Shared Care Agreement FormShared Care Agreement • November 6th, 2013
This treatment has been accepted for shared care according to the agreed shared care protocol available on ADTC link on the NHS Fife intranet (www.fifeadtc.scot.nhs.uk). I am therefore requesting your agreement in the shared care of this patient.
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENT FRAMEWORKShared Care Agreement • October 31st, 2024
Shared care guidelines - Stimulants for Attention Deficit Hyperactivity Disorder (ADHD) in Children & Young People aged at least 6 years old
Shared Care Agreement FormShared Care Agreement • November 6th, 2013
This treatment has been accepted for shared care according to the agreed shared care protocol available on ADTC link on the NHS Fife intranet (www.fifeadtc.scot.nhs.uk). I am therefore requesting your agreement in the shared care of this patient.
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE SHARED CARE AGREEMENTShared Care Agreement • October 4th, 2022
Basingstoke, Southampton and Winchester District Prescribing Committee Shared Care Agreement Licensed ADHD Medications for the Treatment of Childhood ADHD For North Hampshire and West Hampshire CCGsShared Care Agreement • February 9th, 2021
This shared care protocol is produced to support the combination of the best of both primary and secondary care for the benefit of the patient. It facilitates seamless transfer of patient treatment from secondary to primary care and provides an information resource to support clinicians providing primary care to the patient.
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTShared Care Agreement • October 3rd, 2024
Medication covered by this agreement Donepezil Galantamine RivastigmineMemantine Indications for shared care Dementia and Alzheimers Disease as per NICE NG97. Full details in main body of document Specialist Prescribing and Monitoring Responsibilities (summary) GP / Community Team - Primary Care Prescribing and Monitoring Responsibilities (summary) • Confirm diagnosis and clarify supervision• Notify the GP of the need to initiate therapy• Provide details of how the medication will be collected and any support required• Discuss benefits, side effects and prescribing guidelines of treatment with the patient and carer.• Ascertain willingness by the patient to take their medication and co-operation (within the bounds of their illness)• Recommend appropriate dose to initiate treatment.• Communicate any changes in treatment with the primary care prescriber as appropriate.• Monitor response to treatment and advise continuation for up to three months to the prescriber within 28 days of the ini
AREAS OF RESPONSIBILITY FOR THE SHARING OF CAREShared Care Agreement • July 30th, 2021
This shared care agreement outlines suggested ways in which the responsibilities for managing the prescribing of bicalutamide for men with prostate cancer can be shared between the specialist and general practitioner (GP). GPs are invited to participate. If the GP is not confident to undertake these roles, then he or she is under no obligation to do so. In such an event, the total clinical responsibility for the patient for the diagnosed condition remains with the specialist. If a specialist asks the GP to prescribe this drug, the GP should reply to this request as soon as practicable.
EFFECTIVE SHARED CARE AGREEMENT OF LISDEXAMFETAMINE FOR THE TREATMENT OF ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) IN CHILDREN AND ADOLESCENTSShared Care Agreement • August 2nd, 2021
Specialist prescriber responsibilities 1 Discuss the benefits and side effects of treatment with the patient and carer (as appropriate).2 Check for possible drug interactions with lisdexamfetamine and patient’s regular medication. Avoid prescribing interacting drugs.3 Assess likelihood of compliance.4 Ensure patient and carer (as appropriate) are given sufficient information about their treatment.5 Perform all baseline tests as stated on the monitoring requirement.6 Initiate and stabilise treatment with lisdexamfetamine. Stabilisation will usually take 6- 12 weeks.7 Supply medication until care is transferred to GP.8 Ask the GP whether he or she is willing to participate in shared care and explain the intention to share care with patient/carer and obtain consent.9 Monitors appropriately as stated on the monitoring requirement.10 Inform GP of the dose to be prescribed, any changes in dose, when to stop treatment and when to refer the patient back to specialist.11 Physical health monitor
Request to Share Care and Agreement FormShared Care Agreement • June 1st, 2022
This Request to Share Care provides Key Primary Care Information on responsibilities and monitoring. The aim is to support the GP to agree to share care arrangements. Refer to Full Shared Care Protocol for further information (page 4 onwards).
