Shared care in UK private prescribing is an arrangement where a private specialist initiates treatment and the patient's NHS GP takes over ongoing prescribing under an agreed protocol. The most common UK telehealth context is ADHD — private psychiatry initiates the medication, then the NHS GP continues prescribing once stable. Shared care is voluntary for the NHS GP and not always agreed. This piece walks through how it works.
What shared care actually means
Shared care is a clinical and prescribing arrangement: the private specialist (psychiatrist, dermatologist, endocrinologist) initiates and titrates a treatment, and once the patient is stable, the ongoing prescribing transfers to the NHS GP who is the patient's primary care provider. The specialist remains available for review and adjustment; the GP handles routine repeat prescribing.
The benefit to the patient is significant: NHS-charge prescriptions instead of private-cost ongoing supply. The benefit to the system is appropriate division of specialist and primary-care work.
When shared care applies in UK telehealth
The most common UK telehealth shared-care context is ADHD. Private psychiatry assesses, diagnoses, and titrates the patient on ADHD medication; once stable, the NHS GP takes over routine prescribing under a shared care agreement. Other contexts: certain HRT regimens, some specialist dermatology, certain psychiatry beyond ADHD.
Categories where shared care typically does not apply: weight management (GLP-1s are not on NHS shared-care pathways for most patients), ED (not typically transferred), aesthetic prescribing (not appropriate for NHS continuation).
Why NHS GPs sometimes decline shared care
Shared care is voluntary. NHS GPs are not required to accept shared care agreements and increasingly decline — citing workload pressures, indemnity concerns, prescribing budget constraints, or specific concerns about the medication class. This has been a particular issue for ADHD shared care in recent years.
When the GP declines, the patient typically continues on private prescription. This can become commercially significant for the patient — private ADHD medication is materially more expensive than NHS prescription rates.
How to handle shared care professionally
Telehealth services initiating treatment should: write a clear clinical summary to the GP including diagnosis, treatment rationale, titration plan, and proposed shared-care protocol. Offer to take back ongoing prescribing if the GP declines shared care. Maintain continuity for the patient including communication where shared-care is declined or terminated.
The professional relationship between private specialist and NHS GP matters. Services that treat the GP as an adversary or that bypass GP communication damage shared-care prospects for the patient.
The patient experience and pricing implications
Patients on shared care typically pay private rates for the initial consultation and titration phase, then NHS prescription rates for ongoing supply. The cost difference can be significant — particularly in categories like ADHD where ongoing medication cost is substantial.
Services should be clear with patients at intake about what shared care can and cannot achieve. Patients who expect automatic shared care and then find their GP declines feel mislead. Setting expectations honestly is foundational.
How PExpo supports shared care workflows
PExpo's clinic and brand models support shared care workflows where appropriate to the category. The clinical workflow includes GP communication templates, shared-care protocol documentation, and the ongoing-prescribing pathway for cases where the NHS GP declines.
See our clinic model page for the operational scope and our brand model page for the white-label equivalent.
Shared care is voluntary for the NHS GP. Increasingly, GPs decline shared care for categories like ADHD. The patient typically continues on private prescription if shared care is not agreed — set expectations honestly at intake.
Services that treat the NHS GP as an adversary damage shared-care prospects for the patient. The professional relationship matters.
Shared care in UK private prescribing is a voluntary arrangement where private specialists initiate treatment and NHS GPs take over ongoing prescribing under agreed protocol. Common in ADHD; not always agreed. Services should communicate professionally with the NHS GP and maintain continuity where shared care is declined. See our clinic model page for the operational scope and our brand model page for the white-label equivalent.
Frequently asked questions
Why are NHS GPs declining shared care more often?
Workload pressures, indemnity concerns, prescribing budget constraints, and specific clinical concerns about certain medication classes (notably ADHD medications) are commonly cited reasons. Some Integrated Care Boards have issued guidance to GPs on shared care.
Can a UK telehealth service force NHS GP shared care?
No — shared care is voluntary. The telehealth service should communicate professionally with the GP, provide clinical justification, and be prepared to continue private prescribing if shared care is declined.
Does PExpo handle ongoing prescribing if the NHS GP declines shared care?
Yes — PExpo's clinical workflow supports ongoing private prescribing as a fallback when shared care is declined. The patient remains under private care with appropriate clinical oversight. See our brand model page.
