Cross-sector handover and shared-care prescribing policy (gp)

1. What the regulation says

Care and treatment must be provided in a safe way for service users. (Reg 12(1) (the headline duty))

where responsibility for the care and treatment of service users is shared with, or transferred to, other persons, working with such other persons, service users and other appropriate persons to ensure that timely care planning takes place to ensure the health, safety and welfare of the service users. (Reg 12(2)(i) (shared / transferred responsibility))

assessing the risks to the health and safety of service users of receiving the care or treatment, (Reg 12(2)(a) (risk assessment))

doing all that is reasonably practicable to mitigate any such risks, (Reg 12(2)(b) (risk mitigation))

ensuring that persons providing care or treatment to service users have the qualifications, competence, skills and experience to do so safely, (Reg 12(2)(c) (staff competence))

the proper and safe management of medicines, (Reg 12(2)(g) (medicines management))

The full text of the regulation is at https://www.legislation.gov.uk/uksi/2014/2936/regulation/12. Where this policy and the regulation diverge, the regulation wins.

2. Plain-English summary

Care and treatment must be provided in a safe way. The regulation lists the areas a provider must address, including risk assessment, risk mitigation, staff competence, safe premises, safe equipment, sufficient equipment and medicines, medicines safety, infection prevention and shared-care planning. Regulation 12 is central to CQC's safety expectations.

3. Purpose

This policy sets out how the Practice handles clinical handover when a patient is shared between this Practice and another clinical provider, and how the Practice manages prescribing where a patient is also under the care of another prescriber. The most common patterns at private GP practices are:

• A patient who uses this Practice privately AND has an NHS GP for general care.
• A patient under specialist (consultant) care for a long-term condition where prescribing is recommended by the specialist and continued by the GP.
• A patient receiving private psychiatric, endocrine, or other specialist prescribing alongside NHS GP care.
• A patient discharged from an acute episode (hospital stay, private clinic procedure) requiring follow-up by this Practice.
• A patient on a private weight-management, hormone-replacement, or specialist-medication programme that interacts with their NHS-prescribed medications.

This policy covers the documentation, communication, and prescribing-decision discipline for those patterns.

4. Scope

This policy applies to:

• private GP consultations where the patient is also registered with an NHS GP.
• specialist-initiated prescribing where this Practice is asked to continue prescribing under a shared-care agreement.
• private hormone-replacement, weight-management, or off-label prescribing programmes that this Practice initiates.
• discharge follow-up where this Practice receives a hospital discharge summary or private-clinic post-procedure summary.
• referrals from this Practice to specialists, NHS services, allied health professionals, or private treatment providers.
• communications with safeguarding networks where a patient is shared between this Practice and another provider involved in safeguarding.

5. Patient consent for cross-sector data sharing

Before this Practice shares clinical information with another provider (NHS GP, specialist, hospital, community pharmacy, allied health provider), the patient's consent is recorded.

The Practice's default position:

• Implied consent is acceptable for routine clinical correspondence (e.g. a referral letter to a specialist where the patient has consented to the referral; a hospital discharge summary being routed to the patient's named GP).
• Explicit consent is required for non-routine sharing (e.g. sharing private clinical records with an NHS GP where the patient has not previously authorised this; sharing with a non-clinical third party such as an insurer or employer).
• Explicit written consent is required for sharing involving sensitive information (mental health records, sexual health, safeguarding records) or where the recipient is outside the patient's standard care pathway.

Consent records are kept in the patient's clinical record, with the date, scope of consent, named recipient, and signature where applicable.

6. Handover documentation standards

When this Practice corresponds with another provider about a shared patient, the correspondence captures:

• Patient identifier (NHS number where available; private-patient identifier where NHS number is not used).
• Date of consultation / event the correspondence relates to.
• Clinical context (presenting complaint, relevant history, current medications, current investigations).
• Findings (examination, test results, clinical reasoning).
• Decisions made (diagnosis, treatment, prescription, referral).
• Specific ask of the recipient (e.g. "please consider continued prescribing under shared care", "please book follow-up imaging in 6 weeks", "for information only").
• Follow-up plan (what happens next; whose responsibility for what).
• Contact details for queries.

The Practice retains a copy of every outbound clinical correspondence in the patient's clinical record. Inbound correspondence (from NHS GPs, specialists, hospitals) is also added to the patient's clinical record on receipt; the Registered Manager is responsible for ensuring inbound correspondence is reviewed by the appropriate clinician within 5 working days of receipt (Verivius default; not regulator-mandated).

