Shared Care Prescribing

Avonside Health Centre Shared Care Prescribing policy

(including Shared Care Agreements with non-NHS providers)

What is a Shared Care Agreement?

A Shared Care Agreement is a mutual agreement between the patient, their GP, and their consultant specialist. It enables the care and treatment received for a specific health condition to be shared between the hospital and GP. This arrangement ensures that responsibilities for prescribing are clearly defined and governed by local policies, maintaining patient safety and high standards of care.

A Shared Care Agreement contains information about medication, guidance on prescribing and monitoring and the responsibilities of the consultant specialist, the GP and the patient. For a Shared Care Agreement to work effectively, everyone involved must understand and follow it and communicate effectively. The agreement means that medicine started by a specialist may be prescribed by a GP so a patient may collect prescriptions from a local pharmacy instead from a hospital. The specialist, the GP and the patient all need to agree to the Shared Care Agreement for care to be managed in this way.

NHS Shared Care

Under NHS shared care agreements, GPs may work with NHS specialists to prescribe medications. These agreements are supported by local policies, which ensure that:

• Patients are started and stabilised on their medication by the specialist.
• Ongoing specialist reviews are conducted at the hospital.
• GPs can seek advice and support from specialists as required.

Private Providers

In recent years, as a result of long NHS waiting times, people are seeking private treatment and asking GPs to prescribe medications recommended by private specialists under NHS prescriptions. These can differ significantly from NHS shared care agreements and may not adhere to the same safety standards as NHS services. Ensuring patient safety is our top priority, and we must adhere to robust governance protocols. Due to safety concerns and sustainability issues, we will only issue prescriptions for specialist medications initiated by private providers if they adhere to NHS guidance and meet the same criteria of an NHS shared care agreement. If not, patients must obtain these prescriptions directly from their private specialist.

Note that Shared Care agreements rely, by definition, upon ongoing specialist care.  As such should a patient stop seeing their consultant, we will not be able to continue the medication provided under shared care unless an alternative specialist has been consulted and agrees to continue.  For this reason, patients should be reminded of the potential ongoing cost of entering a shared care agreement with a private provider.

 Criteria for Safe Shared Care Prescribing

Avonside Health Centre will consider all requests from both private and NHS providers, where prescribing is within their level of competence as GPs, in line with the following criteria:

• The patient’s clinical condition is stable or predictable and they are established on the medication; patients must be stabilised on their current dose
• Requests for prescribing or monitoring must be in writing from provider in the form of a standardised shared care agreement.
• Shared Care Templates from private providers must be of at least equivalent standard to NHS providers – the templates for this can be found here NHS England » Shared Care Protocols (SCPs)
•  The patient must remain under the care of their specialist whilst on treatment and must be assessed at least annually.
• If a patient has been prescribed medication abroad previously, they must be under the care of a UK provider before we can take on shared care.
• We will not initiate any changes to a patient’s current dose. Any titration or discontinuation needs to be done by the specialist provider.
• We will not perform baseline investigations or examinations needed to initiate medications for external providers.
• GPs reserve the right to decline requests to prescribe unlicensed medication or licensed medicines for unlicensed indications.
• The SCA must be with a named, appropriately qualified, GMC registered specialist doctor and should include:
  • A date and signature (this can be signed digitally or documented verbal agreement)
  • The frequency of patient review by the specialist clinic, which must be at least annually.
  • If monitoring is requested, the thresholds for normal/abnormal findings and acceptance of responsibility for actioning abnormal findings
  • Contact details for the private provider if the need for clinical advice is required.
  • Details about the medication requested, including licensed indications, dose, route, administration, duration of treatments, adverse effects, cautions and contraindications and clinically important drug interactions.

Avonside GPs reserve the right to decline a shared care agreement, or to decline a prescription request if prescribing is thought to no longer be safe, or that the medication has not been taken as originally prescribed.

Use of stimulant drugs for the treatment of Attention Deficit Hyperactivity disorder in Children

The Shared Care Agreements issued by Coventry and Warwickshire Area Prescribing committee list the responsibilities and requirements of GPs who choose to prescribe these drugs.

Avonside Health Centre considers that these monitoring requirements lie outside the scope of work that can safely be delivered in NHS primary care and for this reason does not accept requests for Shared Care Agreements for the prescribing of stimulant drugs for the treatment of Attention Deficit Hyperactivity disorder in Children.

Secondary care NHS specialist doctors may supply the patient with green FP10 prescription for medication. This may be posted to the patient.

FAQs for patients who are receiving medication prescribed under a Shared Care Agreement

What do I do if I am having side-effects to the medicine?

Your consultant should have informed you of the common side-effects to expect and what to do if you experience them. If you think you may be having side-effects from a medicine, report these directly to the specialist team/consultant or GP. Your GP may need to seek advice from your consultant before issuing you with another prescription; this is to ensure it is safe for you to continue on the medication.

What if my disease symptoms change or get worse?

Report any changes in disease symptoms to your specialist team/consultant or GP as your treatment may need to be altered.

What about the other medicines I take? Inform your GP and the consultant of all other medicines you are taking, including those you may have bought yourself. Do not take new medicines (including those you could buy) until you have discussed this with your pharmacist, GP or specialist team/consultant.

What happens if my circumstances change or I change GP Practice?

Alert your GP and/or specialist team/consultant to any changes of circumstances which could affect management of disease e.g. plans for pregnancy; plans to move/change GP. If you register at a new GP Practice a new Shared Care Agreement needs to be put in place between your new GP and the specialist team before you move to ensure your supply of medication is not interrupted. The specialist team can start this process if you provide them with information before you move to make sure there is a smooth handover.