Rutland House Surgery

Shared Care Agreements Policy

Below is a summary of the key points regarding responsibility for prescribing between Primary Care provided by Rutland House Surgery and Secondary, Tertiary, or Private Specialist Care.

When a specialist considers a patient’s condition to be stable, they may seek agreement from the GP to share the patient’s care. This may involve asking the GP at Rutland House Surgery to prescribe specialist medication that would not normally be initiated in primary care. When proposing a Shared Care Agreement, the specialist should clearly advise:

• which medicines are to be prescribed
• what monitoring is required to take place in primary care
• how often the medication should be reviewed
• what actions should be taken in the event of difficulties or adverse effects

Please note the following:

• The doctor or healthcare professional who signs any prescription holds full legal responsibility for that prescription and should only prescribe within their own level of competence. This is set out in the General Medical Council (GMC) guidance Good Medical Practice (GMP). A recommendation from a specialist does not reduce the legal responsibility of the prescriber. For this reason, Rutland House Surgery will only prescribe medications where we have sufficient knowledge of the drug, or where prescribing is supported by an agreed and recognised Shared Care Agreement.

• Shared Care will only commence once the patient has been prescribed the medication by the specialist for at least 3 months, with appropriate monitoring demonstrating that treatment has been optimised and the patient’s response is stable.

• If medication is stopped and restarted, a dose adjustment is made, or alternative drugs are prescribed (for example, due to unavailability of usual medication), the Shared Care Guideline ceases to apply. In the case of ADHD medication, the prescribing psychiatrist must continue to prescribe and supervise treatment until a stable dose is achieved, Rutland House Surgery has been formally informed, and the practice agrees to take over prescribing.

• Shared Care is an agreement, not a directive. The specialist, the patient, and the GP at Rutland House Surgery must all agree before Shared Care can proceed.

• Referral of prescribing responsibility to the GP should only occur once the GP has agreed in each individual case. The hospital or specialist service remains responsible for prescribing until a successful and confirmed transfer of responsibility has taken place.

• Communication from the specialist must be timely and sent directly to Rutland House Surgery. Communication via the patient is not acceptable. Further information is available on the NHS England website.

• Patients treated on the advice of secondary care but no longer under active specialist follow‑up may still require specialist review if problems arise. Appropriate advice and support should remain available from the secondary care team in a timely manner, without necessarily requiring a new referral.