Working in partnership

SHARED CARE PRESCRIBING GUIDELINE

NAME OF DRUG OR DRUG GROUP AND INDICATION

All text printed in red should be superseded or deleted when preparing a new shared care document.

NOTES to the GP

The expectation is that these guidelines should provide sufficient information to enable GPs to be confident to take clinical and legal responsibility for prescribing this drug.

The questions below will help you confirm this:

Is the patient’s condition predictable or stable?

Do you have the relevant knowledge, skills and access to equipment to allow you to monitor treatment as indicated in this shared care prescribing guideline?

Have you been provided with relevant clinical details including monitoring data?

If you can answer YES to all these questions (after reading this shared care guideline), then it is appropriate for you to accept prescribing responsibility.

If the answer is NO to any of these questions, you should not accept prescribing responsibility. You should write to the consultant within 14 days, outlining your reasons for NOT prescribing. If you do not have the confidence to prescribe, we suggest you discuss this with the appropriate Milton Keynes Hospital specialist service, who will be willing to provide training and support.

It would not normally be expected that a GP would decline to share prescribing on the basis of cost.

The patient’s best interests are always paramount
Author’s Name (Job Title)

Review Author’s Name (Job Title)

Date of Approval:

Review Date:

(Unless clinical evidence changes)
Approval group:

Last Review:

Introduction and reason for shared care

DRUG NAME OR DRUG GROUP
CIRCUMSTANCES WHEN SHARED CARE IS APPROPRIATE

Prescribing responsibility will only be transferred when the consultant and the GP are in agreement that the patient’s condition is stable or predictable.

Patients will only be referred to the GP once the GP has agreed in each individual case and the hospital will continue to provide prescriptions until successful transfer of responsibilities as outlined below.

Areas of responsibility

Consultant (include follow up and monitoring arrangements, details to provide to GP, communication with GP, provision of patient information etc)

GP (include monitoring arrangements and indicate when and how to refer back to consultant etc.)

Patient (include attendance for follow up appointment, any tests, keeping record books and showing this to relevant HCP etc)

Communication and support

Hospital contacts:

(the referral letter will indicate named consultant)	Out of hours contacts & procedures:
Hospital name

Consultant names

Tel:
Fax:
E-mail:
Specialist support/resources available to GP including patient information:

CLINICAL INFORMATION

Indication(s):

Place in Therapy:

(for using drug locally in relation to other treatment options, e.g. 2nd line)

Therapeutic summary:

(Brief description of drug’s effects)

Dose & route of administration:

Duration of treatment:
Preparations available (Manufacturer)
Summary of adverse effects:

(See summary of product characteristics (SPC) for full list)

(include incidence, identification, importance and management)

Adverse effect	Frequency	Management

Clarify action to be undertaken by the GP only

(e.g. refer back to hospital, seek advice from hospital or any action to be undertaken by GP)

Monitoring Requirements by specialist:

Monitoring Requirements by GP:

Clinically relevant drug interactions:

(include management of drug interactions)

Clinically relevant Precautions and Contraindications:

Practical issues:

(e.g. supply arrangements, storage and reconstitution instructions if applicable)

Supply of ancillary equipment

(syringe drivers, needles, etc)

Key references:

DRUG NAME + INDICATIONS

Shared Care Guideline: Prescribing Agreement

(Note: Sections A and B MUST be forwarded to GP and returned by GP back to the hospital together)
Section A: To be completed by the hospital consultant initiating the treatment
GP Practice Details:

Name: ………………………………………

Address: ……………………………………

Tel no: ………………………………………

Fax no: ………………………………………

NHS.net e-mail: ……………………………	Patient Details:

Name: ………………………………………………

Address: ……………………………………………

DOB: ……/………/…………

Hospital number: …………………………………

NHS number (10 digits): …………………………
Consultant name: ……………………………

Clinic name: ………………………………….

Contact details:

Address: .........................................................................................................................

Tel no: ……………………………………… Fax no: ………………………………………

NHS.net e-mail: ……………………………
Diagnosis:

……………………………………………………	Drug name & dose to be prescribed by GP:

…………………………………………………………….
Next hospital appointment: ……/……/……..
Dear Dr. ……………………..,

Your patient was seen on …../..…/………and I have started …………………………………………….(insert drug name and dose) for the above diagnosis. I am requesting your agreement to sharing the care of this patient from …../.…./…….. in accordance with the (attached) Shared Care Prescribing Guideline (approval date: …./…./……..). Please take particular note of Section 2 where the areas of responsibilities for the consultant, GP and patient for this shared care arrangement are detailed.

Patient information has been given outlining potential aims and side effects of this treatment and ……………………………………* supplied (* insert any support materials issued such as patient held monitoring book etc where applicable). The patient has given me consent to treatment possibly under a shared care prescribing agreement (with your agreement) and has agreed to comply with instructions and follow up requirements.

.

The following investigations have been performed on ……/……/……… and are acceptable for shared care. Please monitor………...........every ………..

Test

Result

Test

Result

Other relevant information: ………………………………………………………………………………………..

………………………………………………………………………………………………………………………..

Consultant Signature: ………………………………………………Date: …/…/…..
Section B: To be completed by the GP and returned to the hospital consultant as detailed in Section A above
Please sign and return your agreement to shared care within 14 days of receiving this request

Tick which applies:

□ I accept sharing care as per shared care prescribing guideline and above instructions

□ I would like further information. Please contact me on:……………………….

□ I am not willing to undertake shared care for this patient for the following reason:

……………………………………………………………………………………………………………….

GP name: ………………………………………….……….

GP signature: ………………………………………………Date: …/…/…..
(Note: Sections A and B MUST be forwarded to GP and returned by GP back to the hospital together)

1

Shared Care Guideline for ………………	Issue Date:

Version no.:	Review Date:

FRAMEWORK - SHARED CARE

Richard Brady

2019-02-04

Dupe Fagbenro

Croydon Health