16 June 2025
Shared NHS care for rheumatology patients between outpatient rheumatology departments and GP practices has been a mainstay of clinical practice for many years, but shared care agreements (SCAs) are breaking down in some parts of the UK, in the face of workforce shortages and funding challenges.
As part of BSR’s Organisational Survey of rheumatology departments in England and Wales, carried out in late 2024/early 2025, in partnership with King's College London, we sought to understand how well SCAs are working. This followed concerns expressed by BSR members about the rising number of shared care agreements being refused or handed back by GPs.
While a healthy 78 out of 80 rheumatology centres surveyed in England and Wales said they had some kind of SCA in place - generally covering both patient prescribing and monitoring - in one region of England, the Northwest, shared care refusals were common, with over half (56%) of all rheumatology units in the region reporting frequent SCA refusals. While the East of England region reported having a zero SCA ‘frequent refusal’ rate, it had the highest 75% ‘sometimes’ refusal rate. Frequent refusal rates in other English regions were somewhere in between these two extremes (e.g. 25% in London and the South West region and 23% in the South East).
Wales seemed to fare much better overall with only 11% of rheumatology units reporting frequent refusals. A separate short survey conducted by BSR and the Scottish Society for Rheumatology found a 20% frequent refusal rate for SCAs across Scotland, but again with some regional variation reported.
This matters. Failed SCAs mean higher clinical and administrative workloads for rheumatology departments - and longer travel distances for patients to access the medicines they need, with all the inconvenience and practical challenges that can bring.
The causes of failed SCAs are various: frequent refusals may reflect underlying systemic issues such as insufficient training in the prescribing and use of off-label medicines and/or inadequate practice funding - or they may be down to factors such as communication challenges between primary and secondary care providers.
As part of trying to address these problems, BSR has put together an in-depth briefing on the current state of play of SCAs across the UK. The briefing sets out five recommendations on how to potentially tackle the problem:
- Addressing the funding barriers that prevent the consistent implementation of Shared Care Agreements (SCAs)
- Strengthening the monitoring and auditing of SCAs
- Championing the spread of SCAs in underserved areas
- Providing enhanced training and support for GPs and community pharmacists in the use of off-label medicines
- Optimising data sharing on shared care patients between primary and secondary/tertiary care.