Shared care with your NHS GP - how it actually works

Shared care is the arrangement where a specialist starts a medication and the NHS GP agrees to take over prescribing and routine monitoring. For TRT, shared care means you get the benefits of private assessment speed and depth, combined with NHS prescription costs and continuity with your registered GP. When it works, it is the most cost-effective way to sustain long-term TRT.

It does not always work. Here is the full picture.

What shared care actually means

The specialist (us, in this case) does the initial diagnosis, stabilises you on a dose, writes a formal shared-care letter with the plan, and takes on ongoing oversight at a lower frequency. The NHS GP takes over month-to-month prescribing, does routine monitoring bloods, and manages any day-to-day queries. Both parties stay involved, with different roles.

For TRT specifically, the shared-care pattern is: we review you quarterly or biannually (included in our monthly care plan), the GP does the three-monthly testosterone / haematocrit / PSA bloods and writes the repeat prescriptions. Complex decisions stay with us; stable routine management lives with the GP.

Why some NHS GPs accept and some decline

Acceptance depends on four things: the GP's personal comfort with TRT (some were trained in an era when it was rare), the practice's prescribing policy (some practices have blanket policies), the local Integrated Care Board's (ICB) position on privately-initiated hormone treatment (varies by region), and the quality of the documentation from the private clinician.

The fourth factor is the one we control. A clear, structured shared-care letter with the diagnosis, the bloods, the treatment plan, the monitoring schedule, the escalation criteria, and our contact details for queries is significantly more likely to be accepted than a vague "we started TRT, please continue" letter.

UK data is not comprehensive, but our experience across the London / SE region is that roughly 65 to 75 percent of NHS GPs accept TRT shared care when properly approached. Outside London the figure may be higher (less busy practices) or lower (rural single-hander practices with less exposure to the private-specialist model).

Before you raise it with your GP

Four steps that make acceptance much more likely.

First, have your diagnosis well established. Two morning testosterone readings below range, full male hormone panel, competing causes excluded, clinical symptoms documented, stable dose reached. Shared care is not for new diagnoses; it is for maintenance.

Second, have the private monitoring bloods in hand and up to date. A shared-care letter referring to bloods from six months ago is less compelling than one quoting bloods from last week.

Third, ask us for the shared-care letter before you raise it with the GP. We write these to a standard template that includes everything a cautious GP will want to see.

Fourth, book a normal GP appointment to discuss it, not a rushed phone call or online form submission. Ten minutes of face time with the letter in the room beats a request via admin every time.

What the GP is likely to ask

Who is prescribing? (Us, for now; the request is whether they take over.)

What is the indication? (Biochemically confirmed hypogonadism with symptoms.)

What form of testosterone and what dose? (Specify exactly: Nebido 1000mg IM every 10 to 12 weeks, or Testogel 50mg daily, or whichever regimen applies.)

What is the monitoring schedule? (Three-monthly testosterone and haematocrit in the first year; six-monthly thereafter; annual PSA and E2; lipids and metabolic annually.)

What happens if there is a problem? (They contact us; we respond within one working day; we have a named clinical lead.)

Who is responsible if something goes wrong? (Complex legal area; the practical answer is that shared care is explicitly joint responsibility within the roles defined, and we provide an indemnified clinical service.)

A good shared-care letter answers all of the above upfront.

If the GP declines

Not the end of the world. You have three options.

Option 1: stay fully private. Annual cost at LoveMyLife is £1,295 (annual plan) or £1,795 (monthly), including medication from our in-house pharmacy. This is what most of our patients choose when shared care is not available.

Option 2: change GP. You are entitled to register with any practice that has capacity. Some of our patients have switched practices specifically to get a TRT-friendly GP. This is drastic but doable.

Option 3: NHS-only route from scratch. Go back to your GP and ask for an NHS endocrinology referral. This restarts the process on NHS timelines (6 to 12 months typically), but if you already have a clear private diagnosis, the endocrinology clinic often moves quickly once they see the workup.

What we do to support shared care

We write a templated letter for every patient considering shared care. We respond to GP queries within one working day. We send quarterly updates to the GP on how treatment is going. We handle any complexity that arises (rising PSA, high haematocrit, E2 issues) ourselves so the GP's workload is limited to repeat prescribing and straightforward monitoring.

This model requires the private clinician to actually stay engaged rather than handing off and walking away. A significant amount of bad shared-care experience is because the private clinic disappeared after handover, leaving the GP holding complex management they had not signed up for. We specifically do not do that.

When shared care is not appropriate

If your presentation is complex (suspected pituitary disease, rising PSA, raised haematocrit, E2 issues, mood changes on treatment), shared care is not the right setting. Keep us fully involved; revisit shared care when the picture is stable.

If you are within the first six months of starting TRT, shared care is premature. Stability takes three to six months to reach. Shared care is for maintenance, not initiation.

The honest bottom line

Shared care is usually the right long-term answer for cost reasons. It works when the private clinician stays engaged, the documentation is clear, and the GP is willing. When it does not work, staying fully private is a workable alternative, and we make sure the monthly pricing at LoveMyLife reflects this.

Ready to start?

If this article has made you think an assessment might help, the next step is a short consultation with one of our men's health doctors.

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