How Shared Care Arrangements Work Between Your GP and Specialist

Why this matters

If a long-term specialist medication has been prescribed, shared care is likely already in place, even if the term hasn’t been explicitly used. Understanding what it means in practice reduces confusion about who to contact for what and helps identify when something has gone wrong with the arrangement.

What shared care means

Shared care is a formal agreement between a specialist and a GP dividing responsibility for managing a treatment. The specialist diagnoses, initiates treatment, provides the management plan, and monitors the more complex aspects of care. The GP prescribes repeat medication, orders routine blood tests for monitoring, manages the condition while it’s stable, and refers back to the specialist if problems arise.

Shared care is most common for conditions requiring long-term specialist medications. The arrangement reduces the burden on specialist services while giving patients more convenient local access to prescriptions and monitoring, without losing specialist oversight entirely.

How it starts

Shared care doesn’t begin automatically. The specialist proposes it by writing to the GP with a protocol outlining responsibilities. The GP must then agree; they can decline if they aren’t comfortable managing the treatment.

The protocol itself is a written document that specifies the medication details, which blood tests are required and how often, how responsibilities are divided between GP and specialist, and contact information for different types of queries. The protocol is the document that makes the arrangement work in practice, and patients have the right to ask for a copy of it.

When shared care begins, information about the medication, monitoring requirements, warning signs, and who to contact for different issues should be provided. If it isn’t, asking for it is reasonable.

Your role in shared care

• Attend monitoring appointments: routine blood tests detect medication side effects early. GPs may stop prescribing if monitoring is overdue
• Report symptoms promptly: know the warning signs specific to the medication, such as unusual bruising, persistent nausea, signs of infection, or changes in skin colour
• Know who to contact for what: prescription issues and routine results go to the GP; concerns about treatment effectiveness, major side effects, or disease flares go to the specialist
• Track when monitoring is due: keeping a record of blood test dates and upcoming appointments prevents gaps

When shared care breaks down

Delays or gaps can occur, such as a missing protocol at the GP surgery, unclear monitoring requirements, results not being reviewed, or communication breaking down between GP and the specialist.

• If prescriptions are delayed, check whether the GP has the protocol; if not, contact the specialist's secretary
• If monitoring is unclear, ask what tests are needed and how often
• If abnormal results come back without follow-up, contact the GP to review them, do not assume no news is good news
• If it’s unclear who is managing a particular aspect of care, request a review with either clinician to clarify the plan

Shared care is a partnership requiring active engagement from all parties, including the patient.

This article is for general information purposes only and doesn’t constitute legal, financial or benefits advice. For advice specific to your situation, please speak to a qualified professional or contact an organisation such as Citizens Advice, who may be able to assist you further.

References:

‘Principles for shared care prescribing’ (2025) https://www.bma.org.uk/advice-and-support/gp-practices/prescribing/prescribing-in-general-practice/principles-for-shared-care-prescribing

‘Shared care protocols’ (2025) https://www.england.nhs.uk/medicines-2/regional-medicines-optimisation-committees-advice/shared-care-protocols/