For treatment of Rheumatoid Arthritis in AdultShared Care Agreement • February 1st, 2019
This shared care agreement outlines suggested ways in which the responsibilities for managing the prescribing of methotrexate for rheumatoid arthritis can be shared between the specialist and general practitioner (GP). GPs are invited to participate. If the GP is not confident to undertake these roles, then he or she is under no obligation to do so. In such an event, the total clinical responsibility for the patient for the diagnosed condition remains with the specialist. If a specialist asks the GP to prescribe this drug, the GP should reply to this request as soon as practicable.
ARIPIPRAZOLE SHARED CARE AGREEMENT (SCA)Shared Care Agreement • January 24th, 2014
SPECIALIST RESPONSIBILITIES 1. Assess patient, confirm diagnosis, and discuss benefits and risks of treatment with the patient.2. Initiate, titrate and stabilise patient on treatment with oral aripiprazole. Monitor for side-effects during initiation and dose titration, including during any switch period if transferred from alternative treatment. Prescribers should familiarise themselves with the drug indication, dose, administration, contra-indications, cautions, side- effects, interactions, and preparation, by referring to the current version of the Summary of Product Characteristics (http://www.medicines.org.uk/emc/default.aspx) or the BNF/BNF for Children (http://www.medicinescomplete.com/mc/index.htm).3. Provide patient with appropriate written information about aripiprazole (available from http://www.choiceandmedication.org/nsft/).4. Discuss proposed SCA with the patient and explain that their GP may or may not wish to participate. The patient has the choice to continue receiving
Royal Wolverhampton NHS Trust Wolverhampton Shared Care Agreement Wolverhampton Clinical Commissioning GroupShared Care Agreement • April 24th, 2023
Patient Consent I confirm the risks and benefits of treatment, the baseline tests conducted, the need for monitoring, how monitoring will be arranged, and the roles of the consultant and GP, and my role in shared care have been explained to me. I confirm I have been provided with a copy of this shared care information. I will tell the specialist or GP if I do not have a clear understanding of the treatment. I will share any concerns in relation to the above treatment. I will report any adverse effects to the specialist or GP whilst taking the above treatment. Additionally if prescribing is unlicensed I am aware that azathioprine is not licensed to treat my condition but the risks and benefits have been explained to me and I agree to take this medicine as prescribed.
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE SHARED CARE AGREEMENTShared Care Agreement • September 28th, 2022
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE SHARED CARE AGREEMENTShared Care Agreement • October 4th, 2022
This shared care agreement is aimed at General Practitioners with a special interest (GPSI) in drug misuse within the Local Enhanced Service (LES) working alongside specialist services to manage the care of drug users.
Shared Care Agreement: Submission Checklist and Criteria for ApprovalShared Care Agreement • December 17th, 2021
Shared Care Agreements provide valuable clinical information to support shared care. Shared Care Agreements will not be suited to every situation and should only be considered in accordance with the following inclusion criteria.
Effective Shared Care Agreement for patients with amyotrophic lateral sclerosis (ALS) - a form of Motor Neurone Disease (MND)Shared Care Agreement • December 19th, 2018
Effective Shared Care Agreement (ESCA)Shared Care Agreement • November 27th, 2020
This shared care agreement outlines suggested ways in which the responsibilities for managing the prescribing of anti-dementia treatments can be shared between the specialist and general practitioner (GP). This agreement covers all single anti-dementia treatments.
AREAS OF RESPONSIBILITY FOR THE SHARING OF CAREShared Care Agreement • August 2nd, 2021
This shared care agreement outlines suggested ways in which the responsibilities for managing the prescribing of glycopyrronium for the indication above can be shared between the specialist and general practitioner (GP). GPs are invited to participate. If the GP is not confident to undertake these roles, then he or she is under no obligation to do so. In such an event, the total clinical responsibility for the patient for the diagnosed condition remains with the specialist. If a specialist asks the GP to prescribe this drug, the GP should reply to this request as soon as practicable.
Essential Shared Care Agreement for Sulfasalazine for gastroenterological indicationsShared Care Agreement • December 23rd, 2014
This shared care agreement outlines suggested ways in which the prescribing responsibilities can be shared between the specialist and GP. GPs are invited to participate. If the GP feels that undertaking the roles outlined in the shared care agreement is outside their area of expertise or have clinical concerns about the safe management of the drug in primary care, then he or she is under no obligation to do so. In such an event, clinical responsibility for the patient’s health remains with the specialist. If a specialist asks the GP to prescribe, the GP should reply to this request as soon as practicable. Sharing of care assumes communication between specialist, GP and patient.
MERCAPTOPURINE SHARED CARE AGREEMENT (SCA)Shared Care Agreement • March 24th, 2015
SPECIALIST RESPONSIBILITIES 1. Assess patient, confirm diagnosis and discuss benefits and risks of treatment with the patient.2. Perform pre-treatment assessments and on-going monitoring as detailed on page 2.3. Initiate, titrate and stabilise patient on treatment with oral mercaptopurine. Prescribers should familiarise themselves with the drug indication, dose, administration, contra-indications, cautions, side-effects, interactions and preparation by referring to the current version of the Summary of Product Characteristics (http://www.medicines.org.uk/emc/default.aspx) or the BNF/BNF for Children (http://www.medicinescomplete.com/mc/index.htm).4. Provide appropriate written information on mercaptopurine to the patient.5. Discuss proposed SCA with the patient and explain that their GP may or may not wish to participate. The patient has the choice to continue receiving treatment solely from the specialist if they wish.6. Send a letter to the patient’s GP to request participation in th
Shared care agreement for the treatment of Adult renal transplant patients.Shared Care Agreement • May 21st, 2013
This shared care agreement outlines suggested ways in which the responsibilities for managing the prescribing of Sirolimus for renal transplant patients can be shared between the specialist and general practitioner (GP). GPs are invited to participate. If GPs are not confident to undertake these roles, then they are under no obligation to do so. In such an event, the total clinical responsibility for the patient for the diagnosed condition remains with the specialist. If a specialist asks the GP to prescribe this drug, the GP should reply to this request as soon as practicable.
Shared Care Agreement Form for Naltrexone Hydrochloride tablets For opiate dependenceShared Care Agreement • December 6th, 2020
This page is to be completed by the consultant psychiatrist initiating the therapy. A copy of both completed forms should be retained by the GP and a copy should be returned to the consultant (preferably by email) for uploading in the patients records on Rio.
Coventry & WarwickshireShared Care Agreement • August 2nd, 2021
This shared care agreement outlines suggested ways in which the responsibilities for managing the prescribing of sertraline can be shared between the specialist and general practitioner (GP). The recent introduction of a licensed product, advice for the MHRA regarding imported products and Area Prescribing Committee support has facilitated the participation of GPs in shared care. GPs are invited to participate. GPs should not be asked to initially prescribe but may be asked to continue prescribing for those patients in whom sertraline has proved successful. Prescribers should familiarise themselves with the guidelines and the monitoring requirements before agreeing to undertake prescribing. If the GP is not confident to undertake these roles, then he/she is under no obligation to do so. In such an event, the total clinical responsibility for the patient, including issuing prescriptions, remains with the specialist. If a specialist asks the GP to prescribe this drug, the GP should reply
AREAS OF RESPONSIBILITY FOR THE SHARING OF CAREShared Care Agreement • August 2nd, 2021
This shared care agreement outlines suggested ways in which the responsibilities for managing the prescribing of Triptorelin can be shared between the specialist and general practitioner (GP). GPs are invited to participate. If the GP is not confident to undertake these roles, then he or she is under no obligation to do so. In such an event, the total clinical responsibility for the patient for the diagnosed condition remains with the specialist. If a specialist asks the GP to prescribe this drug, the GP should reply to this request as soon as practicable.
Shared Care Agreement FormShared Care Agreement • November 6th, 2013
This treatment has been accepted for shared care according to the agreed shared care protocol available on ADTC link on the NHS Fife intranet (www.fifeadtc.scot.nhs.uk). I am therefore requesting your agreement in the shared care of this patient.
AREAS OF RESPONSIBILITY FOR THE SHARING OF CAREShared Care Agreement • August 2nd, 2021
This shared care agreement outlines suggested ways in which the responsibilities for managing the prescribing of rufinamide for epileptic seizures can be shared between the specialist and general practitioner (GP).* GPs are invited to participate. If the GP is not confident to undertake these roles, then he or she is under no obligation to do so. In such an event, the total clinical responsibility for the patient for the diagnosed condition remains with the specialist. If a specialist asks the GP to prescribe this drug, the GP should reply to this request as soon as practicable.
Royal Wolverhampton NHS Trust Wolverhampton Shared Care Agreement Wolverhampton City Clinical Commissioning GroupShared Care Agreement • July 4th, 2024
Patient Consent I confirm the risks and benefits of treatment, the baseline tests conducted, the need for monitoring, how monitoring will be arranged, and the roles of the consultant and GP, and my role in shared care have been explained to me. I confirm I have been provided with a copy of this shared care information. I will tell the specialist or GP if I do not have a clear understanding of the treatment. I will share any concerns in relation to the above treatment. I will report any adverse effects to the specialist or GP whilst taking the above treatment. Attend for blood monitoring, blood pressure and weight at required intervals (as directed by specialist, and then every 12 weeks when stabilised) Additionally if prescribing is unlicensed I am aware that leflunomide is not licensed to treat my condition but the risks and benefits have been explained to me and I agree to take this medicine as prescribed.
EFFECTIVE SHARED CARE AGREEMENT OF MYCOPHENOLATE FOR THE TREATMENT OF AUTOIMMUNE RHEUMATIC DISEASESShared Care Agreement • July 23rd, 2020
Specialist clinician responsibilities 1 Discuss the benefits and side effects of treatment with the patient.2 Check for possible drug interactions with mycophenolate and patients regular medication. Avoid prescribing interacting drugs.3 Assess likelihood of compliance.4 Ensure patient is given sufficient information about their treatment.5 Perform all baseline tests (including FBC, U&Es and LFTs).6 Initiate and stabilise treatment with mycophenolate. Stabilisation will usually take 4 weeks.7 Supply medication until care is transferred to GP.8 Ask the GP whether he or she is willing to participate in shared care and explain the intention to share care with patient/carer and obtain consent.9 Monitors appropriately as stated on the monitoring requirement.10 Inform GP of the dose to be prescribed, any changes in dose, when to stop treatment and when to refer the patient back to specialist clinician.11 Ensure GP has access to blood results for information.12 Monitor for side effects and rep
EFFECTIVE SHARED CARE AGREEMENT OF SULFASALAZINE PLAIN AND ENTERIC COATED (EC) FOR THE TREATMENT OF ULCERATIVE COLITIS / CROHN’S DISEASE & AUTOIMMUNE RHEUMATIC DISEASES (EC only)Shared Care Agreement • February 8th, 2021
Specialist clinicians responsibilities 1 Discuss the benefits and side effects of treatment with the patient.2 Check for possible drug interactions with sulfasalazine and patient’s regular medication. Avoid prescribing interacting drugs.3 Assess likelihood of compliance.4 Ensure patient is given sufficient information about their treatment.5 Perform all baseline tests (including FBC, U&Es and LFTs).6 Initiate and stabilise treatment with sulfasalazine. Stabilisation will usually take 7 weeks.7 Supply medication until care is transferred to GP.8 Ask the GP whether he or she is willing to participate in shared care and explain the intention to share care with patient/carer and obtain consent.9 Monitors appropriately as stated on the monitoring requirements.10 Inform GP of the dose to be prescribed, any changes in dose, when to stop treatment and when to refer the patient back to specialist clinician.11 Ensure GP has access to blood results for information.12 Monitor for side effects and
SHARED CARE AGREEMENTShared Care Agreement • February 17th, 2022
The Shared Care Agreement (SCA) is intended to facilitate the accessibility and safe prescribing of complex treatments across the secondary/primary care interface. It does not contain all of the relevant product information, which should be sought using the current British National Formulary and manufacturer’s Summary of Product Characteristics. The SCA must be used in conjunction with the NHS Lothian Procedure for the Shared Care of Medicines, available here.
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE SHARED CARE AGREEMENTShared Care Agreement • March 29th, 2023
GP practice Name GP Practice CodeShared Care Agreement • August 19th, 2021
This agreement should be developed as a partnership between the GP Practice Multidisciplinary Team and the Community Pharmacy Team(s). It facilitates a collaborative approach to discuss the parameters which will form the foundation of your SRx service. This could be across a one-to-one or one to multiple GP/Community Pharmacy Team and is a useful tool for developing a SRx SOP.
NORFOLK AND WAVENEY STP THERAPEUTICS ADVISORY GROUP (TAG) SHARED CARE AGREEMENTShared Care Agreement • November 5th, 2024
Generic and Proprietary/Brand Name See Netformulary for up-to-date list of products. Methylphenidate plain: Generic, Ritalin®, Medikinet®Methylphenidate modified-release:Concerta XL®, Delmosart®, Matoride XL®, Xaggitin XL®, Xenidate XL®See appendix 1 for comparative costs of these once-daily methylphenidate products Equasym XL®, Medikinet XL®Dexamfetamine: GenericLisdexamfetamine: Elvanse®, Elvanse Adult®Atomoxetine: Strattera® Indications for shared care In line with NICE NG 87 (March 2018) stimulants and atomoxetine are indicated for the treatment of Attention Deficit/Hyperactivity Disorder (ADHD) as part of a treatment package where remedial measures alone prove insufficient.For newly diagnosed cases in adulthood:Specialist Initiation, with the GP taking over prescribing responsibility in line with this Shared Care Agreement1. Drug treatment is the first-line treatment for adults with ADHD with either moderate or severe levels of impairment.2. Methylphenidate or lisdexamfetamine sho
EFFECTIVE SHARED CARE AGREEMENT OF PENICILLAMINE FOR THE TREATMENT OF AUTOIMMUNE RHEUMATIC DISEASESShared Care Agreement • February 8th, 2021
Specialist clinician responsibilities 1 Discuss the benefits and side effects of treatment with the patient.2 Check for possible drug interactions with penicillamine and patients regular medication. Avoid prescribing interacting drugs.3 Assess likelihood of compliance.4 Ensure patient is given sufficient information about their treatment.5 Perform all baseline tests (including FBC, U&Es and LFTs).6 Initiate and stabilise treatment with penicillamine. Stabilisation will usually take 4 weeks.7 Supply medication until care is transferred to GP.8 Ask the GP whether he or she is willing to participate in shared care and explain the intention to share care with patient/carer and obtain consent.9 Monitors appropriately as stated on the monitoring requirement.10 Inform GP of the dose to be prescribed, any changes in dose, when to stop treatment and when to refer the patient back to specialist clinician.11 Ensure GP has access to blood results for information.12 Monitor for side effects and rep
EFFECTIVE SHARED CARE AGREEMENT OF AZATHIOPRINE FOR THE TREATMENT OF AUTOIMMUNE RHEUMATIC DISEASESShared Care Agreement • December 18th, 2023
Specialist clinician responsibilities 1 Discuss the benefits and side effects of treatment with the patient.2 Check for possible drug interactions with azathioprine and patients regular medication. Avoid prescribing interacting drugs.3 Assess likelihood of compliance.4 Ensure patient is given sufficient information about their treatment.5 Perform all baseline tests (including TPMT, FBC, U&Es and LFTs).6 Initiate and stabilise treatment with azathioprine. Stabilisation will usually take 7 weeks.7 Supply medication until care is transferred to GP.8 Ask the GP whether he or she is willing to participate in shared care and explain the intention to share care with patient/carer and obtain consent.9 Monitor appropriately as stated on the monitoring requirement.10 Inform GP of the dose to be prescribed, any changes in dose, when to stop treatment and when to refer the patient back to specialist clinician.11 Ensure GP has access to blood results for information.12 Monitor for side effects and
