Overview
Shared Care Prescribing is an NHS service where specialists request that GPs share the responsibility for prescribing and monitoring specialist medication. Entering into a shared care arrangement carries important governance and quality assurance implications for prescribers.

NHS Shared Care
GPs may enter into shared care agreements with NHS-commissioned services in accordance with local policies developed between specialists and GPs.
Under shared care arrangements:
The NHS specialist ensures that a patient is properly initiated and stabilized on medication before requesting GP involvement.
A system is in place to ensure the patient continues to receive specialist reviews, with the GP having access to specialist advice when needed.
Common conditions where shared care prescribing applies include rheumatoid arthritis, ADHD, inflammatory eye disease, gender dysphoria, Parkinson’s disease, and inflammatory bowel disease (IBD).

Prescribing and Private Providers
There has been a significant increase in patients seeking private treatment and then requesting NHS prescriptions for specialist medications. However, this is not the same as NHS shared care.
Historically, we have issued some prescriptions on behalf of private providers, but this is no longer a safe or sustainable practice. After careful review, we have aligned our policy with national guidance:
Going forward, we are unable to issue new NHS prescriptions for specialist medications initiated by private providers. Patients must obtain these prescriptions directly from their private specialist.
This decision is based on several key factors:
1. Patient Safety & Governance
Private providers may follow different safety protocols than NHS services. Our priority is ensuring that all medications are prescribed with appropriate monitoring and oversight.
A particular risk arises when patients discontinue private care, leaving the GP to prescribe medication without specialist input. This is unsafe, and GPs are not insured for such prescribing.
2. NHS Commissioning & Resource Allocation
GPs are not funded to carry out private healthcare work. Prescribing on behalf of private providers diverts critical NHS resources, impacting the care available to other patients and contributing to health inequality.
3. British Medical Association (BMA) Guidance
The BMA advises that GPs are not obligated to prescribe medications recommended by private providers unless they feel clinically appropriate and safe. Our policy aligns with this guidance.
Patients who wish to transition their care to the NHS can be referred to an NHS specialist. Once an appropriate shared care agreement is in place, we will be able to take over prescribing in line with NHS protocols.
This policy applies fairly and equally to all private providers, ensuring consistency across patient groups and health conditions.
We understand this may be disappointing, but this approach has been agreed upon across all local GP practices to maintain patient safety and uphold NHS governance standards.

Bridging Prescriptions
We acknowledge that many patients face long NHS waiting times, particularly those seeking gender-affirming care. Some patients request temporary prescriptions (“bridging prescriptions”) while awaiting specialist assessment.
At present, our practice does not initiate bridging prescriptions for specialist treatments, including hormone therapy.
We recognize that:
NHS gender identity services have significant waiting times, often exceeding 24 months.
Some guidance (e.g., Royal College of Psychiatrists) suggests that GPs may prescribe bridging hormones in certain harm reduction scenarios.
However, initiating hormone therapy requires specialist expertise to assess risks, conduct investigations, and provide appropriate counselling.

Our Policy on Gender Dysphoria Care
We are committed to supporting patients with gender dysphoria. Our practice will:

• Make an NHS referral to a specialist gender identity clinic as quickly as possible, considering patient preferences and waiting times.
• Prescribe and monitor hormones under an NHS shared care agreement with an appropriate specialist (endocrinologist or gender identity clinic).
• Provide mental health support to help manage anxiety, depression, or other concerns while awaiting specialist care. This includes self-help strategies, NHS mental health referrals, and signposting to support organizations.

Unfortunately, we are unable to prescribe bridging hormones, as we do not have the necessary specialist expertise to do so safely.
We recognize that this is a difficult situation for many patients. If you require additional support while waiting for NHS care, we recommend exploring:
Gender identity support organizations (e.g., Mermaids, Gendered Intelligence, MindLine Trans+)
LGBTQIA mental health charities
Private specialists who can provide continuity of care until NHS services are available
We appreciate your understanding and are committed to providing safe, high-quality care within the scope of our clinical expertise.

Final Notes
This policy has been developed in alignment with NHS England guidance, local commissioning policies, and BMA best practices. Our priority is patient safety, fair resource allocation, and adherence to NHS governance standards.