Understanding Shared Care – NHS, Right to Choose and Private Providers
What is shared care?
Shared care is a term used within the NHS to describe the situation where a specialist doctor wishes to pass some of the patient’s care, such as prescription of medication, over to their general practitioner (GP). This is something that any specialist can request, but the guidance for all medications is that this may only be done if the GP agrees. The GP will need to consider several factors to decide if this is safe before they can agree.
The GP has a responsibility to ensure they can safely manage any medications they prescribe. So, whilst shared care can be convenient, it is not automatic. Your GP will make this decision carefully based on their competence, your specific case, the protocols for using that medication both locally and nationally and their current workload capacity. If shared care is not possible, prescribing your medication and all related monitoring will remain under the care of your specialist and their team.
All shared care agreements are voluntary and, even where agreements are in place within NHS, Practices can decline shared care requests on clinical and capacity grounds. When this is the case, the responsibility for the patient’s care and ongoing prescribing remains the responsibility of the private provider.
Due to capacity issues, from the 1st December 2024 Northgate Surgery will not be able to participate in any shared care arrangements with private providers.
Alternative NHS Provider
If we are asked to refer to an alternative NHS provider, we would expect the provider to be appropriately accredited and practising in line with UK best practice and willing to follow our locally agreed protocols for shared care.
We would expect the local commissioning team and ICB to provide assurance that the alternative NHS provider is appropriately accredited and that they are willing to work to locally agreed protocols. Therefore, if a patient asks for a referral to an ‘alternative’ NHS provider and the Practice is not familiar with the provider we may wish to seek assurance from the ICB that the provider has been appropriate approved and contracted. In such circumstance you may wish to consider an alternative.
Right to choose provider
In the current climate it is understandable that some patients are considering ‘right to choose’ providers and are requesting referral to independent providers who hold an NHS contract outside of the Wakefield ICB. Some providers are advertising NHS assessment and shorter waiting times.
Patients choosing such services should be mindful that some services will only diagnose and will not prescribe or provide the secondary care part of a shared care arrangement. Please note Northgate Surgery will not be able to enter into a shared care agreement with such providers and this will need to be considered by the patient.
We would expect the local commissioner to provide assurance that the Right to Choose provider is appropriately accredited and is willing to work to locally agreed protocols. If the Practice is not familiar with the provider, we may wish to seek assurance from the ICB that the provider has been appropriate approved and contracted. In such circumstance you may wish to consider an alternative.
Private providers
We understand that some people will chose to access health care privately, which is a choice you are entitled to make. However, there are a few things that you need to be aware of before making this decision.
Patient referrals from a GP for private service
Sometimes, after a private consultation, the private specialist may suggest that you are referred to an NHS service.
Please note that private providers can make referrals to NHS services, without referral back to the GP, whenever the patient would be eligible for NHS referral. Any patients referred should be treated based on clinical need. For further information you can read the NHS England guidance around consultant-to-consultant referrals within the NHS.
If we receive private requests for referral to an NHS service, we will kindly ask the private provider to make the referral themselves.
If a private provider requests more information from a general practice, this can be provided, following the patient’s consent, and the cost of preparing the report can be charged to the private provider.
Organising tests requested by private Providers.
If general practices receive requests from private providers to arrange tests or investigations, it is important to note that complying with such requests – regardless of the GP’s management and treatment of the patient – is outside the scope of NHS primary medical services.
Our contract states that a GP should only carry out investigations and prescribe medication for a patient where the GP is the responsible doctor, and it is necessary for the care of the patient. This means that the GP has had the full consultation with the patient themselves and has agreed, with the patient the investigations that are needed.
We regret that we don’t have the resources or capacity to be able to arrange investigations for patients who have been seen in a private clinic. We advise it is your responsibility to also arrange these privately as part of your package of private care.
Prescribing medication requested by a private Provider.
The practice may not be able to issue you with an NHS prescription following a private consultation for the following reasons:
- If the practice considers that there is not a clear clinical indication for the prescription, and that in the same circumstance an NHS patient would not be offered this treatment.
- If the private doctor recommends a new or experimental treatment or recommends prescribing a medication which only a hospital specialist can prescribe in Wakefield.
- If the medication is not provided within the NHS
- If the medication is prescribed for an off-license indication.
- If the medication is of a very specialised nature requiring ongoing monitoring, we may be unable to accept responsibility for the prescription. This includes medication that we can prescribe on the NHS but requires what is known as a Shared Care Agreement
- Without such a Shared Care Agreement in place with an NHS provider of care we are unable to safely prescribe and monitor certain medication. This would include but is not limited to what are known as Disease Modifying Drugs, IVF associated medications and those to treat ADHD.
Therefore, if the practice is not in a position to take responsibility for a private prescription your private provider will have to continue to do so. This will include any taking, monitoring, and analysing of any required tests to ensure you are receiving the best care.
Caring for patients who have had private treatment abroad.
If you choose to have treatment abroad, the practice will take no responsibility for your aftercare and further treatment, unless you require urgent or emergency care.