Asking for a Shared Care Agreement

Letter templates

• Asking your GP for a Shared Care Agreement

  Subject: Request for shared care agreement with a private or NHS specialist service for gender-affirming healthcare

  (Your Name)
  (Your Address)
  (City, Postcode)

  (Your Phone Number)
  (Your Email Address)

  (Date)
  Dr (GP’s Name)
  (Practice Name)
  (Practice Address)
  (City, Postcode)

  Dear Dr [GP’s Name],

  Request for Shared Care Agreement: gender-affirming hormone therapy

  I am writing to formally request that the practice enter into a shared care agreement for my gender affirming hormone replacement therapy, which has been initiated/will be initiated by [NHS Gender Identity Clinic/Private Specialist Name] under the care of [‘s GP’s Name].

  Background Information

  • NHS Number: (Your NHS Number)
  • Date of Birth: (Your DOB)
  • Specialist service: (Name of NHS GDC or private clinic) and contact details
  • GP: (GP’s name and contact details)
  • Treatment commenced/planned: (Date or “pending”)

  Current treatment plan

  [Choose the relevant section:]

  For testosterone therapy:

  • Medication: (e.g., Testogel, Sustanon, Nebido)
  • Dose: (Current or planned dose)
  • Route: (Topical gel/Intramuscular injection)
  • Frequency: (Daily/weekly/quarterly)

  For oestrogen therapy:

  • Medication: (e.g., Estradiol patches, gel, or tablets)
  • Dose: (Current or planned dose)
  • Route: (Transdermal/oral)
  • Anti-androgen: (If applicable, e.g., Cyproterone or Spironolactone)

  Monitoring requirements

  The specialist, [name], has recommended the following monitoring schedule: [include details, which may include information such as:]

  • Blood tests: (Frequency – typically 3-monthly initially, then 6-monthly)

  Key parameters to monitor:

  • Hormone levels (testosterone/oestradiol)
  • Liver function tests
  • Lipid profile
  • Full blood count
  • (Add any specific requirements from your specialist)

  Clinical reviews: (Frequency of GP appointments for monitoring)

  Supporting documentation

  I have enclosed/will provide: [include all that apply to you]

  • Letter from specialist outlining treatment plan
  • Shared care guidelines from the specialist service
  • Recent blood test results
  • Patient information leaflets

  Benefits of shared care

  A shared care arrangement would: [Choose all those that apply and add anything further you think would be helpful]

  • Ensure continuity of care and regular monitoring
  • Reduce waiting times for routine monitoring
  • Provide local access to prescription renewals
  • Maintain specialist oversight of treatment
  • Follow established NHS and professional guidelines

  Professional guidelines

  My request aligns with:

  • NHS England Service Specification for Gender Identity Services
  • GMC Trans Healthcare Ethical Hub
  • BMA Role of GPs in managing adult patients with gender incongruence
  • WPATH Standards of Care (SOC 8)
  • Endocrine Society Clinical Practice Guidelines

  Request

  I would be grateful if you could:

  1. Review the shared care proposal from my specialist, [NAME]
  2. Confirm your agreement to undertake shared care
  3. Schedule an initial consultation to discuss the monitoring plan
  4. Arrange baseline blood tests if treatment is commencing

  I understand that you may need to discuss this with colleagues or seek additional information from the specialist service. I am happy to provide any additional documentation or attend a consultation to discuss this further.

  Contact information

  Should you need to contact my specialist directly: [CONTACT DETAILS]

  I would welcome the opportunity to discuss this request with you at your earliest convenience. Please let me know if you require any additional information.

  [Please note I consider myself to be protected by the protected characteristic of ‘gender reassignment’ under the Equality Act 2010. All my rights are reserved in this regard.]
  Thank you for considering this request. I look forward to hearing from you.

  Yours sincerely,
  (Your signature)
  (Your printed name)

  Notes for adaptation:

  • Complete all bracketed sections with your specific details
  • Remove sections not relevant to your treatment type
  • Attach any supporting documentation mentioned
  • Consider hand-delivering or sending via recorded delivery
  • Keep a copy for your records
• Asking for your GP to reconsider their decision to refuse a Shared Care Agreement

  Subject: Letter to GP requesting reconsideration of refusal to Shared Care Agreement with a private or NHS specialist service for gender-affirming healthcare

  (Your Name)
  (Your Address)
  (City, Postal Code)
  (Your Phone Number)
  (Your Email Address)

  Date: (Insert Date)

  (GP Name)
  (Practice Name)
  (Practice Address)
  (City, Postal Code)

  Re: Request for reconsideration of Shared Care Agreement: Gender-affirming healthcare

  Patient: (Your Full Name)
  DOB: (Your Date of Birth)
  NHS Number: (Your NHS Number)

  Dear Dr. [GP Name],

  I am writing to formally request reconsideration of the recent decision of [NAME] on [DATE] to decline participation in a shared care agreement (SCA) for my gender affirming healthcare with [Name of Specialist Service/Clinic].