7. Shared-care prescribing: accept or decline

When this Practice receives a request to take over prescribing under a shared-care arrangement (typically from a specialist), the Practice:

7.1 Assesses the request

• Is the medication within the GP's clinical competence to prescribe and monitor?
• Is the shared-care arrangement supported by a published shared-care protocol from the relevant ICB or specialty body?
• Are the monitoring requirements (blood tests, ECGs, weight checks, etc.) feasible to deliver in this Practice's setting?
• Is the specialist's plan clear about what is GP responsibility versus what remains specialist responsibility?
• For private-funded prescribing handed to NHS GP for continuation (or vice versa), is the funding arrangement clear to the patient and to both providers?

7.2 Documents the decision

• If accepting: a written acceptance to the specialist confirming the scope of GP responsibility and the monitoring schedule and the escalation pathway. A copy is added to the patient's clinical record.
• If declining: a written response to the specialist explaining the basis for declining (e.g. monitoring requirement outside Practice setting; medication outside GP clinical competence; absence of an ICB-supported protocol). The patient is informed in writing of the decision and the alternative (typically that prescribing remains specialist-led).

7.3 Reviews periodically

Shared-care prescribing is reviewed at the patient's annual review, OR sooner if the patient's clinical situation changes, OR sooner if the specialist's care relationship changes. Review covers: is the medication still appropriate, are the monitoring requirements being met, has the specialist relationship continued.

8. Private-prescribing handed to NHS GP for continuation

Where this Practice initiates a private prescription (e.g. weight-management, hormone-replacement, off-label) that the patient subsequently asks their NHS GP to continue:

• This Practice provides the NHS GP with a structured handover letter covering: rationale for the original prescription, monitoring undertaken to date, ongoing monitoring expected, the patient's understanding of the medication.
• This Practice does not make any representation to the patient that the NHS GP will accept the prescription; the decision belongs to the NHS GP.
• If the NHS GP declines to continue, this Practice continues to prescribe (subject to clinical appropriateness and ongoing consultation with the patient) and the patient is informed clearly of the funding implications.
• The Practice maintains written records of all handover attempts, responses, and outcomes.

9. NHS-prescribing patient seeing this Practice privately

Where a patient is seen by this Practice privately while also under NHS GP care:

• The Practice asks the patient (at first consultation) which information they wish their NHS GP to receive.
• For consultations relating to general health, the Practice's default is to write a copy-of-record letter to the NHS GP unless the patient declines.
• For consultations relating to specialist or sensitive areas (private mental health, sexual health, occupational health), the Practice asks specifically whether the patient wants the NHS GP informed.
• The Practice does NOT alter the patient's NHS prescription without specific liaison with the NHS GP.
• Where the private consultation surfaces a clinical concern that the NHS GP needs to know about (e.g. a finding requiring further investigation), the Practice ensures the NHS GP is informed in writing within 5 working days (Verivius default; not regulator-mandated). For urgent findings (suspected cancer, acute mental health risk, child safeguarding), the contact is same-day.

10. Hospital and private-clinic discharge follow-up

When the Practice receives a hospital discharge summary or private-clinic post-procedure summary for a patient on the Practice's books:

• The summary is reviewed by a clinician within 5 working days of receipt (Verivius default).
• Any actions identified (medication change, follow-up appointment booking, investigation booking, safety-netting advice) are added to the patient's clinical record and flagged for completion.
• Where the patient is also registered with an NHS GP, the Practice confirms which provider has primary responsibility for each action; duplication is avoided.
• Where the patient's next appointment is with this Practice, the discharge summary informs the consultation; the clinician documents that the summary was reviewed.

11. Safeguarding handover

Where this Practice is involved in shared care of a patient on a safeguarding pathway (child protection, adult safeguarding), the Practice:

• Cooperates fully with the lead safeguarding agency (typically Local Authority Children's or Adult Safeguarding Team).
• Provides information requested under safeguarding statutory powers, in line with the Practice's safeguarding policy.
• Does not require the patient's consent to share information for safeguarding purposes where the threshold for safeguarding sharing is met (per the Practice's separate safeguarding policy).
• Documents the safeguarding handover separately from routine clinical correspondence; safeguarding records are tagged appropriately in the clinical record.

12. Information governance

All cross-sector handover documentation is subject to the Practice's information-governance policy:

• Records are stored in the patient's clinical record on the Practice's clinical system.
• Records shared electronically with other providers use the recipient's secure mechanism (NHS Mail to NHS Mail; encrypted email or secure portal for other recipients).
• Records shared by paper are sent recorded delivery and tracked.
• Records of correspondence include the date sent, the recipient, and the channel.
• Inbound correspondence is added to the clinical record on receipt with the date of receipt recorded.

UK GDPR and Data Protection Act 2018 considerations are addressed in the Practice's separate data-protection policy.

