At Oak Tree Surgery we are committed to delivering safe, fair, and high-quality care to all our patients. To ensure we can continue to provide the core services we are funded to deliver, and provide safe prescribing our patients, we have recently reviewed our approach to shared care arrangements.
What is Shared Care?
Shared care is when a hospital or specialist clinic asks a GP practice to take on part of a patient’s prescribing and monitoring after they have been diagnosed and stabilised on treatment.
- The specialist remains responsible for the overall care plan and reviews.
- The GP may agree to prescribe medicines and arrange monitoring tests under the specialist’s guidance.
- A formal shared care agreement sets out the responsibilities of the patient, the specialist, and the GP.
- Shared care exists across many specialties including rheumatology, gastroenterology, ADHD, and gender dysphoria.
Important: Shared care is not automatic. GPs are not obliged to enter into any shared care agreement, and patient safety and equitable access remain our top priorities.
NHS Shared Care Agreements (SCA)
- We will consider shared care requests from NHS clinics, where patients have been fully assessed, diagnosed, and stabilised.
- In order to agree to a shared care request, we will require a written request from the secondary care provider detailing the following:
- Medication name and indication for use
- Dosing regime
- Monitoring requirements
- Plan for follow up.
- If the practice accepts the SCA, the written document will be signed and returned to the provider.
- We reserve the right to cease prescribing the agreed medication if at any point monitoring is not completed, the agreed reviews are not carried out, or if any safety concerns arise. We will advise the secondary care provider and patient of our intention to cease prescribing if this is the case.
Private Providers including Right to Choose Providers (RTC)
- From September 2025 we will not enter into any new shared care agreements with private providers, including those accessed through the Right to Choose (RTC) pathway.
We Cannot Support Shared Care with Private Providers for the following reasons:
- It takes GP time and resources away from NHS-funded care, which is what we are contracted to provide.
- The BMA advises against shared care with private providers in order to keep NHS and private care clearly separate.
- Supporting only those who can self-fund creates unfairness and disadvantages patients who cannot afford private care.
- We cannot always be confident about the standards, safety, or governance of private clinics. In particular we have clinical concerns that the rate of diagnosis and medication recommendation in some private clinics is far higher than in NHS ones.
- There has recently been an explosion in the number of private clinics offering assessments for conditions such as ADHD, and it is impossible for us to assess each of these providers and their individual shared care agreements.
- If a private or RTC company ceases to operate in future in may leave patients and GP without the necessary support.
Patients already receiving medication through a private or RTC shared Care Agreement
- If a patient is joining our surgery where their previous GP had signed a SCA with a private provider, it does not automatically follow that our surgery will enter into a similar agreement.
- We are aware that historically there may have been shared care agreements that our practice may have accepted that would not be agreed to now. Our current position is that we will continue to honour those agreements but will be starting a process of reviewing each agreement to ensure they meet current standards, and will discuss with individual patients if any changes to these agreements are necessary.
Bridging Prescriptions
Oak Tree surgery cannot provide” bridging prescriptions” for specialist medications started by a private provider that is no longer affordable, or where a patient is waiting on an NHS pathway.
The General Medical Council are clear that responsibility for a medication lies with the prescriber, and a doctor should only prescribe within their range of competence. It is therefore not safe or ethical to provide such prescriptions.
We understand the current limitations of local NHS commissioning leave many patients in a difficult situation. Oak Tree Surgery and the Local Medical Committee in Cornwall is continuing to press for improvements and increased funding to expand specialist services .
In the meantime, Oak Tree Surgery must prioritise safe, equitable care within the NHS framework. We will continue to review this policy if local or national guidance changes.
September 2025