  Background

  [Name of decision maker] was informed that I have been receiving specialist, gender-affirming care from [Specialist Service Name] since [Date].

  My current treatment plan includes [briefly outline current treatment, e.g., hormone replacement therapy, monitoring, etc.].

  The specialist, [name] has recommended a shared care arrangement to ensure continuity of care and appropriate monitoring between appointments.

  Reasons for reconsideration

  I respectfully ask you to reconsider your decision based on the following points:

  [Choose those that apply to you]

  Clinical necessity: A shared care arrangement is essential for me to have access to safe and effective gender-affirming treatment.

  Professional guidelines: The General Medical Council’s guidance on treating transgender patients emphasises the importance of collaborative care. The British Medical Association and Royal College of General Practitioners have both published guidance supporting GP involvement in transgender healthcare where clinically appropriate.

  NHS England policy: NHS England’s service specifications for gender dysphoria services explicitly support shared care arrangements between specialist services and primary care. This is considered standard practice for ensuring comprehensive patient care.

  Patient safety: Refusing shared care may compromise my health and safety by creating gaps in monitoring and continuity of care. This could potentially expose me to unnecessary clinical risks.

  Addressing potential concerns

  If you continue to maintain that you will not provide shared care, please respond clearly to state the reasons for this position.

  Supporting information

  I have attached/can provide:

  [Choose all those that apply]

  • Letter from a specialist recommending shared care
  • Proposed shared care protocol
  • Current treatment summary
  • Relevant clinical guidelines

  Request for meeting

  I would welcome the opportunity to discuss this matter further and address any specific concerns you may have. I am available to meet at your convenience to explore how we might work together to ensure my continued care.

  Alternative solutions

  If you maintain that shared care remains unsuitable for your practice, I would be grateful if you could:

  • Provide specific reasons in writing for the refusal
  • Suggest alternative arrangements for monitoring and care
  • Consider referral to another local practice that may accept shared care
  • Facilitate direct communication with the specialist team

  Gender affirming healthcare is recognised as medically necessary treatment. I want to work together to ensure I receive safe, appropriate, and continuous care. A shared care arrangement serves both my clinical needs and represents good collaborative practice.

  I look forward to your response within a reasonable timeframe [e.g., 2-3 weeks] and hope we can resolve this matter constructively.

  [Please note I consider myself to be protected by the protected characteristic of ‘gender reassignment’ under the Equality Act 2010. All my rights are reserved in this regard.]

  Thank you for your time and consideration.

  Yours sincerely,
  (Your Signature)
  (Your Printed Name)

  Attachments:

  • Specialist recommendation letter
  • Proposed shared care protocol
  • Current treatment summary
  • Relevant clinical guidelines
  • Copy of previous correspondence

  Note: Keep copies of all correspondence and consider sending by recorded delivery or email with read receipt for documentation purposes.

• Raising a formal complaint

  Subject: Complaint letter to GP/Practice manager regarding refusal to a shared Care Agreement for gender-affirming hormone therapy

  (Your Name)
  (Your Address)
  (City, Postcode)
  (Your Phone Number)
  (Your Email Address)

  Date: (Insert date)

  (Practice Manager Name / GP Name)
  (GP Practice Name)
  (Practice Address)
  (City, Postcode)

  Formal complaint regarding refusal of Shared Care Agreement for gender-affirming hormone therapy

  Dear (Practice Manager/Dr. Name),

  I am writing to formally complain about [your/ your practice’s decision to refuse ] to enter into a shared care agreement (SCA) for my gender-affirming hormone replacement therapy (HRT), as recommended by [Specialist Service/Consultant Name] at [Hospital/Clinic Name]. The decision date was [DATE].

  Background

  On [date], I was assessed by [Specialist Name/Service], who recommended that I [commence/continue] gender affirming hormone therapy. [As is their standard practice], they requested that my GP practice enter into an SCA to provide ongoing monitoring and prescription of (specific medication, e.g., testosterone/estradiol).

  On [date], I contacted your practice to discuss this shared care arrangement, and on [date], I received notification that the practice has refused to participate in this shared care agreement.

  Grounds for complaint

  [Choose all that apply and adapt them to your specific set of facts]

  1. Failure to provide appropriate medical care

  • The refusal to participate in SCA for my trans+ HRT care contradicts guidance from the General Medical Council, which states that GPs should provide care within their competence and seek appropriate support when needed.
  • SCAs are established specifically to ensure patients receive appropriate monitoring while specialist services maintain oversight.

