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REMEDY : BNSSG referral pathways & Joint Formulary

BNSSG Paediatric Joint Formulary
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Shared Care

Principles of Shared Care:

  1. Shared care is with agreement of all parties i.e. specialist, GP and patient,

  2. The appropriate stabilisation period has occurred before prescribing is handed over; duration determined by the shared care protocol e.g. 3 months,

  3. There is a structure in place to access on-going advice and support, detailed in the shared care arrangement e.g. side-effects, abnormal blood tests etc.

Note: a prescriber can choose not to accept clinical responsibility because of lack of familiarity or competence in the use of a medicine or if it is used outside agreed guidance. Prescribers may not refuse clinical responsibility solely on grounds of cost. Distance is not a reason for requiring transfer of care.

 

Shared care requests from a private provider

When shared care requests are received from a private provider, it is reasonable for GPs to ask the private provider to meet the principles of shared care for NHS pathways.  Quite often point 3 above is not in place or provided by a private provider however, requests are still made for GPs to take over prescribing responsibility.  Prescribing a medicine is often just a part of the package of care required, however is requested without other care/support in place.

It is reasonable for GPs to ask the private provider to demonstrate that it has the necessary expertise to diagnose and initiate therapy before responding to the provider’s request to continue treatment.  In addition to this a prescriber must feel that they are clinically competent to prescribe the requested medicines before accepting clinical and prescribing responsibility for the patient.

The GP can decide on a case-by-case basis whether they accept the clinical and prescribing responsibility for a patient. A GP would be under no compulsion to continue maintenance treatment for any specialist medication, especially if initiated through a private clinic where there is no guarantee of clinical governance or quality assurance.