Shared Care, private clinics and “right-to-choose” clinics

“Shared care” is when specialist doctor assess a patients needs and then establishes an agreement with the patients GP to support ongoing care in accordance with their assessment and recommended treatment. Under such arrangements it is very important that responsibilities of each of the clinicians involved (i.e. the specialist and the GP) are clear and that there is good communication between them. In many cases the medicines prescribed by a specialist clinic require specialist knowledge which is sometimes beyond the levels of skills of general practitioners. For these reasons it is essential that there are good relationships and clear, established ways of working together between specialist clinics and local GP practices.

Hampshire and Isle of Wight Integrated Commissioning Board (HIOW ICB) commission a range of services for our local population, including, for example, specialist services for Gender Reassignment and ADHD assessment. For our locally commissioned services, St Marys and Mulberry Surgeries have good relationships with the specialist clinicians and there are agreed protocols (or policies) for how we will work together. Shared care arrangements are voluntary and your GP can decide whether or not to accept such an arrangement based on a number of factors. It is important that GP practices are careful about accepting shared care arrangements and make sure that we are clear about roles and responsibilities and the details of any prescribed treatments, monitoring arrangements and arrangements for the review of care. More than that it is a legal requirement that GPs are satisfied that these things are clear and in place before they accept any shared care arrangements. This is to help keep patients safe and also to ensure our clinicians are not exposed to situations where they are working outside of their skills and clinical competence.

St Marys and Mulberry Surgeries strive to deliver high-quality healthcare for our local population through our team of dedicated clinicians. NHS services have never been busier with demand on our services being caused by rising population health needs. We have a dedicated and highly skilled clinical team at our St Marys and Mulberry Surgeries and it is really important that we work hard to optimise their skills and capacity to best meet the needs of all our patients. In considering shared care arrangements we need to take into account the associated workload. For locally commissioned services this is more straightforward since there are already agreed arrangements. For private or out-of-area “Right to Choose” services this is not often the case and entering into shared care will generally require a significant additional workload for our GPs in supporting the arrangements.

With this in mind we will consider requests for shared care carefully and may decline to accept such arrangements unless we are satisfied that there are established arrangements in place for good shared care arrangements. Patients who are already under the care of specialist clinics who are considering registering with St Marys and Mulberry Surgeries should consider our policies around shared care. We may not be willing to continue your arrangements should you register with us, particularly if they are with clinics other than those which are locally commissioned in Hampshire and Isle of Wight.

As an example, for ADHD services we are recommending that patients access our locally commissioned services provided by PHL. For more info please visit the PHL Group website. If you currently have your ADHD care under a different provider then we recommend that you switch your care to PHL – we can support with this. If you choose to access ADHD care from a provider then we may not currently be willing to accept shared care arrangements, in which case you may need to go back to your specialist provider regarding your ongoing care and prescribing.

Our approach to shared care arrangements is informed by guidance from our Wessex Local Medical Committees Guidance which was most recently reviewed in January 2024 and is available on their website