  2. Discrimination

  This decision effectively denies me access to essential medical treatment based on my transgender status. It may constitute unlawful discrimination on the grounds of gender reassignment, which is prohibited under the Equality Act 2010.

  The NHS Constitution guarantees that patients have the right to receive NHS services free from discrimination.

  4. Deviation from professional standards

  The British Medical Association, the GMC and the Royal College of General Practitioners have published guidance supporting GP involvement in transgender healthcare through shared care arrangements.

  All three organisations support the principle that shared care for transgender patients should follow the same frameworks as shared care for any other medical condition, with appropriate specialist support and clear agreements between all parties involved.

  The refusal contradicts established best practice and professional recommendations.

  Impact on patient care

  This refusal has resulted in:

  [Choose all that apply and adapt to your set of facts, and add anything specific that illustrates the impact]

  • Significant distress and anxiety about the continuity of my medical care
  • Potential disruption to my treatment regime
  • Increased burden on specialist services
  • Uncertainty about my ongoing healthcare provision
  • [Include any other specific impacts]

  Resolution sought

  I respectfully request that the practice:

  1. Immediately reconsider the decision to refuse the shared care agreement

  2. Provide a written explanation of the specific clinical reasons for refusal, if maintained, including:

  • What additional training or support would be required
  • What specific concerns exist about the proposed treatment
  • What steps could address these concerns

  3. [Arrange an urgent consultation with the recommended specialist service to discuss the shared care arrangement]

  4. Implement a shared care agreement within a reasonable timeframe (e.g., 14 days)

  Alternative solutions

  If the practice maintains its position and continues to refuse to provide shared care, I would consider accepting:

  • Referral to another local GP practice willing to provide shared care
  • Arrangement for additional clinical support or training
  • Modified shared care arrangement with enhanced specialist oversight
  • A clear timeline for when the practice could provide this care

  Next steps

  I would appreciate a written response to this complaint within [10 working days], as per NHS complaint procedures. If this matter cannot be resolved satisfactorily at the practice level, I reserve the right to escalate this complaint to:

  • The Clinical Commissioning Group/Integrated Care Board
  • NHS England
  • The Parliamentary and Health Service Ombudsman
  • The General Medical Council

  I am hopeful that we can resolve this matter promptly and ensure appropriate continuity of my medical care. I am available to discuss this further and would welcome the opportunity to meet to resolve these concerns.

  [Please note I consider myself to be protected by the protected characteristic of ‘gender reassignment’ under the Equality Act 2010. All my rights are reserved in this regard.]

  Thank you for your attention to this important matter.

  Yours sincerely,

  (Your Signature)
  (Your Printed Name)
  (Date)

  Enclosures:

  • Copy of specialist recommendation letter
  • Copy of proposed shared care protocol
  • (Any other relevant documentation)

  CC:

  • (Specialist Consultant/Service)
  • (Patient Advocate/Support Organisation if applicable)
• Escalating a formal complaint

  Subject: Escalation of formal complaint to ICB following GP Refusal to provide gender-affirming hormone therapy monitoring

  (Your Name)
  (Your Address)
  (City, Postcode)
  (Your Phone Number)
  (Your Email Address)

  Date: (Insert Date)

  To: (ICB Name)
  (ICB Address)
  (City, Postcode)

  Escalation of formal complaint following refusal to provide essential gender-affirming hormone therapy monitoring services

  Dear ICB/PALS Team,

  I am writing to formally escalate a complaint regarding the refusal of my GP practice, [name of practice] to provide essential monitoring services for my prescribed gender-affirming hormone replacement therapy (HRT) via a shared care agreement.

  I believe this refusal constitutes a breach of my right to appropriate healthcare and potentially endangers my health and well-being.

  Background and context

  Patient details:

  • Name: (Your Name)
  • Date of Birth: (DOB)
  • NHS Number: (NHS Number)
  • GP Practice: (Practice Name and Address)
  • Practice Manager: (Name if known)

  Timeline of events:

  [Choose those that apply and add any other key dates you consider necessary to set out the background clearly]

  • (Date): Initially prescribed gender-affirming HRT by (Specialist/Clinic Name)
  • (Date): First approached the GP practice requesting routine monitoring
  • (Date): Formal refusal received from GP practice
  • (Date): Attempted resolution through the practice complaints procedure
  • (Date): Final response received – refusal maintained

  Nature of the complaint

  Through its decision, my GP practice has refused to provide the following essential monitoring services for my prescribed gender-affirming hormone replacement therapy:

  [Choose those that apply to you]

  • Regular blood tests to monitor hormone levels
  • Liver function tests
  • Cardiovascular health monitoring
  • Blood pressure monitoring
  • General health screening related to HRT
  • (Add any other specific monitoring requirements)

  Grounds for complaint

  1. Breach of NHS constitution and Equality Act 2010 I am concerned that the refusal to provide these services may constitute unlawful discrimination based on my characteristic gender reassignment, under the Equality Act 2010.

