Prescribing guidance: Shared care

35. Decisions about who should take responsibility for continuing care or treatment after initial diagnosis or assessment should be based on the patient’s best interests, rather than on your convenience or the cost of the medicine and associated monitoring or follow-up.

36. Shared care requires the agreement of all parties, including the patient. Effective communication and continuing liaison between all parties to a shared care agreement are essential.

Prescribing at the recommendation of a professional colleague

37. If you prescribe at the recommendation of another doctor, nurse or other healthcare professional, you must satisfy yourself that the prescription is needed, appropriate for the patient and within the limits of your competence.

38. If you delegate assessment of a patients’ suitability for a medicine, you must be satisfied that the person to whom you delegate has the qualifications, experience, knowledge and skills to make the assessment. You must give them enough information about the patient to carry out the assessment required. You must also make sure that they follow the guidance in paragraphs 21 – 29 on Consent.

39. In both cases, you will be responsible for any prescription you sign.

Recommending medicines for prescription by colleagues

40. If you recommend that a colleague, for example a junior doctor or general practitioner, prescribes a particular medicine for a patient, you must consider their competence to do so. You must satisfy yourself that they have sufficient knowledge of the patient and the medicine, experience (especially in the case of junior doctors) and information to prescribe. You should be willing to answer their questions and otherwise assist them in caring for the patient, as required.

Shared care prescribing

41. If you share responsibility for a patient’s care with a colleague, you must be competent to exercise your share of clinical responsibility. You should:

a. keep yourself informed about the medicines that are prescribed for the patient

b. be able to recognise serious and frequently occurring adverse side effects

c. make sure appropriate clinical monitoring arrangements are in place and that the patient and healthcare professionals involved understand them

d. keep up to date with relevant guidance on the use of the medicines and on the management of the patient’s condition.

42. In proposing a shared care arrangement, specialists may advise the patient’s general practitioner which medicine to prescribe. If you are recommending a new, or rarely prescribed, medicine, you should specify the dosage and means of administration, and agree a protocol for treatment. You should explain the use of unlicensed medicines, and departures from authoritative guidance or recommended treatments and provide both the general practitioner and the patient with sufficient information to permit the safe management of the patient’s condition.14

43. If you are uncertain about your competence to take responsibility for the patient’s continuing care, you should seek further information or advice from the clinician with whom the patient’s care is shared or from another experienced colleague. If you are still not satisfied, you should explain this to the other clinician and to the patient, and make appropriate arrangements for their continuing care.