Initiation by a Private Provider
RAG rating
Amber protocol
Document type
Patient information
Hertfordshire and West Essex ICB
Output type
Pharmacy / Prescribing

Shared care

NHS ‘Shared Care’ Medicines Prescribing after Initiation by a Private Provider

A small number of medications that require ongoing monitoring and specialist input are specifically classified as ’Shared care’ medications. The prescribing and monitoring of these complex medicines is always held by the specialist for longer than routinely prescribed medicines before being moved to shared care. The shared care medicines also have locally agreed documents ‘Shared Care Agreements’ to support all parties to share the care between the patient, the NHS specialist and the NHS GP and to keep patients safe.

Examples of medications that require shared care include medications for Attention Deficit Hyperactivity Disorder (ADHD), specialist medications for arthritis and skin complaints such as methotrexate, ciclosporin, and some specialist drugs with known side effects that require additional monitoring.

In general, GPs and other NHS services will not issue NHS prescriptions for shared care medications for conditions where patients are being treated privately. This is because it is important to ensure that private specialists treating patients remain in control of, and are responsible for, prescribing treatments for the conditions they are managing.

Locally defined ‘Shared Care Agreements’, allow specialist NHS services to share care with primary care (e.g. NHS GPs). Where appropriate, and agreed, NHS GPs can then prescribe the ‘shared care’ medicine. If the patient’s condition becomes unstable, or if there are any issues with their ongoing care, prescribing should be able to be seamlessly transferred back to specialist NHS care. This strategy aims to ensure that it is clear both to the patient and to all the clinicians involved in a patient’s care, where the clinical responsibilities associated with prescribing lie at all times and to keep patients safe.

Note: NHS GPs can decline to prescribe a ‘shared care’ medicine for example if they do not feel clinically comfortable with prescribing it. In NHS care this would result in the NHS GP asking the NHS specialist to continue the medication.

How can patients access medications requiring shared care on the NHS?

All patients are able to ask their primary care clinician (e.g. NHS GP, NHS nurse) to refer them to an NHS specialist service for management of their condition. Where appropriate, following an NHS specialist review, prescribing can occur on the NHS under a shared care protocol. Every attempt is made by the NHS services to do this as quickly as possible. Whilst patients are being seen privately, the current expectation for medications that require shared care, is for these to continue to be prescribed on a private basis from their private provider.




Version number
Developed by
Approved by
Date approved / updated
August 2023
Review date
The recommendation is based upon the evidence available at the time of publication. This recommendation will be reviewed upon request in the light of new evidence becoming available.
Superseded version