  The NHS Constitution guarantees my right to receive healthcare services free from discrimination.

  2. Clinical negligence and patient safety Hormone replacement therapy requires regular monitoring to ensure my safety. The GP’s refusal to provide this monitoring:

  • Places my health at unnecessary risk
  • Could lead to serious complications from unmonitored hormone therapy
  • Fails to meet basic standards of clinical care

  3. Breach of GMC professional standards The General Medical Council’s “Good Medical Practice” guidance requires doctors to:

  • Put patients’ interests first
  • Provide care based on clinical need, not personal beliefs
  • Work collaboratively with colleagues and other healthcare professionals

  4. Inconsistency with NHS England Guidance NHS England guidance states that GPs should provide routine monitoring for patients receiving specialist treatment, including gender-affirming care prescribed by appropriate specialists.

  Personal impact

  This refusal has resulted in: [Set out the impact this has had on you; for example, this may include:]

  • Health risks: Inability to monitor for potential complications
  • Financial burden: Forced to seek private monitoring at personal expense of £(amount)
  • Emotional distress: Anxiety about unmonitored treatment and discrimination
  • Treatment disruption: (Describe any impact on your treatment continuity)
  • Time loss: (Hours spent seeking alternative arrangements)

  Previous attempts at resolution

  • Practice-level complaint:
  • Date submitted: (Date)
  • Outcome: (Summary of practice response)
  • Reason for escalation: (e.g., “Unsatisfactory response maintaining refusal without adequate clinical justification”)

  Discussions with practice staff:

  (Briefly summarise key conversations and their outcomes)

  Resolution sought

  I request that the ICB: [choose all that apply to you]

  1. Immediate action: Direct my GP practice to commence appropriate HRT monitoring services without delay
  2. Policy clarification: Issue clear guidance to all practices within the ICB regarding their responsibilities for monitoring specialist-prescribed treatments
  3. Training: Ensure relevant staff receive appropriate training on transgender healthcare and equality obligations
  4. Financial redress: Compensation for private monitoring costs incurred: £(amount) with receipts attached
  5. Formal apology: Written acknowledgement of the inappropriate refusal and its impact
  6. Systematic review: Investigation of whether this represents a wider pattern of discrimination within the practice

  Supporting evidence

  Please find attached: [choose all that apply to you]

  • Copy of original HRT prescription and monitoring requirements
  • Correspondence with GP practice, including a refusal letter
  • Evidence of private monitoring costs (receipts)
  • Relevant clinical guidelines and NHS England guidance
  • (Any other supporting documentation)

  Legal framework references

  • NHS Constitution (2015) – Right to healthcare free from discrimination
  • Equality Act 2010 – Protection from discrimination based on gender reassignment
  • Human Rights Act 1998 – Article 8 (Right to private and family life)
  • NHS England Service Specification for Gender Identity Services
  • GMC Good Medical Practice guidance
  • (Any relevant local ICB/PALS policies)

  Urgency and health implications

  This matter requires urgent attention as: [choose those that apply to you]

  • Unmonitored hormone therapy poses genuine health risks
  • Each day of delay potentially compromises my safety
  • The discrimination continues to cause ongoing distress

  I trust that the (ICB/PALS) will investigate this matter thoroughly and take appropriate action to ensure I receive the healthcare services I am entitled to under NHS principles of universal access and equality.

  I would appreciate an acknowledgement of this complaint within (5 working days) and a full response within (20 working days) as per NHS complaints procedures.

  [Please note I consider myself to be protected by the protected characteristic of ‘gender reassignment’ under the Equality Act 2010. All my rights are reserved in this regard.]

  Should this matter not be resolved satisfactorily, I reserve the right to escalate matters.

  Thank you for your attention to this serious matter.

  Yours sincerely,
  (Your Signature)
  (Your Printed Name)

  Attachments:

  • Supporting documentation as listed above
  • Copy of this letter for your records

  Contact information for follow-up:

  • Email: (Your Email)
  • Phone: (Your Phone Number)
  • Preferred contact method: (Email/Phone)

  If you remain unhappy with how your complaint has been handled following the conclusion of local resolution, you can ask the Parliamentary and Health Service Ombudsman (PHSO) to review your complaint.

  Attachments:

  • Supporting documentation as listed above
  • Copy of this letter for your records

  Contact information for follow-up:

  • Email: (Your Email)
  • Phone: (Your Phone Number)
  • Preferred contact method: (Email/Phone)

  If you remain unhappy with how your complaint has been handled following the conclusion of local resolution, you can ask the Parliamentary and Health Service Ombudsman (PHSO) to review your complaint.