Operational controls to adapt

Step-by-step operational procedure

1. Log the request or correspondence. Record the date received, source provider, patient identifier, type of request, requested action and responsible clinician.
2. Check consent and lawful sharing. Confirm the patient's consent or the lawful basis for sharing, including safeguarding or serious-risk exceptions where consent is not required.
3. Triage clinical risk. Mark same-day items such as safeguarding, urgent cancer suspicion, acute mental-health risk, medication safety, abnormal results or discharge actions that cannot wait.
4. Assign clinical ownership. Allocate the task to a clinician with the competence and authority to accept, decline, prescribe, monitor or hand over.
5. Decide accept, decline or clarify. For shared-care prescribing, confirm whether a valid protocol exists, the specialist remains involved, monitoring is feasible and the Practice has competence.
6. Write the response. Send a clear acceptance, decline, request for clarification or handover letter that states responsibilities, monitoring, escalation and patient communication.
7. Track completion. Do not close the log entry until the patient record, correspondence copy, monitoring plan, prescription decision and patient communication are complete.
8. Escalate failures. Unreviewed correspondence, unclear responsibility, missed monitoring, unsafe prescribing pressure or failed handover is opened on the incident, risk or improvement-actions register.

Records and evidence fields

The handover and shared-care record should include:

• patient identifier, NHS number where available, source provider and destination provider
• correspondence date, route, sender, recipient, secure-channel check and copy saved to the clinical record
• consent scope, lawful basis or safeguarding/public-interest reason for sharing without consent
• specific ask, clinical context, medicines involved, monitoring requirement and urgency
• accept, decline or clarify decision, with reason and named responsible clinician
• shared-care protocol, ICB or specialty guidance used, and whether specialist follow-up remains active
• monitoring schedule, test owner, abnormal-result escalation, prescription issue or hold decision
• patient communication, funding explanation where private and NHS care interact, and safety-netting advice
• linked incident, risk, complaint, medicines, safeguarding or improvement-action reference

Training and competence

Clinicians who accept shared-care prescribing must be competent for the medicine, monitoring, adverse-effect advice and escalation route. Administrative staff who handle correspondence must be trained to recognise urgent clinical handovers and to route them without delay. The Practice records competence, role limits and refresher dates.

Local adaptation prompts

Before adoption, the Practice should state:

• which shared-care protocols it recognises, including local ICB or specialty sources
• who can accept, decline or pause shared-care prescribing
• the maximum timescale for reviewing routine and urgent inbound correspondence
• how private-to-NHS prescribing requests are explained to patients
• which register is used for failed handovers, missed monitoring and prescribing concerns

13. Roles and responsibilities

14. Audit and review

This policy is reviewed annually by the Registered Manager and the Clinical Lead. Sooner review is triggered if:

• A SEA (per the separate SEA policy) surfaces a cross-sector handover failure.
• An ICB or specialty body publishes new shared-care guidance that affects the Practice.
• A CQC inspection identifies a handover-related finding.
• The Practice's structure changes materially (new clinical service, new specialist relationship, change in NHS-contract status).

Review is recorded with date, reviewer, and any changes made.

15. Sources and further reading

This template is based on CQC's guidance for providers and managers, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and other topic-specific legislation and guidance listed below. It is a starting point for adaptation, not a substitute for legal, clinical, HR, safeguarding or specialist professional advice.

• CQC Regulation 12: Safe care and treatment
• CQC Regulation 17: Good governance
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (https://www.legislation.gov.uk/uksi/2014/2936/regulation/12)
• GMC, Good practice in prescribing and managing medicines and devices
• GMC, Good medical practice (continuity of care and the named GP)
• NICE Clinical Knowledge Summaries (CKS) for the medicines being prescribed
• MHRA drug safety alerts
• Shared-care protocols published by the relevant Integrated Care Board or specialty body
• BMA shared-care prescribing guidance
• NHS England shared care guidance and ICB-level shared-care protocols (varies by region)
• UK GDPR and Data Protection Act 2018 (data sharing between healthcare providers)
• ICO data sharing code
• NHS Records Management Code of Practice
• Caldicott principles
• CQC GP mythbusters series, including on shared-care arrangements
• CQC assessment framework and sector-specific guidance, as updated by CQC from time to time
• CQC Fundamental Standards

Related reading

• Related policy: GP safe prescribing and high-risk medicines policy
• Related policy: Medicines management policy
• Related policy: Record keeping and documentation standards policy
• Related policy: Incident reporting, investigation and learning policy
• Related policy: Risk management and risk register policy

16. When to seek further advice

Seek specialist advice where the issue involves serious harm, safeguarding, deprivation of liberty, restraint, children, professional misconduct, controlled drugs, radiation, termination of pregnancy, infection outbreak, water safety, employment dismissal, DBS barring referral, or regulatory enforcement.

17. Document control

This sample policy template was issued by Verivius. It is a template, not a substitute for legal advice or the tenant's own policy-development process. Where this template and live law or regulator guidance diverge, the live source wins.