Shared care agreements: What Can an External Pharmacy Team Take On?

• 27th October 2026
• Clinically reviewed by: Adeem Azhar, MPharm, IPres

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• What should a practice check before work starts?
• What can an external pharmacy team take on?
• What must a shared care agreement clarify before acceptance?
• How should a practice assess GP shared care?
• Who continues treatment while acceptance is unresolved?

An external Clinical Pharmacy team can add capacity to shared-care workflows, with responsibilities agreed between the practice, specialist service and Clinical Pharmacy provider. Each clinician remains accountable for the decisions and actions they undertake. For GP shared care in England, name the decision maker for prescribing, clinical monitoring and escalation.

Key takeaways

• A shared care agreement needs informed agreement from the patient, specialist and practice.
• An external team can assess agreed work, make recommendations and support independent prescribing within scope.
• Until transfer is accepted, the specialist continues prescribing to protect continuity of care.

What should a practice check before work starts?

1. Confirm the local pathway, stability and specialist input.
2. Record whether shared care is accepted, declined or awaiting clarification, and communicate the next steps.
3. Name the clinical decision maker for each task.
4. Agree the route for monitoring, liaison and escalation.

What can an external pharmacy team take on?

A team working under a shared care agreement can provide defined clinical and operational support. The practice must set its scope, information access, supervision and escalation routes before work starts.

Activity	What the external team can deliver	Authority, competence and accountability required
Clinical correspondence	Triage letters, identify missing information and keep an auditable tracker.	A named clinician decides action and escalates unanswered queries.
Monitoring and recalls	Search, review results against agreed parameters and flag cases requiring action.	A named clinician owns interpretation, action and follow-up.
Medication requests	Assess requests against the shared care protocol, recommend action and provide independent prescribing only when qualified and authorised.	The prescriber who signs remains accountable and must work within agreed scope.
Specialist liaison and care coordination	Chase missing details, send agreed queries and document the response, handover and outstanding action.	The practice names who contacts the specialist, acts on advice and returns the case to specialist care.

The named clinical decision-maker may be an appropriately qualified external Clinical Pharmacist where this falls within their competence and the agreed service arrangements. This is more than administrative support. It can include specialist pharmacy input where the work needs clinical expertise.

What must a shared care agreement clarify before acceptance?

The shared care agreement should record the patient’s agreement, the medicine, review arrangements, monitoring ownership, communication route and route back to the specialist. For shared care prescribing, it should identify the prescriber and the action required if results, information or advice are missing.

Check that the local shared care protocol is current. The specialist must supply enough information for the practice to decide, and the patient should know who to contact and how treatment will be supplied. The local process should say how clinical correspondence is received, allocated and recorded when it affects the agreed plan.

Need external Clinical Pharmacy support for shared-care workflows?

Discuss shared care pharmacy support

How should a practice assess GP shared care?

Before GP shared care begins, assess capacity, competence, resourcing and confidence in the specialist support available. The BMA describes shared care prescribing as voluntary, so a request is not an automatic transfer.

A clinician should accept only work they can undertake safely. Every task needs a clearly identified decision maker and escalation route.

How should specialist liaison work in practice?

Agree a routine contact route, an urgent escalation route and a follow-up process for unanswered queries. Record who is responsible for obtaining advice and acting on it. This supports continuity of care when information is missing, a result is abnormal or treatment changes.

Drug-specific schedules and safety actions remain within local policy and high risk medication monitoring guidance.

Expert insight from Adeem Azhar, qualified Clinical Pharmacist and CEO

The question we ask practices and PCNs is whether the work is waiting for time or waiting for the right expertise.

Adeem Azhar, MPharm, IPres
Co-Founder and Chief Executive Officer – Core Prescribing Solutions
Qualified Clinical Pharmacist

Who continues treatment while acceptance is unresolved?

Until a shared care agreement is accepted for the individual patient, the hospital or specialist service should continue providing prescriptions. It should cover the transition period. This protects continuity of care. NHS England guidance says referral to the GP should take place only after the GP has agreed.

Until a shared care agreement is accepted for the individual patient, the hospital or specialist service should continue providing prescriptions. It should cover the transition period. This protects continuity of care. During the transition, care coordination between the specialist service, practice and pharmacy provider should keep the patient informed about who will supply treatment. NHS England guidance says referral to the GP should take place only after the GP has agreed.

FAQs

Build shared-care pharmacy support around clear ownership and escalation

Core Prescribing Solutions can support GP practices and PCNs with Clinical Pharmacist capacity for agreed shared-care activities, including clinical correspondence, monitoring, medicines requests and specialist liaison within defined scope. We can help establish clear decision ownership, escalation, handover and governance while each clinician remains accountable for the decisions and actions they undertake.

Discuss your shared care requirements