Summary of Shared Care Responsibilities

Below is a summary of the key points of the responsibility for prescribing between Primary & Secondary/Tertiary Care approach:

When a specialist considers a patient’s condition to be stable they may seek the agreement of the GP to share their care which may mean asking the GP to prescribe specialist medication that would not normally be prescribed by the GP. In proposing shared care agreements, a specialist should advise

• which medicines to prescribe
• what monitoring will need to take place in primary care
• how often medicines should be reviewed
• what actions should be taken in the event of difficulties

Please note the following

• The doctor or health professional who signs any prescription holds legal responsibility for this and should only prescribe within their own level of competence. This is described within the General Medical Council’s (GMC) core guidance “Good Medical Practice” (GMP). A recommendation to prescribe a medicine by a specialist does not reduce the legal responsibility on the actual prescriber. This is why we only prescribe when we have knowledge of the medication we are prescribing or are able to prescribe specialist medication because it is supported by a Shared Care Agreement.
• Shared Care will only start when a patient has been prescribed the medication for at least 3 months and has been monitored to demonstrate the treatment has been optimised and the response is consistent.
• If medication is stopped and restarted, or a dose adjustment is made, or drugs other than the usual ones have been prescribed (for example due to unavailability of usual drugs) then the Shared Care Guideline ceases to be valid. In the case of ADHD medication, the psychiatrist would need to prescribe and supervise until a stable dose has been achieved and the GP has been informed and is able to take over prescribing.
• Shared Care is an agreement, not a directive, so the specialist, patient AND the GP need to agree to it.
• Referral to the GP should only take place once the GP has agreed to this in each individual case, and the hospital or specialist will continue to provide prescriptions until a successful transfer of responsibilities.
• Communication from the specialist must be timely and directly to the GP, communication cannot be via the patient. Please see the NHS England website for more details
• People who are being treated on the advice of the secondary care team, but are no longer actively being seen in that setting, may still need review should problems arise. The appropriate level of care and advice should be available from the secondary care team in a timely manner without necessarily requiring a new referral.