Common use of Shared Care Clause in Contracts

Shared Care. 4.4.1 Shared care agreements are a specific approach to the seamless prescribing and monitoring of medicines which enables patients to receive care in an integrated and convenient manner. Shared care is a particular form of the transfer of clinical responsibility from a hospital or specialist service to general practice in which prescribing by the primary care prescriber, or other primary care prescriber, is supported by a shared care agreement. 4.4.2 When a specialist considers a patient’s condition to be stable or predictable, they may seek the agreement of the primary care prescriber concerned (and the patient) to share their care. In proposing shared care agreements, a specialist should advise which medicines to prescribe, what monitoring will need to take place in primary care, how often medicines should be reviewed, and what actions should be taken in the event of difficulties. Classification: 4.4.3 At a system level, medicines and conditions suitable for shared care are usually identified through a traffic light system determined by an Area Prescribing Committee (APC). Shared care typically applies to medicines for which a shared care agreement must be in place before prescribing responsibility is transferred. This contrasts with medicines which are categorised as suitable for routine prescribing in primary care, or those that should remain the responsibility of specialist prescribers only. All prescribers have a responsibility to be aware of medicines identified through the traffic light system, so that prescribing decisions can be made most effectively. 4.4.4 At an individual patient level, patients themselves and/or carers must be centrally involved in any decision-making process. They should be supported by good quality information that helps them to both come to an informed decision about engagement in a shared care arrangement and sets out the practical arrangements for ongoing supplies of medicines. Given the increasing use of, and benefits derived from, the Summary Care Record and other digital innovations, it is important that a comprehensive primary care record is in general practice, particularly in situations where not all medicines for a patient are prescribed by their primary care prescriber and supplied by their community pharmacy. 4.4.5 When clinical responsibility for prescribing is transferred to general practice, it is important that the primary care prescriber, or other primary care prescriber, is confident to prescribe the necessary medicines. Shared care agreements play a key role in enabling primary care prescribers to prescribe medicines with which they may not initially be familiar. For this reason it is important that agreements reflect the principles set out in Annex 1, and are agreed locally through an APC or an equivalent authoritative committee. 4.4.6 Prescribers are responsible for the prescriptions they sign and they must be prepared to explain and justify their decisions and actions. Service Condition 11.4 of the NHS Standard Contract 2017/19 makes clear that when a shared care protocol exists and where the primary care prescriber has confirmed willingness to accept the transfer of care, the hospital must initiate and abide by that agreement. 4.4.7 When a primary care prescriber accepts responsibility for prescribing medicines which are not usually dispensed in the community, and where the patient is stabilised on a particular medication, there should be liaison with the transferring hospital and if appropriate the relevant community pharmacist to ensure continuity of treatment. 4.4.8 To overcome some of the challenges associated with shared care agreements, this guidance is accompanied by ‘Shared Care Prescribing Guidelines’ – local policies which enable primary care prescribers to agree to the prescribing and monitoring of medicines/treatment in primary care, in agreement with the specialists and patient. 4.4.9 The purpose of these guidelines is to provide a framework for seamless transfer of care for a person from a hospital or specialist service setting to general practice, where it is appropriate and in their best interest. These are set out in Annex 1, and form part of this guidance. It is recommended that all professionals from primary and secondary care follow these principles when developing shared care agreements in collaboration with patients.