As a rule, GPs from MHP will not participate in shared care arrangements with private providers. Specifically, we will not consider shared care arrangements if ANY of the following conditions apply (most of these describe situations that are, by definition, not shared care):
🔒 There is no written shared care agreement. This is not shared care
🚪 The private provider has discharged the patient back to the GP. This is not shared care.
🧪 The private provider is only an assessment and diagnostic service and does not initiate and stabilise medication. This is not shared care.
❌ The medication being prescribed is one which falls outside the GP’s knowledge, competence or experience to prescribe. We cannot prescribe.
⚙️The private provider has not initiated the medication, adjusted the dose appropriately and/or stabilised the patient on the medication. This is not shared care.
⚖️There is a written shared care agreement but it does no match the shared care agreement that would be given to an NHS patient with the same condition. This is not equivalent care.
⚠️The private provider is recommending use of medication which falls outside its licensed indications (for example, being used in a patient in a different age group or for a condition which is different from the manufacturer’s recommendations). The medication is not licensed.
📋 The private provider has not completed an appropriate assessment of the patient’s suitability for the medication, performed baseline investigations or provided appropriate counselling about the benefits, risks, side effects and interactions of the medication. This is not shared care.
🔄 With regard to treatment of patients with ADHD, the same situation applies as above. Given the long waiting times for NHS services, should either party default on their appointments as well as the questionable standard of diagnosis (usually not meeting NICE guidance) within the private sector, we will be unable to enter into shared care for these patients. We cannot prescribe.
🌈 Specifically, with regard to hormone treatment of trans patients, we will not enter into shared care agreements with private providers. This is because, if the provider or patient defaults in maintaining future appointments, there is a situation which is dangerous to the patients involved. In all other circumstances, we could stop prescribing and/or refer the patient on the NHS, but this is not safe for these patients and NHS services have very limited availability for trans patients. Prescribing and monitoring in these cases is outwith the competence and experience of GPs – we are continuing to press for adequate NHS services for this under-resourced group of patients. We cannot prescribe.
📜 The medication being prescribed is one which is not available for GPs to prescribe on the North Central London formulary. We cannot prescribe.
We will not consider prescribing in any of the above situations because there is no proper specialist oversight and therefore patient safety is at risk. Whilst it is often more convenient (and cheaper) to be asked to “get a prescription from the GP” this is inappropriate, and we will not enter into any agreements which have the potential to risk patient safety.
If none of the above elements apply, we may consider entering into a shared care agreement with a private provider. However, this will be unusual, will be on a case-by-case basis and this is not a guarantee that the prescription will be provided.
If you are being referred to a private provider, we will ask you to sign a disclaimer stating that you are aware of these limitations and that any costs of ongoing private prescriptions and appointments will be borne by you.