Good practice in prescribing and managing medicines and devices

Shared care


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 convenience or the cost of the medicine and associated monitoring or follow-up.


Shared care requires the agreement of all parties, including the patient. It’s essential that all parties communicate effectively and work together.

Prescribing at the recommendation of a colleague


If you prescribe based on the recommendation of another doctor, nurse or other healthcare professional, you must be satisfied that the prescription is needed, appropriate for the patient and within the limits of your competence.


If you delegate the assessment of a patient’s suitability for a medicine, you must be satisfied that the person you delegate to 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. You must also make sure that they follow our guidance on ‘Decision making and consent’ in paragraphs 42 to 47.


In both cases (paragraphs 76 – 77), you will be responsible for any prescription you sign.

Recommending medicines for a colleague to prescribe


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

Shared care prescribing


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:

  1. keep yourself informed about the medicines that are prescribed for the patient
  2. be able to recognise serious and frequently occurring adverse side effects
  3. make sure appropriate clinical monitoring arrangements are in place and that the patient and healthcare professionals involved understand them
  4. keep up to date with relevant guidance on the use of the medicines and on the management of the patient’s condition.

In proposing a shared care arrangement, specialists may advise the patient’s GP 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. You should also provide both the GP and the patient with sufficient information to permit the safe management of the patient’s condition.21 


For more information about shared care prescribing see resources published by NHS England, Welsh Medicines Information Centre, NHS Scotland health boards and Health and Social Care in Northern Ireland.


If you are uncertain about your competence to take responsibility for the patient’s continuing care, you should ask for further information or advice from the clinician who is sharing care responsibilities 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.