The information on this page is intended for healthcare professionals. You can find information for trans patients on our How to access medical transition page.
You may receive requests to enter into a shared care agreement with a private gender service. In this arrangement, the GP provides routine monitoring tests and NHS prescriptions, while the private service provides expert advice and is responsible for the initial titration and stabilisation.
Entering into such an agreement is voluntary. It is your decision whether to agree and whether you believe it is in the best interests of the patient.
Benefits of shared care agreements to patients
The costs of accessing private services, medications, and blood testing can be significant. In our Transition Access Survey in 2022, respondents reported their average estimated expenditure on hormone therapy was £1,302. Under a shared care agreement, the patient is not required to pay out-of-pocket for blood testing or medication costs.
If you do not decide to enter into a shared care agreement, the patient can still ask their private provider to continue writing private prescriptions, and the patient can request blood testing from a private blood testing service. Alternatively, you could decline to prescribe, but you might be willing to share some aspects of care, such as providing blood test results.
Patients who are paying full price for private prescriptions may take actions to minimise their costs such as requesting cheaper medications with harsher side effect profiles, using less accurate finger prick blood tests instead of venous draw blood testing, or withdraw from professional supervision entirely and purchase medications from unregulated sources.
Making your decision
When making a decision whether to enter into a shared care agreement with a private provider, you may wish to consider:
- Does your local ICB, trust, or health board have a policy that allows you to enter into a shared care agreement with a private provider?
- Are you satisfied that the private service is reputable and provides a safe and effective service?
- Are you satisfied that the health professional making the request is an appropriate gender specialist?
- Is there a written shared care agreement?
- Has the specialist stabilised the patient’s treatment dose already?
If you are concerned about the private provider they have chosen or the health professional making the request, you might suggest the patient consider a different provider. Patients can find information about finding a provider in our guide to private care and our guide to choosing a gender service.
If you are concerned about being asked to prescribe medications outside of their UK license, you may wish to read the GMC’s guidance on this issue.
Further information and guidance
- Leeds GIS: Prescribing on the Request of a Private Provider
- NHS England: Primary Care Responsibilities In Regard To Requests by Private On-Line Medical Service Providers to Prescribe Hormone Treatments for Transgender People
- BMA: General practice responsibility in responding to private healthcare
Have we missed anything?
Have we missed a link on this page? Have you spotted an error? Let us know.
Disclaimer: TransActual do not provide medical, health, or legal advice. The content of this page is intended to be read by healthcare professionals and is for information purposes only. Use this information in conjunction with your professional judgement and expertise. Information on this page is not a substitute for advice from a legal professional, and we strongly suggest you consult a legal professional for specific legal advice about your situation. TransActual do not advocate or recommend the purchase of any specific product or paid healthcare service. We do not endorse or guarantee the credentials or appropriateness of any health care provider, any product or any provider of insurance and legal services.
Page last updated: