From today (Wednesday 1 July), the BMA is asking GP practices across England to reject new requests from hospitals to transfer prescribing and monitoring responsibilities for a patient onto practices, unless these are under locally agreed pathways which adequately fund the additional responsibility, complexity and workload.

These so-called ‘shared care agreements’ are voluntary pathways developed by the local NHS system, setting out how hospital specialist treatment may be transferred from the hospital specialist to the GP. Examples may be around specialist drugs for the immune system, heart and lungs, or to treat ongoing prostate cancer or osteoporosis, among other examples.

Too often, practices are expected to ‘automatically’ take on the responsibilities for prescribing and monitoring the specialist treatment – without any recognition of the clinical safety, accountability, workload and modelling that is needed prior to such a pathway being agreed between the local NHS commissioner and practices.

The GP committee for England (GPC England) argues that it is negligent for commissioners to place unresourced additional responsibilities on GPs who are struggling with capacity whilst seeing on average 1.5 million patients every day.

Lack of accountability for the provision of key patient services by commissioners is leaving GPs as providers struggling to cope with demand for their services, which has a negative knock-on effect on the other services GPs provide for their patients by stretching under resourced practices even further.

From Wednesday 1 July, practices across England will be asked to begin the following:  

• Refuse to accept any informal requests for new shared care agreements.
• Accept only those new agreements which are appropriately resourced and safe.
• Ensure a formal agreement is in place before prescribing and monitoring begins, which confirms:
  • specialist support will continue to be available to the patient 
    clear responsibilities are set out between the hospital specialist and their GP surgery.  
  • Review all existing shared care agreements and confirm that they are aligned to what’s required for the service to operate safely.  

GPC England chair Dr Katie Bramall said:  

"This next phase of collective action is about GPs rejecting the transfer of additional work from hospitals to practices – beyond their existing contractual arrangements with the NHS – that is too often unsafe and unfunded.  

"Practices may choose to take on additional work, if the additional workload has been calculated and costed to ensure other services do not become unreasonably stretched. The profession must take a stand against the ICBs which oversee this, else the demand on practices will continue to grow pushing them ever closer to closure. 

"The BMA recognises that both specialist hospital and GP services are stretched too thin across the NHS. This is why we want to see a long-term solution that gives patients with complex care needs the reassurance that their long-term care can be managed closer to home and safely by both specialists and GPs. However, if there is no additional resource to cover the additional workload and time GPs and their practices need to take on the additional ask, services for other patients suffer and practice staff become even more overworked than they are now. GPs should not be expected to fill commissioning gaps at a cost to their own practice’s long-term survival. 

"For the sake of safe patient care, and keeping local GP surgeries open and viable, practices will therefore refuse any new requests for shared care, if these are inappropriately resourced. Once commissioners have drawn up formal proposals which are safe and sustainable, GP practices with capacity may be able to take on more specialist prescribing and deliver more care closer to home for their patients."

Notes to editors

The 2026/27 GP contract, rejected by 99% of around 17,000 BMA GP members who voted in the referendum earlier this year, did not address two immediate concerns: the mandated use of Advice and Guidance (A&G) and unlimited patient access to online consultation software. As a result, the BMA launched collective action, beginning with GPs ceasing signing up to voluntary data-sharing agreements on 1 May 2026, and moving on to switching off non-contractual medicines optimisation software from 1 June 2026.

BMA directed collective action will not advise or instruct any practices to breach their contract or obligations as part of their 2026/27 arrangements. However, unless the Government can deliver greater flexibility to reassure the profession, the BMA reserves the right to continue to escalate by introducing further directed practice actions in future months.

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.