Patients on Lithium Shared Care Agreements (SCA)

The LMC has received concerns about patients on Lithium who are discharged from secondary care, and the practice subsequently have difficulty in getting further support from psychiatry.

The LMC has raised this with Dr Samantha Hamer, Associate Medical Director, Leicestershire Partnership NHS Trust, and agreed the following.

The Shared Care Agreement is available on the LLR area prescribing committee website CLICK HERE. which details the agreements and responsibilities for both secondary and primary care.

Appendix 2 on Page 11 of the Guidelines document has some FAQs that answer some of the concerns raised.

1. Patients can be discharged from secondary care on Lithium if there are no on-going mental health needs other than lithium monitoring, however it should be made clear how to refer back if that changes.
2. If a level is found to be out of range advice can be sought via either email lpt.sharedcare@nhs.net or the SCA also has the following information “For advice on management of abnormal blood test results or a significant increase in weight and BMI or waist circumference, contact a LPT clinical pharmacist in the first
   instance on 0116 295 8384 (Mon-Fri 8.30am – 5.30pm and Sat 9-11am) or Consultant Psychiatrist via LPT switchboard 0116 2256000”

We have agreed that in preference, discharge letters should reference this information, so it is clear for GPs. If there are then concerns about poor information and lack of clarity, these can be escalated via TCS using the PRISM form.

LPT have a clear DNA policy, which includes the clinician determining the level of risk before either offering further contact, discharging or pursuing urgent intervention. As there are risks with Lithium, LPT would expect this to be considered.

The LMC view is that a patient taking Lithium should not be discharged by psychiatry to not attending an appointment, unless psychiatry is certain that the patient is stable.

If you have a patient on Lithium who has been discharged due to DNA and the risks have not been considered, please escalate via TCS. If the patient is not stable, also contact psychiatry via the LPT switchboard, or consider referral to CRISIS Team.

If you have any concerns about this or a related problem please contact the LMC.