Transfer of prescribing responsibility to GP

There must be effective channels of communication between HPFT and GPs to ensure safe and effective management of service users. GPs must be provided with sufficient information on prescribed medication, including rationale for choice of medicines. This is particularly important when transferring prescribing responsibility of specialist medicines, off label use of medicines or unlicensed medicines from HPFT to primary care.

Due to the specialist nature of some medicines it may be appropriate to support the safe prescribing and management of patients in primary care through shared care arrangements. Medicines which have approved shared care protocols are indicated in the formulary and a link provided to the relevant protocol on the HPFT website.

There are circumstances when it would not be appropriate for GPs to take over the prescribing of medicines that have been initiated by HPFT clinicians during an in-patient stay, or attendance at an out-patient or community clinic. These circumstances include:-

• Where there is an agreement with the local commissioners for prescribing and supply of medication to remain with HPFT e.g. clozapine and agomelatine.

• Where the treatment requires continued monitoring before stabilisation or pending a shared care arrangement.

• Drugs intended for treatment of patients admitted as inpatients and included in the commissioned services or for treatment intended to be administered in community clinics /outpatients.

• Where approval of a drug on a named patient basis stipulates that prescribing must remain with HPFT.

• When a drug has been approved on a named patient basis the patients GP should be informed that a non-formulary drug has been approved. It will be an individual GP decision as to whether they agree to take over prescribing responsibility. To support GPs, relevant clinical and prescribing information should be provided, as well as the opportunity for the GP to ask questions.

HPFT is expected to provide a prescription for a minimum of 14 days for

• discharge medication,

• all newly initiated medicines or

• medicines where a dose has been changed

A prescription for less than 14 days will be provided when it is clinically appropriate.

When a service user is discharged from an in-patient unit, the discharge notification should be with the GP within 48 hours. The discharge notification must contain a list of all medications that the service user is currently taking as well as details of any medication changes made whilst in hospital including explanations for stopping or initiating new drugs.

Any changes in medication that have been made following community or out-patient clinic attendance must be communicated to the GP within 7 days. This communication should include details of any changes made to drug treatment including the rationale for initiating or stopping medication, as well as for dose increases or reductions.