Information for Patients Seeking NHS Shared Care

We understand that you have a legal right to choose the NHS hospital or service you prefer.

A shared care agreement is a formal agreement that enables GPs to accept responsibility for the safe prescribing and monitoring of specialist medicines.

Please be aware that we only enter into NHS shared care agreements with NHS services approved by the NHS Lancashire and South Cumbria Integrated Care Board (ICB) or nationally commissioned services where a local service is not commissioned.

There are a number of reasons for this:

  • We rely on our Integrated Care Board (ICB) to commission specialist services.
  • Your GP is not trained or sufficiently experienced to deal with specialist diagnosis and management. 
  • Where there may be shortfalls in specialist service provision, we will not put our patients at risk by trying to fill any deficiencies.
  • We are unable to review every NHS clinic or individual and be assured that they provide a high quality service.
  • We are unable to determine that appropriate follow up and ongoing specialist care is in place at other clinics, should any complications arise during treatment.

If you choose an NHS specialist service that is not approved, the responsibility for NHS prescription drugs will remain with the specialist. You may wish to discuss this with your clinician at the time of your referral.

All shared care arrangements are voluntary, so even where agreements are in place, practices can decline shared care requests on clinical and capacity grounds. The responsibility for your care and ongoing prescribing of drugs then remains the responsibility of the NHS provider.


We will not undertake monitoring or investigations on behalf of an NHS provider or nationally commissioned services where no ICB Shared Care Agreement is in place.

Prescribing of medication

Guidance is in place for the prescribing of medication on the basis of patient safety. A traffic light system is used to determine responsibility for prescribing of drugs initiated in primary care and secondary care.

The category that your medication falls into will determine if it will be prescribed by the practice. It will also depend if the practice agrees with the treatment plan being suggested by an external clinician.

  • Green drugs – We can prescribe green drugs if the medication is licensed for the indication given. All prescribing is at the discretion of the prescriber and there may be circumstances where the prescriber is not in agreement with the treatment plan. If this is the case, we reserve the right to decline prescribing medications and an explanation will be provided.
  • Amber drugs – These are specialist drugs that must be initiated by secondary care specialist prescribers. We will not enter into any shared care agreements, other than those approved by the NHS Lancashire and South Cumbria ICB. Patients will need to return to their provider for ongoing prescribing of amber drugs where an approved shared care agreement is not in place.
  • Red drugs – These drugs are for hospital use or for use by a specialist within a specialist centre only. Initiation and monitoring of treatment should remain under the total responsibility of the hospital clinician or specialist. We will not prescribe any medications from the red drug list.

Transferring your care to a locally-commissioned service where there is a shared care agreement in place or a nationally commissioned service where a local service is not commissioned

If you are relocating to this area, we can refer patients to approved NHS secondary care specialties when appropriate. Waiting times vary considerably depending on the NHS specialty.

While you are waiting for your approved NHS secondary care appointment, you will need to obtain medication and continue receiving care from your current provider.

Any other new physical or psychological medical issues that arise can be managed under standard NHS care.