Shared Care Prescribing Policy

Hospital NHS departments (Secondary Care) sometimes ask General Practitioners (Primary Care) to “share care” of patients, once a health condition has been diagnosed and the relevant medication prescribed at a dose that is stable and unlikely to change.

 

Shared care in the NHS is a formal local agreement that allows General Practitioners (GPs) to take responsibility for prescribing and monitoring specialist medicines. It involves a partnership between patients, their families, and healthcare professionals, enabling informed health choices.

 

Shared care requires the consent of the specialist, GP, and patient. The specialist must provide advice to the GP if this is asked for and review the medicine at regular intervals to make sure it is still safe and effective.

 

To take on prescribing and monitoring, the GP must be satisfied they have sufficient information, experience and knowledge of the patient and the medicine, treatment or device in order to prescribe. GP’s must feel competent to exercise their share of clinical responsibility and feel they will be able to access timely support from secondary care when needed.

 

Patients must also agree to

· Request repeat prescriptions from the GP in enough time.

· Attend follow up monitoring appointments with the GP and the specialist (this may be blood tests or other health markers such as weight or blood pressure).

· If not able to attend an appointment with the GP or the specialist, inform them as soon as possible and make another appointment.

· Report suspected side effects to the specialist or GP.

 

Often, this process is straightforward, and we will be happy to accept shared care agreements.

 

However, this is not always possible.

There are varying reasons for this, including but limited to -

· GP’s do not feel they have the required training or competence to manage conditions and their prescribed medications in primary care.

· There may be significant difficulty accessing timely and appropriate advice and support from the relevant secondary care department.

· Paediatric patients. This group of patients have increased vulnerabilities due to their rapidly changing body sizes and/or changes to social circumstances and mental health, and their needs can change quickly.

 

We reserve the right to decline shared care agreements with secondary care at our discretion and request the specialist to continue the management and prescribing. We also reserve the right to withdraw our agreement to share care if specialist or patient do not meet their responsibilities.

 

WE DO NOT CURRENTLY ACCEPT SHARED CARE REQUEST FROM PRIVATE PROVIDERS (This includes private ADHD or Gender Clinics)

WE DO NOT CURRENTLY ACCEPT SHARED CARE REQUEST FROM PRIVATE PROVIDERS (This includes private ADHD or Gender Clinics)

We are aware that patients may wish to engage with private provision of health care for many reasons (including but not exclusively) such as long waiting lists on the NHS. We recognise this frustration, and we ask our patients to please be aware of our policy regarding “shared care” before they engage with private specialists with a plan to subsequently transfer care to the GP surgery. This may be, for example, requests for ADHD assessments and medication, gender transition hormone prescriptions, and more.

 

Our practice policy is that we do not enter into shared care agreements with private providers. This usually covers both assessments/diagnoses of conditions and any specialist medication recommended by the private provider as a result. We will not continue prescriptions initiated by private providers (unless care is subsequently taken over by the NHS and it becomes an NHS shared care agreement).

 

There are several reasons for this.

 

1) It is important to keep a clear separation between NHS and private care.

 

2) Many medications are to be issued and managed by specialist services only, whether they are NHS or private providers. The responsibility for prescribing medication rests on the prescribing doctor themselves.

 

3) Following on from this, it is very clear in the BMA and GMC guidance that GPs have a responsibility to only prescribe within their competences. Many medications requiring a specialist service do not fall within this area, therefore GPs should not prescribe medication outside their competence, as the prescription then becomes their responsibility.

 

4) There is no guarantee that the private provider and the patient will continue their relationship, potentially leaving a patient without appropriate specialist support. This will then leave the prescribing doctor vulnerable to mistakes and potentially causing harm to the patient.