Shared Care Update
Monitoring of specialist drugs is an issue which the LMC has been working on for many years. There is not uniformity of provision across Lincolnshire. This leads to an unequal service for patients, which leads to increased risks.
The issues which the LMC has working to address are:
- Not all specialists request shared care, this is particularly relevant to North Lincolnshire and Goole hospital Trust
- Some specialists discharge patients from follow up when they have a shared care agreement, this is not therefore “shared” care
- Some specialists request sharing of care when the patients are not adequately stabilised on the drug
- Some GP practices do not provide the Shared Care LES, which creates a postcode lottery for patients and specialists
- Some drugs which require monitoring are not subject to shared care agreements, such as long term anti-psychotic medications
- Some drugs which are subject to shared care agreements do not have a commissioned service to share the care with, for example adult ADHD medications
- Many shared care protocols are out of date
Recent NHSE guidelines have been published which clarify many of the contentious issues around the prescribing interface between primary and secondary care. These guidelines can be found at https://www.england.nhs.uk/wp-content/uploads/2018/03/responsibility-prescribing-between-primary-secondary-care-v2.pdf .
This guideline is a useful starting point for clarifying some issues around shared care. The guidelines clarify that:
- GPs do not have to do that which is not in our contract
- LMCs should be involved in reaching local agreements
- GPs can decline shared care work
- There is an obligation on secondary/tertiary care to prescribe in those situations where GPs have declined to take on responsibility for ongoing prescribing.
- Commissioners need to determine the resources and capacity needed before shared care prescribing can take place
Based upon this guidance the LMC will continue to work to resolve the issues.