Staying with your NHS GP: shared care and the HRT prepayment certificate

Choosing a private assessment does not mean leaving the NHS behind. Many women have their menopause assessed and optimised privately while getting their actual HRT on NHS prescription, which keeps the medication cost low. This is called shared care, and it is a sensible use of both systems.

This article explains how shared care works in practice and how the HRT prepayment certificate fits in.

What shared care means

Shared care is an arrangement where one clinician handles the assessment, the dose decisions and the reviews, while your NHS GP issues the repeat prescriptions. You get the time and continuity of a dedicated review alongside the low cost of NHS prescribing. It depends on your GP being willing to prescribe what is recommended, which for standard, body-identical HRT is usually straightforward because these are everyday medicines. The arrangement is common in the NHS for many long-term conditions, so most practices are familiar with how it works in principle, even if their capacity to take on new cases varies.

How it works in practice

• You have your assessment and start, or adjust, treatment on a private plan.

• We write to your GP setting out the recommended HRT and the monitoring plan.

• Your GP adds the items to your NHS repeat prescription, so you collect them from any pharmacy at NHS cost.

• We continue your reviews and symptom tracking, and update your GP if the dose changes.

Not every GP takes on shared care for every medicine, and they are entitled to decline, particularly for less standard treatments. For routine HRT it is common and usually uncomplicated. It is always worth a conversation with your practice early.

The HRT prepayment certificate

If you live in England and pay for prescriptions, the HRT prepayment certificate, sometimes called the HRT PPC, is one of the best-value parts of the system. For a single annual fee, set at roughly the price of two prescription items, it covers all your HRT prescriptions for twelve months no matter how many you need. Given that HRT often means more than one item, an oestrogen and a progesterone for instance, it usually pays for itself quickly.

Who the certificate suits

The certificate covers HRT items specifically, such as oestrogen gels, patches and sprays, progesterone, and certain combined products. It does not cover non-HRT medicines. It is worth having if you pay prescription charges and use HRT regularly. In Scotland, Wales and Northern Ireland prescriptions are already free, so the certificate is an England-only consideration. You buy it through the NHS, not through us.

When full private prescribing makes more sense

Shared care is not always the right fit. If your GP is unable to take it on, if you want your medication dispensed and delivered together with your reviews, or if you are on a less standard regimen, having us prescribe and dispense directly can be simpler. The trade-off is that you pay for the medication privately rather than at NHS cost. Many women weigh this up as their treatment settles.

If your GP cannot take it on

Shared care depends on goodwill and capacity, and not every practice can offer it for every patient or every medicine. If your GP declines, it is not a dead end. For standard HRT, you can ask whether they would prescribe on the strength of our recommendation letter even without a formal shared-care agreement, which many will. If that is not possible, we can prescribe and dispense your HRT directly, with the medication charged privately, and you keep the reviews with us.

It is worth sorting this out early rather than at the point you run low. Knowing which route you are on means your prescriptions never lapse during the handover, and you are not left rationing a patch while paperwork catches up.

The honest summary

For most women on standard HRT, the lowest-cost route is an NHS prescription plus the prepayment certificate, with reviews wherever suits you. Shared care lets you combine that low cost with private continuity. We are happy to support it, and we will tell you plainly when full private prescribing would actually serve you better.

Ready to start?

If you want to move from reading to acting, the next step is a short assessment with a doctor on the GMC GP Register. It takes about ten minutes and tells you whether HRT is right for you.

Begin your assessment at this link. Online or in person at Westfield London.