Updated on Prescribing in General Practice

Shared Care Prescribing refers to medication which is initiated by a specialist and ongoing prescribing and monitoring is shared with a GP practice, usually accompanied by guidance or a shared care agreement.

The GMC has guidance on shared care prescribing which requires a clinician to be informed about the side effects of the medication and undertake the required monitoring.

The following principles should apply to all shared care prescribing.

Shared care prescribing is non-core voluntary activity that can be declined by the GP practice for any reason

This includes:

• Inadequate capacity within the practice
• Inadequate competency about the specialist medication, despite training
• Lack of assurance to provide the ongoing specialist support required for shared care.

Please note that you should ensure any refusal is consistent and framed by a set of principles so it is not discriminatory to specific patient groups.

The GP practice is satisfied with the quality assurance and clinical governance of the specialist provider

This will be more challenging if the provider is not commissioned by the NHS

If ongoing medical monitoring is required

Responsibility for this should be clear within associated guidance in the form of a shared care agreement

The appropriate stabilisation period has occurred before prescribing is handed over to the GP practice

The duration is determined by the shared care agreement (often 3 months).

There is enduring specialist input 

For example:

• Ongoing out-patient follow-up
• A mechanism which allows timely advice from the specialist, which could be converted into an out-patient review.

Please note, enduring specialist care may be variable for self-funding arrangements, especially if funding should cease, and this should be discussed with patients in advance of any agreement. Your local Commissioner/LMC may have a policy on shared care with private providers.

Any additional work undertaken by general practice in the form of medication monitoring, is delivered through a funded, commissioned pathway

This would usually be in the form of an ICB medicines monitoring Local Enhanced Service

The BMA GP committee’s prescribing policy group has published guidance to help with the clinical responsibilities on prescribing.

The below gives an insight into the topics alphabetically, or you can download the guidance in full.