Shared care agreements for high-risk medications

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Introduction

Some medications that are potentially harmful or require special monitoring can only be prescribed by a specialist, for example: methotrexate, sulfasalazine, other drugs which suppress the immune system, and the medications prescribed for ADHD.  Where all your treatment is carried out in an NHS setting, GPs can agree to share care with your specialist to take pressure off the NHS secondary care clinics.  This is arranged via a contract known as a ‘Shared Care Agreement’ between the specialist and the GP, which lays out a detailed set of rules for the specific drug including the responsibilities of the secondary care specialist, the GP, and the patient. 

Secondary Care Specialist 

The secondary care specialist is responsible for initiating, titrating and prescribing the medication until the dosage and any blood or other monitoring are stable. They are responsible for continuing to monitor and assess, usually on an annual basis. They are responsible for giving the patient all the information about the medication in writing. They can then ask the GP in writing to continue prescribing the medication via the ‘Shared Care Agreement’.  This is at the discretion of the GP who has to formally agree to share care before the medication can be prescribed. In some areas of the UK, GPs are funded to provide this work but this is not the case in Cambridge.  

If the GP agrees to share care they will continue to work together with the specialist and the patient within the terms of the agreement to carry out monitoring and follow up. 
Where the specialist or the patient does not follow the requirements of the shared care agreement, e.g. if the patient does not attend for monitoring or specialist review, all prescribing responsibility will return to the specialist and the patient will need to liaise with their specialist directly.

Shared Care

We only enter into ‘shared care’ initiated by an NHS provider of care and where there is an agreed NHS contract from the ICS.  We do not ‘share care’ in this way with clinicians in the private sector including private clinics who run a NHS service or any specialist overseas, due to the lack of agreed protocols for monitoring and raising alarms. We are unable to carry out any monitoring of medication that falls within this scope other than via a ‘Shared Care Agreement’ as above.

If your private specialist prescribes or recommends a high-risk, ‘Shared Care’ medication for you, your choices are either to:

1. request a referral to an NHS specialist from your usual GP, to see if the NHS specialist would be willing to initiate the same medication (you would need to wait the usual time to be seen for this, as NHS rules forbid ‘queue jumping’ through mixing NHS and private care and the GP would not be able to prescribe while you are waiting ); or
2. continue all of your care including prescribing and monitoring in the private sector.

Please see Shared Care Guidance | CPICS Website