This page summarises the national position on shared care prescribing and related interface responsibilities, and provides a practical framework for GP practices when they receive requests to take on prescribing and monitoring initiated elsewhere. It also explains the role of locally agreed shared care agreements that are based on national templates.
Shared care in brief
Shared care prescribing is where a specialist initiates treatment and a GP practice is asked to continue prescribing and undertake agreed monitoring, supported by a shared care agreement or protocol. NHS England describes shared care prescribing guidelines as local policies that enable GPs to accept responsibility for prescribing and monitoring in primary care in agreement with the initiating specialist.
Key principles
- Shared care requires agreement
Shared care requires the agreement of all parties, including the patient, and depends on effective communication between the clinicians involved. This is explicit in GMC professional standards. - Shared care is voluntary for GP practices
The BMA position is clear that participating in shared care prescribing is a voluntary, non-core activity and can be declined by the GP practice. - Prescribing should only be accepted where it is safe and workable
GMC prescribing standards require clinicians to work within the limits of their competence and only prescribe when they have sufficient information and are satisfied that it is safe. This applies equally when prescribing is proposed or requested by another service. - Shared care should not be used to bypass commissioning or service responsibilities
NHS England’s guidance on prescribing responsibility is intended to clarify responsibilities and support safe transfer of care. Shared care is a structured arrangement, not a mechanism for unplanned transfer of workload without the necessary information and support. - Private providers and shared care
Where a patient is being treated privately, the BMA advises that shared care is voluntary and if a practice declines, responsibility for ongoing prescribing remains with the private provider.
The role of local shared care agreements
Local shared care agreements are usually based on national shared care protocol templates and adapted to local commissioning arrangements. Their purpose is to ensure consistency, safety, and fairness across providers delivering the same or similar services.
Where a locally agreed shared care agreement exists, this is the preferred document for practices to use. Using a single local agreement helps ensure that expectations placed on general practice are consistent across different providers, including where multiple providers deliver similar services, such as Right to Choose providers for ADHD assessment and prescribing.
The existence of a local shared care agreement does not remove the voluntary nature of shared care. Practices should still consider whether they can safely and realistically deliver the prescribing and monitoring requirements set out in the agreement.
A practical decision framework for practices
Holding prescriptions and bridging supply
A common interface issue is an implied expectation that the GP will provide a short-term supply while waiting for clinic correspondence or while responsibility is disputed.
National interface work from Getting It Right First Time (GIRFT) supports the principle that patients should not be left without medication because of system delays or unclear responsibility. In its July 2025 guidance on bridging the interface, GIRFT states that secondary care should prescribe medication for 28 days where clinically appropriate on discharge, and that commencement of new medication in outpatient settings should usually include an initial supply, alongside timely communication and agreed local processes.
This is not the same as a shared care agreement, but it is relevant where practices are being asked to provide interim prescriptions to compensate for incomplete handover.