Broadshires Health Centre -Shared Care Prescribing Policy (provisional)

Effective from: 01/03/2026
Reviewed monthly

1. Purpose of this Policy

Broadshires Health Centre is committed to providing safe, equitable, and sustainable care for all patients registered with the practice.

This policy sets out the practice approach to Shared Care Agreements (SCAs) for medications initiated by specialist services.

Shared care arrangements allow prescribing and monitoring responsibilities to be shared between secondary care specialists and GP practices once treatment has been initiated and stabilised.

While shared care can support continuity of care for individual patients, it requires additional clinical oversight, administrative capacity, and monitoring infrastructure within general practice.

These activities are not routinely funded within the NHS General Medical Services (GMS) contract, and practices must therefore carefully assess whether they have the resources and capacity to safely deliver shared care arrangements.

This policy ensures that shared care prescribing is undertaken only where it is clinically safe, appropriately supported by specialist services, and sustainable within available resources.

2. What is a Shared Care Agreement?

A Shared Care Agreement (SCA) is a formal arrangement between:

• The patient
• A specialist clinician (for example a hospital consultant or specialist service)
• The GP practice

Under shared care:

• The specialist retains overall clinical responsibility for the condition
• The GP practice may agree to prescribe medication and undertake monitoring
• The specialist remains responsible for treatment decisions and ongoing specialist review

Shared care agreements are voluntary and are not part of core contractual obligations for general practice.

3. Principles of Shared Care at Broadshires Health Centre

Broadshires Health Centre will consider shared care where:

• The medication has been initiated and stabilised by a specialist
• A formal written shared care protocol is provided
• The specialist service remains responsible for ongoing clinical review
• Monitoring requirements are safe and feasible within primary care
• Adequate clinical and administrative resources exist to support the arrangement

The practice has a duty to balance the needs of individual patients with the safe delivery of care for the wider practice population.

Where shared care arrangements place significant additional workload or unfunded responsibilities on general practice, the practice may decline to participate.

4. Criteria for Accepting Shared Care

Shared care will only be considered where all of the following apply:

4.1 Specialist initiation and stabilisation

The specialist must:

• Confirm the diagnosis
• Initiate the medication
• Undertake dose titration
• Ensure the patient is stable prior to requesting shared care

GPs will not initiate specialist-only medications.

4.2 Written shared care documentation

A written shared care agreement must be provided that clearly outlines:

• Diagnosis and treatment plan
• Current medication and dosage
• Monitoring requirements and frequency
• Responsibilities of the specialist, GP practice and patient
• Thresholds for abnormal results
• Process for medication adjustments
• Named responsible specialist and contact details

Requests without clear documentation may be declined.

4.3 Ongoing specialist oversight

The specialist must:

• Provide ongoing follow-up and review
• Remain responsible for treatment decisions
• Be available for advice if concerns arise
• Accept the patient back if treatment becomes unstable

If specialist oversight ceases, the practice may withdraw from the shared care arrangement.

5. Private Providers and Right to Choose

Shared care may occasionally be requested following assessment by:

• NHS Right to Choose services
• Private providers

The practice will only consider shared care where:

• The provider is appropriately qualified and regulated
• A formal shared care agreement is supplied
• The specialist remains responsible for ongoing review
• Safe monitoring arrangements are in place

Where a provider does not offer ongoing follow-up or specialist responsibility, the practice will not take over prescribing.

6. ADHD Medication – Practice Position

Broadshires Health Centre recognises that many patients are seeking assessment and treatment for ADHD, and that demand for ADHD services nationally has increased significantly.

ADHD medications require:

• Specialist diagnosis
• Careful dose titration
• Ongoing physical health monitoring (e.g. blood pressure, pulse, weight)
• Regular specialist review
• Careful governance as many medications are controlled drugs

While shared care arrangements for ADHD medication exist in some areas, there is currently no locally commissioned service or dedicated funding to support the transfer of ADHD prescribing and monitoring into general practice within Oxfordshire.

The monitoring, prescribing governance, and administrative workload associated with ADHD shared care represent a significant additional responsibility for GP practices, which is not funded within the core GP contract.

Given the current pressures on general practice and the absence of commissioned funding or resources to safely support this work, Broadshires Health Centre will not enter into new Shared Care Agreements for ADHD medication.

Responsibility for prescribing, monitoring, and medication review therefore remains with the specialist service that initiated treatment.

This applies to ADHD treatment initiated through:

• NHS specialist services
• NHS Right to Choose providers
• Private ADHD providers

Patients receiving ADHD medication should therefore contact their specialist provider for prescriptions, medication reviews, and ongoing management.

Diagnosis and treatment pathways for ADHD, including medication initiation, review, and prescribing arrangements, are commissioned and funded by the NHS Integrated Care Board (ICB) through specialist services.

Where shared care prescribing is not commissioned or funded within primary care, responsibility for prescribing and monitoring ADHD medication remains with the specialist provider responsible for the patient’s care.

GP practices are not commissioned or resourced to independently provide specialist ADHD medication management in the absence of an agreed and funded shared care pathway.

Broadshires Health Centre will therefore continue to refer patients to appropriate specialist services for ADHD assessment and treatment, but prescribing and medication review must remain under the care of the specialist service unless a locally commissioned and funded shared care service is introduced.

7. Existing Shared Care Agreements

Existing shared care arrangements may be reviewed periodically to ensure they remain safe and sustainable.

Where necessary, the practice may review or withdraw from shared care agreements if:

• Specialist follow-up is no longer provided
• Monitoring requirements cannot be safely delivered
• Practice capacity or resources change

8. Patient Responsibilities

Patients prescribed medication under shared care are expected to:

• Attend specialist follow-up appointments
• Attend monitoring appointments arranged by the GP practice
• Inform the practice of side effects or concerns
• Request prescriptions in a timely manner

Failure to complete required monitoring may result in prescribing being paused for safety reasons.

9. Review of Policy

This policy will be reviewed periodically to ensure it reflects current clinical guidance, commissioning arrangements, and practice capacity.

Approved by: Partners, Broadshires Health Centre
Date approved: 01/03/2026
Review date: 01/04/2026

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