Shared Care and PGDs

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 GP, or other primary care prescriber, is supported by a shared care agreement.

When a specialist considers a patient’s condition to be stable or predictable,they may seek the agreement of the GP 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.

It should be noted that where a shared care agreement has been approved by the Somerset Prescribing Forum, a condition of the transfer from Specialist to Primary care is on the basis that:

• the specialist clinician is usually responsible for initiating and stabilising treatment;
• it is normally presumed that GPs will accept the shared care of amber drugs. If a GP wishes to decline a shared care they should respond promptly to the specialist, setting out appropriate reasons;
• monitoring requirements and responsibility for monitoring treatment have been clearly defined;
• the drug is being used for the indication and in accordance with the shared care guidance that has been agreed;
• a GP may choose not to accept clinical responsibility on the basis of lack of familiarity or experience with a drug or if it is being used outside of the guidance that has been agreed;
• Cost of a medicine is not a basis for transferring care or a reason for refusing to accept clinical responsibility.