To promote a standard approach to Shared Care Protocols (SCPs), on behalf of the national Regional Medicines Optimisation Committees (RMOCs) system, RMOC (North) led the development of Shared Care for Medicines Guidance – A Standard Approach. This guidance defines the principles for a national system of shared care for medicines. The guidance provides a framework for the seamless shared care and decision making between the patient, specialist service and primary care prescriber in relation to medicines use. It builds on the NHS England guidance Responsibility for prescribing between primary and secondary/tertiary care (2018).

This page includes:

• About the Shared Care Protocols
• Developing the Shared Care Protocols
• How they are intended to be used
• List of current Shared Care Protocols

About the Shared Care Protocols

SCPs are clinically focussed and provide the information required to support safe and effective shared care for the specified medicines. They include licensed indications and established off-label uses.  Standardised templates will improve patient safety, reduce duplication and reduce inequity of access. There is no legal obligation nor mandatory requirement to use the SCPs.

Developing the Shared Care Protocols

Development included robust engagement and consultation with wide stakeholder representation and followed the governance processes set out below

Working group

RMOC (North) convened a multidisciplinary SCP working group including commissioning pharmacists, area prescribing committee pharmacists, medicines optimisation GP clinical leads and medical consultants to develop the first 18 SCPs.

Stakeholder engagement

Each draft SCP underwent a national 6-week open consultation with a wide range of comments received from primary and secondary care clinicians, National Clinical Directors and appropriate specialist bodies. Following this open consultation process the comments were reviewed, SCP drafts were updated by the Specialist Pharmacy Service Medicines Information Service, Regional Drug and Therapeutics Centre.

Approval and sign-off process – RMOCs

All SCPs were signed off by the SCP working group and approved by RMOC (North) (January 2022). This was to ensure the content of the SCPs was accurate and clinically correct.

Approval and sign-off process – NHS England

National clearances and approvals that were undertaken for publication on the national NHS England webpage were:

• Clinical review and approval from relevant National Clinical Directors and clinical experts.
• Director level sign off including by the Chief Pharmaceutical Officer.

Commissioning review by the national Primary Care team and engagement and consultation with the British Medical Association (BMA), including its General Practitioners Committee (GPC) and Consultants Committee.

How the Shared Care Protocols are intended to be used

The SCPs have been developed as a national document that can be adopted and adapted where relevant, using local governance processes for use. In most cases the need for changing the document should be minimal. This shared care protocol includes all information required for safe prescribing in strict accordance with current guidance.

Where the nationally published SCPs are adopted locally, organisations are responsible for taking them through their local medicines governance process before use, as for local SCP development and adoption.

Development of the SCP is not an endorsement of the medicine’s use or choice and national guidance and advice should always be followed.

Patients and/or carers should be given appropriate information about the medicine’s efficacy and safety in order to balance the risks and benefits to help them decide on the best treatment for them after a discussion with the patient and prescriber. Where a treatment may be suitable for shared care, the SCP supports those involved in the patient’s care, to prescribe safely in strict accordance with current guidance.

Shared Care Protocols

Along with using these protocols, please ensure that summaries of product characteristics (SPCs), British National Formulary (BNF) or the Medicines and Healthcare products Regulatory Agency (MHRA) or NICE websites are reviewed for up-to-date information on any medicine.

• Amiodarone for patients within adult services (last updated January 2022)
• Atomoxetine for patients within adult services (last updated January 2022)
• Azathioprine and mercaptopurine for patients within adult services (non-transplant indications) (last updated January 2022)
• Ciclosporin (oral) for patients within adult services (non-transplant indications) (last updated January 2022)
• Dexamfetamine for patients within adult services (last updated January 2022)
• Dronedarone for patients in adult services (last updated January 2022)
• Guanfacine for patients within adult services (last updated January 2022)
• Hydroxycarbamide for myeloproliferative disorders and sickle cell disease for patients within adult services (last updated January 2022)
• Hydroxychloroquine for patients within adult services (last updated January 2022)
• Leflunomide for patients within adult services (last updated January 2022)
• Lisdexamfetamine for patients within adult services (last updated January 2022)
• Lithium for patients within adult services (last updated January 2022)
• Methylphenidate for patients within adult services (last updated January 2022)
• Methotrexate (oral and subcutaneous) for patients in adult services (excluding cancer care) (last updated January 2022)
• Mycophenolate mofetil and mycophenolic acid for patients within adult services (last updated January 2022)
• Riluzole for patients within adult services (last updated January 2022)
• Valproate medicines for patients of child-bearing potential (last updated January 2022)
• Sulfasalazine for patients within adult services (last updated January 2022)

Reviewing and updating the shared care protocols

A process for reviewing and updating the shared care protocols is in development.