SHARED CARE MEDICATIONS/ MONITORING

Posted by: olivercobbin - Posted on:

Shared care is a process whereby responsibility for a patient’s medication and/or monitoring is shared between a GP and consultant. In such a situation, the consultant will assess a patient’s suitability for the medication, perform any necessary baseline investigations and counsel the patient fully on the medication, before prescribing the medication and adjusting the dose until the patient is stable.

Once the patient is stable, the consultant then writes to the GP to ask them to consider shared care. If the GP accepts, they then take over the prescribing and monitoring of the patient, notifying the consultant should any problems arise. The patient must remain under the care of the consultant. For shared care to be valid, there must also be a written agreement on the duties and responsibilities of each party.

The whole process of shared care is to facilitate appropriate clinical oversight and to maintain patient safety, all in the patient’s best interests.

Having said the above, it must be noted that shared care is entirely voluntary for GPs and GPs are NOT obliged to enter into shared care, for whatever reason.

In general, we do not participate in shared care arrangements with private providers or NHS providers whom only have a short term contract with the NHS which may not be renewed leaving the patient without a secondary care provider. Specifically, we will not consider shared care arrangements if ANY of the following conditions apply (most of these describe situations that are, by definition, not shared care):

  • There is no written shared care agreement  NOT SHARED CARE
  • There is a shared care agreement, but it does not match the equivalent NHS shared care agreement for the same cohort of patients  NO EQUIVALENCE
  • The private provider is an assessment or diagnosis only service, that is, it does not prescribe medication at all NOT SHARED CARE
  • The provider has not completed an appropriate assessment of patient’s suitability for the medication, performed baseline investigations or provided counselling for the medication (for example, information on side effects, interactions)  NOT SHARED CARE
  • The provider has not initiated the patient on medication and/or has not adjusted dosage accordingly and/or has not stabilised the patient on the medication  NOT SHARED CARE
  • The provider has discharged the patient back to sole GP care  NOT SHARED CARE
  • The medication being recommended is one that falls outside the GP’s knowledge, experience or competence to prescribe  CANNOT PRESCRIBE
  • The provider is recommending use of medication that falls outside its licensed indications (for instance, it is being used for a different age group or different reason from the manufacturer’s recommendations)
  • The monitoring needed is more frequent than 3 monthly  THIS SUGGESTS A NON STABLE SITUATION WHICH IS SAFER MANAGED BY THE SPECIALIST
  • There is no named consultant who is a specialist in their field of medicine – We cannot accept shared care

The reason why we do not consider prescribing medication in any of the above situations is that there is no proper specialist oversight and consequently patient safety is potentially at risk. Whilst it may seem convenient (and cheaper) to ‘get a prescription from the GP’, we will not enter into any arrangement that has the potential to put a patient at risk.

If you are being referred to a private provider or a NHS provider on a short term NHS contract (ie not a service provided by a NHS hospital), you will need to understand the implications of how we deal with medication requests, including shared care requests, and test requests from private providers.

This policy was created by – Ivy Grove Surgery : Family Doctors : Ripley : Derbyshire : East Midlands