Shared Care Agreements/Medications
The LMC receives a lot of questions in relation to Shared Care Agreements (SCA), specifically around Private Providers and whether they have to accept SCA. Shared Care is incorporated within the Community Based Services (CBS) contract, so practices should make sure they are aware of the contract and funding arrangement associated to SCAs.
The GMC[1] reminds GPs that they “are responsible for the prescriptions you sign” and “must recognise and work within the limits of [their] competence[2].” GPs must have “have sufficient information to prescribe safely.”
“Decisions about who should take responsibility for continuing … treatment … should be based on the patient’s best interests, rather than on convenience or the cost of the medicine and associated monitoring or follow up,” and the GMC remind us that “shared care requires the agreement of all parties.”
NHS England advise that “Shared care is a particular form of the transfer of clinical responsibility from a hospital or specialist service to general practice[3]” and “it is important that the GP, or other primary care prescriber, is confident to prescribe the necessary medicines”
NHS E further state that:
- “shared care may not be the most appropriate mechanism, and where specialists would therefore normally retain responsibility for prescribing, … [for medications] that are unlicensed; or are used off-label without an associated evidence base or being recognised as standard treat.”
- “However, when decisions are made to transfer clinical and prescribing responsibility for a patient between care settings, it is of the utmost importance that the GP feels clinically competent to prescribe the necessary medicines.”
- “Legal responsibility for prescribing lies with the doctor or health professional who signs the prescription and it is the responsibility of the individual prescriber to prescribe within their own level of competence.”
Therefore, regardless of the Shared Care ‘Rag Rating’ when considering whether to prescribe a medication, GPs must consider whether they have the appropriate knowledge and clinical competence, whether they have the right information, and whether the medication is appropriate and supported by current evidence, and practices can decline to adopt the SCA if the above applies.
Attached is a policy which a practice has developed on shared care with private providers and is available for other practices to use if wish. The appendix would be scanned into the notes if any private provider met the criteria, and that the policy can be shared with both private providers and patients as needed.
The ICB has published guidance on private prescriptions which is available to give to patients - LLR-Standards-for-Prescribing-across-the-NHS-Private-interface.pdf (areaprescribingcommitteeleicesterleicestershirerutland.nhs.uk)
Standards For Prescribing and Medicines Optimisation at the interface between Secondary and Primary care settings guidance
Over the last 12 months the Leicester, Leicestershire and Rutland Area Prescribing Committee (LLR APC) has been working with system colleagues to update the guidance relating to Medicines Optimisation at interface between secondary and primary care. This process is now complete and has been approved by the relevant committees to produce guidance that will ensure that patients receive the most efficient transfer of care with medicines.
The key updates to the guidance include (but are not limited too):
- The previous guidance allowed for interpretation of immediate vs non-immediate need when it came to prescribing from outpatients. This has now been removed and the supply of new medicines issued from outpatients (including remote consultations) to cover a 28-day period where appropriate. Exclusion from the 28-day rule includes for example antibiotics, short-term analgesia, short course corticosteroids etc. and a maximum of 30 days supply can be prescribed for controlled drugs. The outpatient clinician will be expected to provide counselling to the patient on the medication(s) initiated and document this within the communication sent to GP practice.
- Updates on the legal responsibility of prescribing during transfer of care
- Patient own medicines and permissions to use their own medicines during inpatient stays where appropriate
- Inclusion of information relating to recent changes with LMWHs and discharge guidance
- Ensuring patients are supplied appropriate ancillary items e.g., syringes for feeds
The guidance has been updated on to the LLR APC website and available at: https://www.areaprescribingcommitteeleicesterleicestershirerutland.nhs.uk/wpcontent/uploads/2015/06/Standards_for_Prescribing_and_-MM_V8.1_Mar12.pdf
Departments across both UHL and LPT have also had the updated guidance and are in the process of implementing this guidance. We have agreed that the guidance will go live as of 1st October 2024 with a 3-month implementation period with the guidance and all principles adhered to from 1st January 2025.
|
|