Shared Care Agreements
From 17th November 2025 Carisbrooke Surgery will no longer accept new Shared Care agreements for prescribing and monitoring of specialist medications.
This also applies if you are new to the practice and had an existing shared care agreement in place as your agreement was between your previous practice and the provider.
Shared Care agreements are for drugs which are higher risk and can only be started on the advice of a Specialist. These drugs need ongoing specialist monitoring to ensure safe and effective prescribing.
We have been receiving a growing number of requests for Shared Care agreements from an increasingly large number of providers.
These requests place an increasing amount of work on our Practice team, and at times, this additional workload is impacting our ability to deliver our core services to you, our patients.
Shared Care Agreements are not a ‘core’ part of our work in General Practice, and without adequate resources to deal with this increasing demand, we cannot continue to assure ourselves that patients are safely monitored to the highest standards of care.
For patients with new treatment plans put in place by Specialists, responsibility for prescribing and monitoring your medication will remain solely with your Specialist. Rather than coming to the Practice for monitoring or reviews, you may be given an outpatient appointment at a hospital or other NHS location.
If you already have a Shared Care Agreement with us, this will continue.
Please check these examples of medications that may be affected
Prescribing and Private Providers
There has been a significant increase in patients seeking private treatment and then requesting NHS prescriptions for specialist medications. However, this is not the same as NHS shared care.
We are unable to issue NHS prescriptions for specialist medications initiated by private providers. Patients must obtain these prescriptions directly from their private specialist.
This decision is based on several key factors:
1. Patient Safety & Governance
Private providers may follow different safety protocols than NHS services. Our priority is ensuring that all medications are prescribed with appropriate monitoring and oversight.
A particular risk arises when patients discontinue private care, leaving the GP to prescribe medication without specialist input. This is unsafe, and GPs are not insured for such prescribing.
2. NHS Commissioning & Resource Allocation
GPs are not funded to carry out private healthcare work. Prescribing on behalf of private providers diverts critical NHS resources, impacting the care available to other patients and contributing to health inequality.
3. British Medical Association (BMA) Guidance
The BMA advises that GPs are not obligated to prescribe medications recommended by private providers unless they feel clinically appropriate and safe. Our policy aligns with this guidance.
Patients who wish to transition their care to the NHS can be referred to an NHS specialist. Once an appropriate shared care agreement is in place, we will be able to take over prescribing in line with NHS protocols.
This policy applies fairly and equally to all private providers, ensuring consistency across patient groups and health conditions.
We understand this may be disappointing, but this approach has been agreed to maintain patient safety and uphold NHS governance standards.
Bridging Prescriptions
We acknowledge that many patients face long NHS waiting times, particularly those seeking gender-affirming care. Some patients request temporary prescriptions (“bridging prescriptions”) while awaiting specialist assessment.
Our practice does not initiate bridging prescriptions for specialist treatments, including hormone therapy.
We recognise that:
NHS gender identity services have significant waiting times, often exceeding 24 months.
Some guidance (e.g., Royal College of Psychiatrists) suggests that GPs may prescribe bridging hormones in certain harm reduction scenarios.
However, initiating hormone therapy requires specialist expertise to assess risks, conduct investigations, and provide appropriate counselling.
Our Policy on Gender Dysphoria Care
We are committed to supporting patients with gender dysphoria. Our practice will:
- Make an NHS referral to a specialist gender identity clinic as quickly as possible, considering patient preferences and waiting times.
- Provide mental health support to help manage anxiety, depression, or other concerns while awaiting specialist care. This includes self-help strategies, NHS mental health referrals, and signposting to support organisations.
Unfortunately, we are unable to prescribe bridging hormones, as we do not have the necessary specialist expertise to do so safely.
We recognise that this is a difficult situation for many patients. If you require additional support while waiting for NHS care, we recommend exploring:
Gender identity support organizations (e.g., Mermaids, Gendered Intelligence, MindLine Trans+)
LGBTQIA mental health charities
Private specialists who can provide continuity of care until NHS services are available
We appreciate your understanding and are committed to providing safe, high-quality care within the scope of our clinical expertise.