Good practice in proposing, prescribing, providing and managing medicines and devices

Shared care

73

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.

74

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

Prescribing based on a proposal or recommendation by a colleague

75

If you prescribe based on the proposal or recommendation of another healthcare professional, you must be satisfied the prescription is needed, appropriate for the patient, within the limits of your competence and that you have enough information to safely proceed.

76

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.

77

In both cases (paragraphs 75-76), you will be responsible for the steps you take to ensure that the prescription is appropriate, necessary and safe.

Recommending and proposing medicines, treatments or devices for a colleague to prescribe

78

If you recommend or propose that a colleague prescribe a particular medicine, treatment or device for a patient, you must consider whether they are able to do so safely. You must be satisfied they have sufficient information, experience and knowledge of the patient and the medicine, treatment or device 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

79

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.
80

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.22 

22

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.

81

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.