stable.
A document is then sent by the specialist asking the GP to share the care of a patient. The specialist must agree to provide assessments, titrations, and stabilisation of medication for the patient, and continue to provide annual reviews to the patient and advice should the GP request it.
A GP will not agree to take on shared care unless deemed appropriate, and until a patients treatment has been commenced and stabilised.
Shared care is not something a GP is legally bound to sign, it is a ‘professional courtesy’ that GPs often sign to help patients continue to receive convenient care. A GP is fully entitled to refuse sharing care if they are not happy with the burden of responsibility it puts on them, and then the specialist must take full responsibility for prescribing and any necessary monitoring.
Prescribing of medication for Attention deficit hyperactivity disorder (ADHD)
NICE guidance issued in 2018 on the diagnosis and management of ADHD in adults states; ‘After titration and dose stabilisation, prescribing and monitoring of ADHD medication could be carried out under Shared Care Protocol arrangements with primary care’.
If a GP refuses shared care, then ‘appropriate arrangements for the continuing care’ of a patient are warranted, which could mean being passed back to the psychiatric team who made the assessment.
We will not carry out any prescribing instruction from any non-medically led specialist provider.
What this means for adults with ADHD is that any diagnosis from a private clinic for which a GP refuses to sign a shared care agreement will likely result in the requirement for medications to be issued privately, rather than by the NHS. However, shared care agreements with private healthcare providers when this service is being provided for the patient on behalf of the NHS (such as through the Right to Choose scheme) are common.
Prescribing of medication for Gender Dysphoria
Some GPs may prescribe private provider recommended drugs for gender dysphoria but only after careful consideration on a case-by-case basis. This is because there are many private providers operating in this area of specialty, but not all are deemed suitable.
If the organisation is a suitable provider, and we are reassured with the monitoring, advice and follow up care the specialist organisation is providing, only then, may a GP consider prescribing for gender transitioning medication
What to do if shared care is refused
As GPs are not legally obliged to take on shared care, options are limited by there are steps that may help in some cases:
- If your GP is unwilling to accept your diagnosis, you can ask them if they are willing to refer you through the NHS pathway, and to take on shared care while you are waiting.
- It is possible to change GP if you are having difficulties with them, though it is important to make sure that a new GP will accept shared care before you do so.
- You can carry on being prescribed by a private specialist