Certain medications can only be prescribed by us in primary care once a Shared Care Agreement (SCA) is in place between the specialist team recommending them and ourselves. A number of medications for various health conditions have this requirement to ensure the ongoing prescription is safe and that the correct health monitoring (e.g. blood tests, weight, blood pressure etc) is in place so that adverse effects are picked up quickly. An SCA places responsibilities on us as prescribers but also on the specialists so that these medications can be used and monitored safely. SCAs were originally set up to provide clarity between NHS Secondary Care services and NHS Primary Care services as a binding contract to empower Primary Care Services with the ability to prescribe certain medications suggested by secondary care which are outside of the experience remit of Primary Care.
Our concern is that entering an SCA with a private provider means that:
- We cannot guarantee the provider would provide the same terms that we would expect in an NHS-based SCA
- SCAs from different private providers may vary, creating confusion and potential for error.
- A private provider may not fulfil their responsibilities if a patient could no longer afford to attend paid-for appointments with them.
- It may be harder for us to hold a non-NHS organisation to account if the SCA terms were not being met.
- It also sets a precedent for potential ‘queue jumping’. Heath access inequality is something that we are not allowed to encourage, and although we see big issues with waiting times and the consequences this has in everyday practice, it is something that we must manage as best we can without creating loopholes that would further create health access inequality.
We have therefore made the decision that our practice will not be engaging in Shared Care Agreements (SCA) for the prescription of medications initiated by any private provider for any condition unless they have a locally commissioned contract for providing an NHS service. Furthermore, that patient would have to have their agreement with the private company funded by the NHS rather than seeking it privately as the conditions of that agreement may vary depending on how it is funded and the obligations towards the patient from the private company may differ depending on how it is funded.
We are not obligated to agree to any SCA (including those from NHS providers) that we do not feel we can safely deliver. This approach is confirmed in General Medical Council (GMC) guidance. The Integrated Care Board (ICB) who commissions services have not provided instructions that prevent us from entering an SCA, their communications have only highlighted the fact that we are under no obligation to do so.
Any patient, parent or guardian is welcome to make an appointment to discuss or ask questions regarding the above policy with any of the GP Partners.
Updated 28/01/25
