Introduction
A shared care guideline outlines ways in which the responsibilities for managing the prescribing of a medicine can be shared between the specialist and a primary care prescriber. Primary care prescribers are invited to participate. If they are unable to undertake these roles, then he or she is under no obligation to do so. In such an event, the total clinical responsibility for the patient for that diagnosed condition remains with the specialist.
AMBER with SHARED CARE medicines require significant monitoring and to qualify must be designated so by the East Lancashire Drug & Therapeutics Committee. Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards to monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of the locally approved shared care document (where available) should accompany this letter which outlines these responsibilities. Primary care prescribers should then inform secondary care of their intentions as soon as possible by letter, and then arrange the transfer of care as necessary. . This will ensure that there is absolute clarity as to who is taking over the prescribing, and any associated monitoring responsibilities.
Sharing of care assumes communication between the specialist, primary care prescriber and patient. The intention to share care is usually explained to the patient by the prescriber initiating treatment. It is important that patients are consulted about treatment and are in agreement with it. Patients should remain under regular follow-up in secondary care, where it is expected that the patients overall response to treatment, and need for continued treatment will be monitored.
Prescribers are reminded that the doctor who prescribes the medication legally assumes clinical responsibility for the drug and the consequences of its use. A Department of Health circular first set out the principles that govern shared care. It was EL91(127) and can be accessed below:
