ࡱ> ')"#$%& @ ەbjbjFF /,,A  rrr8. ^`{{{_______$bRfdx` Y"{` S` 8 __M:  B QrN=`C.`0^`5>ddB d B {o/{{{`` r r Local Enhanced Service for Shared Prescribing Service Outline for April 2006-March 2007 Local Enhanced Service for Shared Prescribing Service Outline for April 2006 March 2007 1 Shared Prescribing The treatment of several diseases within the fields of medicine, particularly in rheumatology, is increasingly reliant on drugs that, while clinically effective, need regular blood monitoring. This is due to the potentially serious side-effects that these drugs can occasionally cause. It has been shown that the incidence of side-effects can be reduced significantly if this monitoring is carried out in a well-organised way, close to the patient's home. The nGMS contract therefore contains a provision for an enhanced service entitled near-patient testing (NPT). Such drugs represent a small proportion of those where treatment is initiated by experts in secondary care, but where for various reasons, ongoing monitoring and treatment is provided in primary care. Such reasons include patient convenience, willingness of GP to accept clinical responsibility for ongoing care, reduction of workload in secondary care and transfer of costs (both prescribing costs and associated costs), as well as better risk management. A number of shared prescribing guidelines have already been developed for such drugs. Several more shared care guidelines are in development for other clinical areas. For 2004-2006, it was agreed by the PCT Primary Care Commissioning Group (formerly the Enhanced Services Steering Group) that in order to facilitate the introduction of shared care guidelines practices would be encouraged to participate in a shared prescribing local enhanced service (LES). The aim of the LES is to prevent patients, for whom shared prescribing arrangements are requested by secondary care for a pre-arranged range of drugs, being referred back to secondary care for financial reasons (rather than risk management or clinical responsibility reasons). It is proposed that practices will be reimbursed a fixed amount according to practice list size, for shared prescribing arrangements for up to 20 drugs, some of which have already been identified (see Para 3). This Service Level Agreement (SLA) replaces the SLA for April 2004 March 2006. 2 Service Outline The service will operate in accordance with the Principles of Shared Care (see Appendix 1). Up to 20 drugs may be included in the service (see Para 3 for those already identified). Less than 20 will be included in 2006/07. This will be treated as a windfall to practices. If more than 20 are included in 2006/07 (see Para 10 for an explanation of future development of the service) then the funding will be re-evaluated. The principles of shared care are: 2.1 Best interest of the Patient The best interests of the patient should be at the centre of any shared care agreement. Arrangements should never be detrimental or inconvenient for the patient. 2.2 Individual, patient by patient arrangements Shared care prescribing guidelines should be accompanied by individual patient information, outlining all relevant aspects of that patients care. 2.3 Reasonably predictable clinical situation Transfer of clinical responsibility to primary care should only be considered where a patients clinical condition is stable or predictable. 2.4 Willing & informed consent of all parties, including patients and carers All parties must have sufficient, accurate, timely information in an understandable form. Consent must be given voluntarily. 2.5 Clear definition of responsibility The areas of care for which each partner has responsibility should be clearly defined and should be patient specific. The guideline should include details of any specialist resources that may be available. 2.6 Communication network & emergency support A telephone contact point, fax number and email address (if appropriate) should be detailed so that the GP can access advice and information if problems arise. This should include out-of-hours contact numbers e.g. how to access the on-call Duty Doctor. 2.7 Clinical information This should include a brief overview of the disease and more detailed information on the treatment(s) being transferred including (as a minimum): Summary of NICE or other guidance, where applicable (and a web link to access the full guidance) Licensed indications & therapeutic class Dose, route of administration and duration of treatment Adverse effects (incidence, identification, importance and management) Monitoring requirements and responsibilities Clinically important drug interactions and their management Peer reviewed references for product usage 2.8 Contacts for more detailed information The guideline should state how often the patient will be reviewed; and provide a route of return should the patients condition become less predictable (return of symptoms, development of adverse effects). Progress reports should be produced to an agreed timescale. 3 Register of Shared Prescribing Guidelines (SPG) for 2006-07 Shared prescribing guidelines have already been developed and circulated for the following drugs: 3.1 Methylphenidate in ADHD 3.2 Acetylcholinesterase inhibitors (donepezil, rivastigmine & galantamine) for Alzheimers Disease Disodium clodronate for management of bone metastases Erythropoietin & darbepoietin for renal patients with anaemia Calcium acetate for correction of hyperphosphataemia associated with chronic renal failure Methotrexate (update due in 2006/07) Growth hormone in children with growth failure Triptorelin for precocious puberty Shared prescribing guidelines in development: 3.9 Tacrolimus / sirolimus for prophylaxis of organ rejection in kidney allograft patients Mycophenolate for prophylaxis of acute rejection in renal transplant patients Bicalutamide for prostate cancer Leflunomide Letrozole For those shared prescribing guidelines not yet developed the PCT expects practices to adhere to the service outline as agreed in the NES for near-patient testing for the following drugs (already been circulated to practices): Penicillamine Auranofin Sulphasalazine Sodium Aurothiomalate 4 Referrals Each shared prescribing guideline is (or will be) specific concerning responsibilities and reasons for route of return-consult for details e.g. instability, non-compliance. For shared prescribing guidelines not yet developed (see 3) agreement will be sought by the PCT from consultants in secondary care concerning their responsibilities and reasons for route of return. Specifically this relates to access to results e.g. blood, pathology, X-rays, scans. The PCT will provide secondary care consultants with a list of GPs who have agreed to participate in the LES so that all results can be copied to GPs. Practices should report non-compliance with this requirement to the relevant Associate Director for Commissioning at the PCT. Persistent non-compliance by secondary care clinicians may necessitate re-referral of patients for prescribing purposes i.e. this represents a route of return from GP to secondary care. Should this become necessary, practices should ensure this is documented in the quarterly reports to the PCT Chief Pharmacist (see 11). There should be a reciprocal arrangement where tests are requested by the practice (to enable hospital clinicians to access results). It is always the responsibility of secondary care to make decisions on dosage changes. 5 Accreditation, Competency & Training Those doctors who have previously provided services similar to the proposed enhanced service and who satisfy at appraisal and revalidation that they have such continuing medical experience, training and competence as is necessary to enable them to contract for the enhanced service shall be deemed professionally qualified to do so. The specialist department seeking the shared care arrangement (i.e. secondary care consultant) should provide any specific training, which may be needed by the GPs e.g. managing the disease, administration of the drug etc. Information on how to access this should be provided in the shared care prescribing guideline. GPs who do not have the confidence or knowledge to prescribe will be expected to attend such training. It is not expected that GPs will decline to prescribe on the basis of inadequate knowledge, in view of the above. 6 Patient records 6.1 A register. Practices should be able to produce and maintain an up-to-date register of all shared care drug monitoring service patients, indicating patient name, date of birth and the indication and duration of treatment and last hospital appointment. Shared drug monitoring should be indicated-* by the use of the following standard READ codes, which have been agreed by the NHSIA. Use of these codes should be restricted to the drugs outlined in this LES, to facilitate searching and reporting to the PCT. Shared prescribing declined8BM6Shared prescribing referred back to secondary care8BM7 6.2 Call and recall. To ensure that systematic call and recall of patients on this register is taking place either in a hospital or general practice setting 6.3 Education and newly diagnosed patients. To ensure that all newly diagnosed / treated patients (and / or their carers when appropriate) receive appropriate education and advice on management of and prevention of secondary complications of their condition. This should include written information where appropriate 6.4 Continuing information for patients. To ensure that all patients (and/or their carers and support staff when appropriate) are informed of how to access appropriate and relevant information 6.5 Individual management plan. To ensure that the patient has an individual management plan, which gives the reason for treatment, the planned duration, the monitoring timetable, the therapeutic range to be obtained, if appropriate and the names of the designated responsible clinicians. For those drugs for which SWL shared prescribing documentation exists, the box on the front page should be completed and scanned into the patient record (or alternative retrievable electronic records may be kept). 6.6 Professional links. To work together with other professionals when appropriate. Any health professionals involved in the care of patients in the programme should be appropriately trained 6.7 Referral policies. Where appropriate to refer patients promptly to other necessary services and to the relevant support agencies using locally agreed guidelines where these exist 6.8 Record keeping. To maintain adequate records of the service provided, incorporating all known information relating to any significant events e.g. hospital admissions, death of which the practice has been notified, route of return & reasons 6.9 Training. Each practice must ensure that all staff involved in providing any aspect of care under this scheme have the necessary training and skills to do so 6.10 Annual review. All practices involved in the scheme should perform an annual review which must include brief details as to arrangements for each of the aspects highlighted in the LES i.e. points 6.1 to 6.9 above to include the following information where appropriate: (a) details as to any computer-assisted decision-making equipment used and arrangements for internal and external quality assurance (b) details as to any near-patient testing equipment used and arrangements for internal and external quality assurance (c) details of training and education relevant to the drug monitoring service (d) details of the standards used for the control of the relevant condition (e) assurance that any staff member responsible for prescribing must have developed the necessary skills to prescribe safely. 7 Review Shared care prescribing guidelines will be reviewed by acute Trust and host PCT (varies) every 3 years or sooner if indicated. Revised guidelines will be disseminated to practices. 8 Feedback The PCT will develop a questionnaire to ask patients about satisfaction with the service they have received (compared with the previous service). This will be used to inform future development of the service. 9 Funding Total budget 2006/0750,000Payment per practiceAccording to list size-see Appendix 2Practice payment 2006/07Quarterly in arrears on submission of data (see para 11) 10 Future development of the service At the end of each year of operation of the service, it will be reviewed by the PCT Enhanced Services Steering (Primary Care Commissioning) Group in the light of secondary to primary care shift in activity any changes in legislation ICRS changes Patient feedback Practice feedback 11 Monitoring & Evaluation Each practice must run three-monthly searches on READ codes (see 6.1) and drug searches to identify patients as follows: Numbers of patients for whom the practice is prescribing under shared care arrangements Number of patients for whom shared prescribing has been declined Number of patients referred back (see 2.8 Route of Return) Numbers of patients on each drug for whom the practice is prescribing under shared care arrangements Number of patients on each drug for whom shared prescribing has been declined Number of patients on each drug referred back (see 2.8 Route of Return) and provide this information to the PCT Prescribing Support Officer by dates listed below using the Shared Care Monitoring Proforma (Draft copies of these are included in this SLA. Final copies of these will be sent out in year). Form and Data required by PCTDeadline dateShare Prescribing Monitoring Pro forma 2006/07 Q130th June 2006Share Prescribing Monitoring Pro forma 2006/07 Q229th September 2006Share Prescribing Monitoring Pro forma 2006/07 Q329th December 2006Share Prescribing Monitoring Pro forma 2006/07 Q416th March 2007 Practices will also need to provide evidence and narrative on reasons for declining to prescribe (e.g. IPI forms for KHT & WMUH patients or anonymised copy letters for other patients). Additional monitoring: Decrease in outpatient activity possibly leading to disinvestment from secondary care (to be monitored by PCT) 12 Risk Management 12.1 Untoward events It is a condition of participation that practitioners will give notification, in addition to their statutory obligations, within 72 hours of the information becoming known to him/her, to the PCT clinical governance lead of all emergency admissions or deaths of any patient covered under this service, where such admission or death is or may be due to usage of the drug(s) in question or attributable to the relevant underlying medical condition. To be addressed by monitoring arrangements: Refusal by GPs/practices to participate-GP freedom to prescribe, clinical responsibility issues as outlined in EL 91(127) which will be monitored by use of the relevant READ code (see 6.1) Adherence to shared prescribing guideline, which will be monitored by use of the relevant READ code (see 6.1) Route of return for patients & management of this, which will be monitored by use of the relevant READ code (see 6.1) Lead-in time for paperwork development (often dependent on other PCTs) (primary care prescribing budget)-allowable appeal against LPIS if overspend incurred (evidence from LES data monitoring will be used to test any appeals) (secondary care-additional activity) 13 Length of contract Practices undertaking this LES will be required to sign the attached SLA which states that if the practice fails to meet the above service outline then 3 months notice will be given by the Commissioner (PCT). The same period of notice 3 months will be required to be given by the practice if they no longer wish to provide this service to the Commissioner. The contract will run from April 2006-Mar 2007. Brenda So On behalf of the PCT Primary Care Commissioning group, April 2006 SERVICE LEVEL AGREEMENT This service level agreement is between: Commissioner: Richmond and Twickenham Primary Care Trust Provider: (name of practice) Both parties agree to the content of this service level agreement and are bound by its terms for the specified period: Provider: 1st April 2006 to 31st March 2007 Practice Name: Authorised Signatory (Senior Partner): Signature: Date:. Commissioner: Richmond and Twickenham Primary Care Trust Authorised Signatory (Name): Signature: Date.. Please sign and return to Caroline Allanson by 7th April 2006 Fax 020 8973 3134 Shared Prescribing Monitoring Pro forma (draft) 2006/07 Q1 Please answer the following questions for each drug in the table below: How many patients do you provide Shared Care Prescribing service to Quarter 1 2006/2007? Total No of Pts on Register: .. How many patients do you have for each drug for whom the practice is prescribing under shared care arrangements (Search on each drug ) for Quarter 1 2006/07. How many patients do you have for each drug for whom shared prescribing has been declined (READ Code: 8BM6 and drug ) for Quarter 1 2006/07. How many patients do you have for each drug who have been referred back, having previously undertaken shared prescribing (see 2.8 Route of Return) for Quarter 1 2006/07 (READ code 8BM7and drug) How many patients do you have for each drug who have stopped treatment during Quarter 1 2006/07 (READ code: 9kD and drug) Quarter 1 (Apr-Jun) 2006/07Prescribing- see 2 aboveprescribing declined- see 3 aboveprescribing referred back- see 4 aboveprescribing stopped- see 5 aboveDrugREAD Code for drug READ Code 8BM6 and for drugREAD Code 8BM7 and for drug READ Code 9kD and for drug MethylphenidateAcetylcholinesterase inhibitors (donepezil, rivastigmine & galantamine)Disodium clodronateGrowth hormone in children (not adults)TacrolimusSirolimusErythropoietin & darbepoietinMycophenolateBicalutamideCalcium acetateMethotrexatePenicillamineAuranofinSulphasalazineSodium Aurothiomalate.TriptorelinLeflunomideLetrozoleTotal Name:Signature:.. Senior Partner Name:Signature:.. Practice Manager Date: . *see over Please return by 30th June 2006 to:Caroline Allanson, Prescribing Support OfficerTel: 020 8973 3141E mail: caroline.allanson@rtpct.nhs.ukFax: 020 8973 3134 Prescribing declined Please describe reasons for declining to prescribe and number of patients declined for this reason (please also attach anonymised copy letters or other evidence e.g. IPI form): Quarter 1 (Apr-Jun 2006/07)DrugNumber of patients declined Reason (please state)     Shared Prescribing Monitoring Pro forma (draft) 2006/07 Q2 Please answer the following questions for each drug in the table below: How many patients do you provide Shared Care Prescribing service to Quarter 2 2006/2007? Total No of Pts on Register: .. How many patients do you have for each drug for whom the practice is prescribing under shared care arrangements (Search on each drug) for Quarter 2 2006/07. How many patients do you have for each drug for whom shared prescribing has been declined (READ Code: 8BM6 and drug ) for Quarter 2 2006/07. How many patients do you have for each drug who have been referred back, having previously undertaken shared prescribing (see 2.8 Route of Return) for Quarter 2 2006/07 (READ code 8BM7and drug) How many patients do you have for each drug who have stopped treatment during Quarter 2 2006/07 (READ code: 9kD and drug) Quarter 2 (Jul - Sep) 2006/07Prescribing- see 2 aboveprescribing declined- see 3 aboveprescribing referred back- see 4 aboveprescribing stopped- see 5 aboveDrugREAD Code for drugREAD Code 8BM6 and for drugREAD Code 8BM7 and for drug READ Code 9kD and for drug MethylphenidateAcetylcholinesterase inhibitors (donepezil, rivastigmine & galantamine)Disodium clodronateGrowth hormone in children (not adults)TacrolimusSirolimusErythropoietin & darbepoietinMycophenolateBicalutamideCalcium acetateMethotrexatePenicillamineAuranofinSulphasalazineSodium Aurothiomalate.TriptorelinLeflunomideLetrozoleTotalName:Signature:.. Senior Partner Name:Signature:.. Practice Manager Date: . *see over Please return by 29th September 2006 to:Caroline Allanson, Prescribing Support OfficerTel: 020 8973 3141E mail: caroline.allanson@rtpct.nhs.ukFax: 020 8973 3134 Prescribing declined Please describe reasons for declining to prescribe and number of patients declined for this reason (please also attach anonymised copy letters or other evidence e.g. IPI form): Quarter 2 (Jul Sep 2006/07)DrugNumber of patients declined Reason (please state)     Shared Prescribing Monitoring Pro forma (draft) 2006/07 Q3 Please answer the following questions for each drug in the table below: How many patients do you provide Shared Care Prescribing service to Quarter 3 2006/2007? Total No of Pts on Register: .. How many patients do you have for each drug for whom the practice is prescribing under shared care arrangements (Search on each drug) for Quarter 3 2006/07. How many patients do you have for each drug for whom shared prescribing has been declined (READ Code: 8BM6 and drug ) for Quarter 3 2006/07. How many patients do you have for each drug who have been referred back, having previously undertaken shared prescribing (see 2.8 Route of Return) for Quarter 3 2006/07 (READ code 8BM7and drug) How many patients do you have for each drug who have stopped treatment during Quarter 3 2006/07 (READ code: 9kD and drug) Quarter 3 (Oct - Dec) 2006/07Prescribing- see 2 aboveprescribing declined- see 3 aboveprescribing referred back- see 4 aboveprescribing stopped- see 5 aboveDrugREAD Code for drugREAD Code 8BM6 and for drugREAD Code 8BM7 and for drug READ Code 9kD and for drug MethylphenidateAcetylcholinesterase inhibitors (donepezil, rivastigmine & galantamine)Disodium clodronateGrowth hormone in children (not adults)TacrolimusSirolimusErythropoietin & darbepoietinMycophenolateBicalutamideCalcium acetateMethotrexatePenicillamineAuranofinSulphasalazineSodium Aurothiomalate.TriptorelinLeflunomideLetrozoleTotalName:Signature:.. Senior Partner Name:Signature:.. Practice Manager Date: . *see over Please return by 29th December 2006 to:Caroline Allanson, Prescribing Support OfficerTel: 020 8973 3141E mail: caroline.allanson@rtpct.nhs.ukFax: 020 8973 3134 Prescribing declined Please describe reasons for declining to prescribe and number of patients declined for this reason (please also attach anonymised copy letters or other evidence e.g. IPI form): Quarter 3 (Oct - Dec 2006/07)DrugNumber of patients declined Reason (please state)     Shared Prescribing Monitoring Pro forma (draft) 2006/07 Q4 Please answer the following questions for each drug in the table below: How many patients do you provide Shared Care Prescribing service to Quarter 4 006/2007? Total No of Pts on Register: .. How many patients do you have for each drug for whom the practice is prescribing under shared care arrangements (Search on each drug ) for Quarter 4 2006/07. How many patients do you have for each drug for whom shared prescribing has been declined (READ Code: 8BM6 and drug ) for Quarter 4 2006/07. How many patients do you have for each drug who have been referred back, having previously undertaken shared prescribing (see 2.8 Route of Return) for Quarter 4 2006/07 (READ code 8BM7and drug) How many patients do you have for each drug who have stopped treatment during Quarter 4 2006/07 (READ code: 9kD and drug) Quarter 4 (Jan - Mar) 2006/07Prescribing- see 2 aboveprescribing declined- see 3 aboveprescribing referred back- see 4 aboveprescribing stopped- see 5 aboveDrugREAD Code for drugREAD Code 8BM6 and for drugREAD Code 8BM7 and for drug READ Code 9kD and for drug MethylphenidateAcetylcholinesterase inhibitors (donepezil, rivastigmine & galantamine)Disodium clodronateGrowth hormone in children (not adults)TacrolimusSirolimusErythropoietin & darbepoietinMycophenolateBicalutamideCalcium acetateMethotrexatePenicillamineAuranofinSulphasalazineSodium Aurothiomalate.TriptorelinLeflunomideLetrozoleTotalName:Signature:.. Senior Partner Name:Signature:.. Practice Manager Date: . *see over Please return by 16th March 2007 to:Caroline Allanson, Prescribing Support OfficerTel: 020 8973 3141E mail: caroline.allanson@rtpct.nhs.ukFax: 020 8973 3134 Prescribing declined Please describe reasons for declining to prescribe and number of patients declined for this reason (please also attach anonymised copy letters or other evidence e.g. IPI form): Quarter 4 ( Jan - Mar 2006/07)DrugNumber of patients declined Reason (please state)     Appendix 1 Principles of Shared Care  1. Introduction The purpose of these guidelines is to provide a framework for the seamless transfer of care from the hospital to general practice, where this is appropriate and in the best interests of the patient. Where possible, shared care will be disease specific rather than drug specific and will link into and complement local integrated care pathways. Application of the following principles will facilitate effective shared care. However, it should be remembered that the provision of shared care prescribing guidelines does not necessarily mean the GP has to agree to and accept clinical and legal responsibility for prescribing; he or she should only do so if they feel confident in managing that condition. 2. Principles of Shared Care Best interest of the Patient The best interests of the patient should be at the centre of any shared care agreement. Arrangements should never be detrimental or inconvenient for the patient. Individual, patient by patient arrangements Shared care prescribing guidelines should be accompanied by individual patient information, outlining all relevant aspects of that patients care. Reasonably predictable clinical situation Transfer of clinical responsibility to primary care should only be considered where a patients clinical condition is stable or predictable. Willing & informed consent of all parties, including patients and carers All parties must have sufficient, accurate, timely information in an understandable form. Consent must be given voluntarily. Consultants and general practitioners are encouraged to communicate directly where questions arise around shared care for a particular patient. If issues remain, after these discussions, the Chief / Senior Pharmacist at the PCT or Hospital Trust should be contacted for advice. Clear definition of responsibility The areas of care for which each partner has responsibility should be clearly defined and should be patient specific. The guideline should include details of any specialist resources that may be available. Communication network & emergency support A telephone contact point, fax number and email address (if appropriate) should be detailed so that the GP can access advice and information if problems arise. This should include out-of-hours contact numbers e.g. how to access the on-call Duty Doctor. The guideline should state how often the patient will be reviewed; and provide a route of return should the patients condition become less predictable (return of symptoms, development of adverse effects). Progress reports should be produced to an agreed timescale.  Clinical information This should include a brief overview of the disease and more detailed information on the treatment(s) being transferred including (as a minimum): Summary of NICE or other guidance, where applicable (and a web link to access the full guidance) Licensed indications & therapeutic class Dose, route of administration and duration of treatment Adverse effects (incidence, identification, importance and management) Monitoring requirements and responsibilities Clinically important drug interactions and their management Peer reviewed references for product usage Contacts for more detailed information Training The specialist department seeking the shared care arrangement should provide any specific training, which may be needed by the GPs e.g. managing the disease, administration of the drug etc. Information on how to access this should be provided in the shared care prescribing guideline. Review Shared care prescribing guidelines will be reviewed every 3 years or sooner if indicated. 3. Circumstances where shared care is not appropriate Hospitals would normally retain responsibility for prescribing in the following instances: Where patients receive the majority of on-going care, including monitoring, in hospital and the only benefit to transferring care would be to hospital costs Where the drug is only available through hospitalsThe drug is included on the Commissioners list of products not suitable for shared careWhere a drug requires specialist intervention, stabilisation and monitoring; however, following stabilisation it may be possible to transfer careDrugs are unlicensed, or are being used for an unlicensed indication or at an unlicensed dose and the GP does not feel confident to take on clinical responsibilityWhere drugs are being used as part of a hospital-initiated clinical trialThe GP feels that he/she does not have sufficient knowledge to accept clinical responsibility The indication for prescribing is contrary to NICE guidance and the use of the drug has not been approved on an exceptional basis New drugs, until they have been approved for addition to the formulary and agreed as suitable for shared care by the Drug and Therapeutics Committee (see also under 6)  4. Checklist for GPs when considering sharing care GPs should only agree to prescribe if, after reading the shared care prescribing guideline, they can answer YES to the following questions: Is the patients condition predictable or stable? Do you have the relevant knowledge, skills and access to equipment to allow you to monitor treatment as indicated in this shared care prescribing guideline? Have you been provided with relevant clinical details including monitoring data? If the answer is NO to any of these questions, the GP should not accept prescribing responsibility and should write to the consultant within 14 days, outlining the reasons for NOT prescribing. If the GP does not have the confidence to prescribe, this should be discussed with the local Trust/specialist service, who will be willing to provide training and support. If the GP still lacks the confidence to accept clinical responsibility, they still have the right to decline. PCT pharmacists will assist GPs in making decisions about shared care. 5. Involving the Patient The consultant should only obtain the consent of the patient (and his/her carers if appropriate) after the GP has agreed in principle to sharing care. Patients should never be used as a conduit for informing the GP that prescribing is to be transferred. Nor should they ever be placed in a position where they are unable to obtain the medicines they need because of lack of communication between primary and secondary/ tertiary care. 6. Process for approval of shared care arrangements When an Acute / Mental Health Trust* or other specialist centre seeks to establish shared care arrangements with primary care, the suitability of a shared care prescribing arrangement should be assessed at the local Acute / Primary Care Trust Drug and Therapeutics Committee, Mental Health Prescribing Interface Forum (MHPIF) or equivalent committee. In case of doubt, the local host (or lead) Primary Care Trust may consult neighbouring PCTs or discuss the suggestion for shared care arrangements at the South West London (SWL) Prescribing Committee. Once it has been agreed that shared care would be appropriate, the Acute / Mental Health* Trust or other specialist centre is responsible for producing the shared care prescribing guideline using the attached template while consulting with their pharmacy department, colleague clinicians that are affected by the guideline and the Primary Care Trust Chief / Senior Pharmacist and nominated healthcare professional (usually a GP). Once all above parties are in agreement the host (or lead) PCT will subsequently circulate the shared care prescribing guideline to the administrator of the SWL Prescribing Committee for onward distribution to PCTs in South West London or the Mental Health Prescribing Interface forum for comments (deadline 1 month). In case of disagreement or controversy resolution should be sought at the SWL Prescribing Committee meeting. The shared care prescribing guideline should subsequently be approved and signed by the local Acute / Primary Care Trust Drug and Therapeutics Committee, Mental Health Prescribing Interface Forum (MHPIF) or equivalent committee and the final version should be sent to the administrator of SWL Prescribing Committee for onward distribution to all relevant PCTs. Any Trust seeking shared care arrangements for the same intervention can adapt the agreed shared care prescribing guideline for local use and agree this with the host (or lead) PCT. Each shared care prescribing guideline should be reviewed every 3 years or sooner if indicated. * Please note that shared care prescribing guidelines produced by South West London and St. Georges (SWLSG) Mental Health Trust through the Mental Health Prescribing Interface Forum will only apply to Richmond and Twickenham, Kingston, Wandsworth and Sutton & Merton PCTs. Richmond and Twickenham PCT is the lead commissioner PCT for the SWLSG Mental Health Trust. Agreement of shared care between consultant and GP Prescribing responsibility will only be transferred when the consultant and the GP are in agreement that the patients condition is stable or predictable. The patient will only be referred to the GP once the GP has agreed in each individual case and the hospital will continue to provide prescriptions until successful transfer of responsibilities as outlined below. The signature section on the front cover of each shared care prescribing guideline, can be used to confirm that shared care has been agreed between both parties. It is suggested that the consultant will send a signed agreement to the GP. If agreeable, the GP should confirm the acceptance of the shared care prescribing arrangement by signing and returning a copy of the front cover to the consultant. The patient should subsequently be informed to obtain further supplies from the GP. APPENDIX 2Practice CodeJan 06 Astro PUAnnual PaymentH84002500053,212H84005256581,648H84006333582,143H84007298331,916H84012434262,789H8401415188976H84017550353,535H84018215871,387H84023309101,985H84031190641,225H84032313472,0148403615467993H84039402462,585H84040567773,647H84041172871,110H84043207641,334H84044273781,759H84048224551,442H84055363222,333H840576577422H8405914369923H84060205091,317H846089297597H8461513195848H84623240691,546H84625188801,213H846308166524H84632168001,079H8463310849697H846395590359Y01206380132,442 Final Enhanced Services Richmond & Twickenham PCT 2006-07 j5`^- 8%9%`%&(((())**5+6+I++++-7---//00>1P122>2225577ǻջջջǻǻǻǎǂǂǎǠǠǠǠǠǠǠDZhOJQJ^JaJ#hB*CJOJQJ^JaJph h5CJOJQJ\^JaJhOJQJ^JhCJOJQJ^JhCJOJQJ^JaJh5CJOJQJ\^Jh5CJ$OJQJ\^Jh5OJQJ\^J3     >?i $a$ؕڕEsM"Z  9r $a$$a$ 5`op,^_ & F%  & F$ 9r 0^`0$a$ 9r  - . : Z$$8%9%`%&S(((()****$If$a$ & F%**/+4+$Ifnkd$$Ifl0 8 064 la4+5+6+556666777777 $$Ifa$$a$nkd$$Ifl0 8 064 la7777 $$Ifa$nkd*$$Ifl09 064 la778M8 $$Ifa$nkd$$Ifl09 064 laM8N8O8P8u89D9_9l9}9999%:}:{ & F$ & Fa$$a$nkd8$$Ifl09 064 la7O8P899<< =?=A=====>>>>>>^?_?s??GAD D6DEEFFꞍpaTh6OJQJ]^Jh6CJOJQJ]^Jh6CJOJQJ]^JhCJOJQJ^JaJ h5CJOJQJ\^JaJh5CJOJQJ\^JhCJOJQJ^JhCJH*OJQJ^J"h56CJOJQJ\]^J"h56CJOJQJ\]^JhOJQJ^JhCJOJQJ^J}:::^;;;<<< = ===L={rr $$Ifa$nkd$$Ifl0m#w 064 la $$Ifa$$a$$ & Fa$ L=M=== $$Ifa$nkdT$$Ifl0m#w 064 la==== $$Ifa$nkd$$Ifl0m#w 064 la== >> $$Ifa$nkd~$$Ifl0m#w 064 la>>>>>>^?_?s?FAGAsA0BB{{{vv & F$a$$ & Fa$$a$nkd$$Ifl0m#w 064 la BC[CCD D6DEEEFF3F4F]F^FFFFFF4G5G?G@GAGdG$If$a$$a$ & FFFF3F^FkFFF5G?G@GBGDGVGXGdGeGGGGGG:HP?PfPyPZGkd$$Ifl0 . 64 la $$Ifa$Gkd`$$Ifl0 . 64 la $$Ifa$$a$ OOOOO*P+P=P?PePfPxPzPPPCQDQQQQQ@RAR$$Iflr$ 0&64 laPl`m`z`{`|`}`~`UOFFFF $$Ifa$$Ifkd?$$Iflr$ 0&64 laP~```````UOFFFF $$Ifa$$Ifkdk@$$Iflr$ 0&64 laP```````UOFFFF $$Ifa$$IfkdBA$$Iflr$ 0&64 laP```````UOFFFF $$Ifa$$IfkdB$$Iflr$ 0&64 laP```````UOFFFF $$Ifa$$IfkdB$$Iflr$ 0&64 laP```````UOFFFF $$Ifa$$IfkdC$$Iflr$ 0&64 laP```````UOFFFF $$Ifa$$IfkdD$$Iflr$ 0&64 laP`````aa aGaHaaaaaaaaaaaabbbbc[cqc$If^kd I$$Ifl4  064 lalf4qcrcsctcucvcwcxcyc~uuuuuuu $$Ifa$kdI$$IflFx f06    4 lalyczc{c|c}c~cccc~uuuuuuu $$Ifa$kdZJ$$IflFx f06    4 lalccccccccc~uuuuuuu $$Ifa$kd K$$IflFx f06    4 lalccccccccc~uuuuuuu $$Ifa$kdK$$IflFx f06    4 lalccccccddAeef~|sqqkf^^^$ & F-a$ & F-^$^a$kdjL$$IflFx f06    4 lal fgg0g1g2gKgbgnggggyssssss$If $$Ifa$ckdM$$Ifl4$&0&64 laPf4 $$Ifa$$^a$$ & F-a$ gg0g2ggg2h3hBhChHhhhhhhhhhhhhhhhhhiii+i0i=iBiRiWicidiiiviwi|iiiiiiiiiiiiiiii1j׾ͰͰͰͰͰͰ h5CJOJQJ\^JaJ h5\hCJOJQJ^JaJh5CJOJQJ\^Jh hCJhCJOJQJ^Jh5OJQJ\^JhOJQJ^J hCJ9ggggggh2hULFFFFF$If $$Ifa$kdM$$Iflr$ 0&64 laP2h3hChDhEhFhGhUOFFFF $$Ifa$$Ifkd{N$$Iflr$ 0&64 laPGhHhhhhhhUOFFFF $$Ifa$$IfkdRO$$Iflr$ 0&64 laPhhhhhhhUOFFFF $$Ifa$$Ifkd)P$$Iflr$ 0&64 laPhhhhhhhUOFFFF $$Ifa$$IfkdQ$$Iflr$ 0&64 laPhhhhhhhUOFFFF $$Ifa$$IfkdQ$$Iflr$ 0&64 laPhhhhhhhUOFFFF $$Ifa$$IfkdR$$Iflr$ 0&64 laPhhiiiiiUOFFFF $$Ifa$$IfkdS$$Iflr$ 0&64 laPii+i,i-i.i/iUOFFFF $$Ifa$$Ifkd\T$$Iflr$ 0&64 laP/i0i=i>i?i@iAiUOFFFF $$Ifa$$Ifkd3U$$Iflr$ 0&64 laPAiBiRiSiTiUiViUOFFFF $$Ifa$$Ifkd V$$Iflr$ 0&64 laPViWidieifigihiUOFFFF $$Ifa$$IfkdV$$Iflr$ 0&64 laPhiiiwixiyizi{iUOFFFF $$Ifa$$IfkdW$$Iflr$ 0&64 laP{i|iiiiiiUOFFFF $$Ifa$$IfkdX$$Iflr$ 0&64 laPiiiiiiiUOFFFF $$Ifa$$IfkdfY$$Iflr$ 0&64 laPiiiiiiiUOFFFF $$Ifa$$Ifkd=Z$$Iflr$ 0&64 laPiiiiiiiUOFFFF $$Ifa$$Ifkd[$$Iflr$ 0&64 laPiiiiiiiUOFFFF $$Ifa$$Ifkd[$$Iflr$ 0&64 laPiiiiiiiUOFFFF $$Ifa$$Ifkd\$$Iflr$ 0&64 laPiiiiiiiUOFFFF $$Ifa$$Ifkd]$$Iflr$ 0&64 laPii"j1j2j]jnjojjUSSSSSNN$a$kdp^$$Iflr$ 0&64 laP1j2jnjojjjjjjjjjjjjjj#k$k6k8k9kNkOkllZl|l}l~llllllll嶩埶xrrhhCJOJQJ hCJ4jh5CJOJQJU\^JmHnHsH uhCJOJQJ^JhOJQJ^Jh5OJQJ\^Jhh5CJH*OJQJ\^JhCJOJQJ^Jh5CJOJQJ\^Jh5CJOJQJ\^JhCJOJQJ^J$jjjjjjjj$k7kZGkd_$$Ifl0 h 64 la $$Ifa$GkdG_$$Ifl0 h 64 la $$Ifa$$a$ 7k8k9kNkOkll l $$Ifa$$^a$$a$Gkd `$$Ifl0 h 64 la l!l&lClYl$If^kdm`$$Ifl4  064 lalf4YlZl[l\l]l^l_l`lal~uuuuuuu $$Ifa$kd`$$IflFx f06    4 lalalblcldlelflglhlil~uuuuuuu $$Ifa$kda$$IflFx f06    4 laliljlklllmlnlolplql~uuuuuuu $$Ifa$kdWb$$IflFx f06    4 lalqlrlsltlulvlwlxlyl~uuuuuuu $$Ifa$kdc$$IflFx f06    4 lalylzl{l|l}lllll~uuusmdm $$Ifa$$If$^a$kdc$$IflFx f06    4 lalllllmmnnooooo{r $$Ifa$ $ & F$Ifa$$a$  9r ^ 9r $a$[kdgd$$Ifl#~&    064 la lo_p`pp qMqq&rrssttttuuvvvvw[ygyzzzzzz"{|A}C}}5~~gjσ҅Oؖܦh56B*CJ\]ph h^JhCJOJQJ^Jh5CJOJQJ hCJh6CJOJQJ]^Jhh5CJOJQJ\h6CJOJQJ]hCJOJQJ7o^p_p`papp q!q $$Ifa$$If $$Ifa$ $ & F$Ifa$Gkdd$$Ifl0L# !$64 la $$Ifa$!q"q#qMqqqqq&rrUO$IfGkde$$Ifl0L# !$64 la$If $$Ifa$ $ & F$Ifa$Gkd[e$$Ifl0L# !$64 la rrssssstt $$Ifa$ $ & F$Ifa$Gkd)f$$Ifl0L# !$64 la  9r $If $$Ifa$$IfttttuuvvFGkdf$$Ifl0L# !$64 la $$Ifa$$If$If $$Ifa$ $ & F$Ifa$Gkdf$$Ifl0L# !$64 lavvvwww!xYxxx y4y[y\y]y^yGkd^g$$Ifl0L# !$64 la & F 9r $If  9r $If $ & F$Ifa$$a$^ygyzzzzzz $$Ifa$$If $ & F$Ifa$Gkdg$$Ifl0L# !$64 la$If$If $$Ifa$zzzz"{}{~{{||VGkdh$$Ifl0L# !$64 la $$Ifa$ $ & F$Ifa$$a$Gkd,h$$Ifl0L# !$64 la ||R|S|T||||A}[R $$Ifa$Gkdai$$Ifl0L# !$64 laGkdh$$Ifl0L# !$64 la $$Ifa$ $ & F$Ifa$A}B}C}}}}3~[R $$Ifa$Gkd/j$$Ifl0L# !$64 la $$Ifa$ $ & F$Ifa$Gkdi$$Ifl0L# !$64 la3~4~5~~~~[R $$Ifa$Gkdj$$Ifl0L# !$64 la $$Ifa$ $ & F$Ifa$Gkdj$$Ifl0L# !$64 la[VVTTO & F#$a$Gkdk$$Ifl0L# !$64 la $$Ifa$ $ & F$Ifa$Gkddk$$Ifl0L# !$64 la Y΃҅[\njȌߍNO  9r ^ $ 9r a$$a$ 9r ^$a$^$a$ & F#Oޒqskd2l$$If;F'J ''6'#'6    2 22 22 24a$If^  & F 9r  &',-345;ȴl^L8^^'hB*CJOJPJQJ^JaJph#hB*CJOJQJ^JaJphhCJOJQJ^JaJ3h56B*CJOJPJQJ\]^JaJph/h56B*CJOJQJ\]^JaJph*h56CJOJPJQJ\]^JaJ&h56CJOJQJ\]^JaJhhCJOJPJQJ^JaJ$h5CJOJPJQJ\^JaJ h5CJOJQJ\^JaJ$Ifskdm$$IfF'J ''6'#'6    2 22 22 24a '-4y $$Ifa$ $$Ifa$skdm$$IfF'J ''6'#'6    2 22 22 24a45<BIy $$Ifa$ $$Ifa$skdn$$IfF'J '&6#'6    2 22 22 24a;<ABHIJPQVW]^_efklrstz{ēœƓ͓̓ғӓٓړۓ ʼʼʼʼʼʼʼʼʼʼhhCJOJQJ^JaJ'hB*CJOJPJQJ^JaJph#hB*CJOJQJ^JaJphhCJOJPJQJ^JaJHIJQW^y $$Ifa$ $$Ifa$skdo$$IfF'J '&6#'6    2 22 22 24a^_flsy $$Ifa$ $$Ifa$skdp$$IfF'J '&6#'6    2 22 22 24ast{y $$Ifa$ $$Ifa$skdq$$IfF'J '&6#'6    2 22 22 24ay $$Ifa$ $$Ifa$skdr$$IfF'J '&6#'6    2 22 22 24ay $$Ifa$ $$Ifa$skds$$IfF'J '&6#'6    2 22 22 24aœy $$Ifa$ $$Ifa$skdt$$IfF'J '&6#'6    2 22 22 24aœƓ͓ӓړy $$Ifa$ $$Ifa$skdu$$IfF'J '&6#'6    2 22 22 24aړۓy $$Ifa$ $$Ifa$skdv$$IfF'J '&6#'6    2 22 22 24ay $$Ifa$ $$Ifa$skd~w$$IfF'J '&6#'6    2 22 22 24a y $$Ifa$ $$Ifa$skdyx$$IfF'J '&6#'6    2 22 22 24a#$*+,2389?@AGHMNTUV\]bcijkqrwx~