We occasionally enter in to a “shared care” agreement with specialists, to prescribe medication to a patient with the ongoing involvement of a specialist. This is typically to prescribe medication that falls outside the normal scope of practice for GPs in primary care.
The following are the general steps taken to ensure the delivery of safe, regulated, resourced services that are high quality and sustainable. Each request is dealt with on a case-by-case basis.
Before accepting shared care, the specialist is expected to evidence to the GP:
- The diagnosis has been made according to national guidance and in particular NICE guidance where it exists.
- The proposed shared care is with a UK GMC registered specialist.
- That the organization that employs the specialist is regulated by the CQC.
- That the organizations adopts the practice’s local ICB shared care agreement where one has been agreed previously.
The ICB will:
- Ensure additional administrative or clinical work required as part the share care agreement is adequately resourced and available to the patient, either at the practice or (if needed) by an additional specialist or allied professional service.
The practice will:
- Prescribe medications only in compliance with our local prescribing formulary, which they feel competent to do so for the reason provided by the specialist.
- Assess whether the proposed shared care agreement is sufficiently resourced and decline if there is transfer of work that is excessive. (Normally an agreed local shared care agreement with the ICB would have covered this.)
- Not feel pressurized into entering into shared care before reasonably clarifying the above details and insist that prescribing and monitoring remains with the specialist whilst this is carried out. Prescriptions can be issued directly by the specialist and sent to the patient during this time and need not delay the patient receiving treatment recommended by the specialist.
The patient will:
- engage fully with monitoring requirements and attend appointments as required by the shared care agreement.
Under a shared care agreement that the GP is solely responsible and liability rests entirely with the GP. Therefore, the GP can decline to prescribe, any time, even if the all the above are all satisfied at outset. Refusal of shared care by the GP does not represent withholding of treatment, as the specialist involved can assume prescribing responsibilities
The practice may have specific policies on certain medications or patient groups in addition to this general guidance.
