Agenda item

The Leicester City Clinical Commissioning Group to submit a report on Shared Care Agreements.

The Leicester City Clinical Commissioning Group submitted a report on Shared Care Agreements.  Dr Danahar, GP Lead for Prescribing and Lesley Gant, Head of Medicines Optimization attended the meeting to present the report and respond to members’ questions.

It was noted that:-

a)         Shared Care Agreements (SCAs) aimed to facilitate the seamless transfer of an individual patient from secondary care to general practice to allow patients with complex conditions and drugs treatment regimes to be cared for closer to home.  The full range of medical conditions where SCAs could be used were outlined in the report.

b)         The process and monitoring requirements surrounding SCAs were robust and provided safeguards for the patient.  An SCA was an agreement and, if the patient’s GP agreed to take on the care in the agreement, the shared care arrangements would start and monitoring would take place between the GP and the secondary care commissioners via e-mail.  Not all GP practices accepted SCA’s and where this was refused by the GP, the patient’s care continued to be provided by the secondary care sector.  In these instances the CCG worked with the GP to provide support aimed at enabling the GP to work towards accepting SCA’s in the future.  From October to December 2016 103 SCA’s had been refused by GPs in the LLR area.  The refusal in the City was approximately a third of the total refusals and this equated, on average, to less that I per practice per quarter.  More than half of the refusals by GPs were of a temporary nature until further support or training could be provided. It was thought that the total number of refusals not accepted altogether was in the region of 40 for the quarter.

In response to Members’ questions the following responses were received:-

a)         In instances where the SCA was refused by the GP, the secondary care commissioner would try to resolve the issues.  The responsibility for the patient’s care would remain with the specialist practitioner in the secondary care sector.  Very few SCA’s involved patients who were already in hospital, so this did not impact directly upon patients’ length of stay in hospital.  A number of SCA’s involved patients with rheumatoid conditions and GP’s would monitor any side effects the patient may have to the medication they received and would discuss changes to the medication with the specialist practitioner where appropriate.

b)         Should a GP practice close the patient could transfer to another practice, which could then consider taking over the patient’s SCA. If not then the patient’s care would revert to the secondary care specialist.

c)         The secondary care specialist would first discuss the possible use of an SCA with a patient before any referral was made to a GP.  If a patient refused to have treatment in a safe environment then the treatment could be withdrawn.  Equally if the patient did not fully comply with the monitoring arrangements with the GP then this would be flagged on the system and the patient would be called in for testing and monitoring on a quarterly basis.

d)         Approximately 2,500 SCA’s were agreed in a year compared to the 120 overall refusals in a year.

e)         The responsibility for the patient’s care rested solely with the secondary care clinician until a GP took on the responsibility for the patient’s care under the SCA.

Members felt that many patients did not fully understand the process and suggested that it would be helpful if the CCG provided patients with FAQ sheet to explain the pathways involved in the process and to provide contact details in the event that there problems are encountered in the pathway.

The Head of Medicines Optimization stated that the CCG would look into specific cases where patient’s felt there was an issue with SCAs and invited Members to provide details of any known cases after the meeting.

AGREED:

1)         That the report be received and the CCG representatives be thanked for their presentation on the report.

2)         That the CCG consider providing patients with a FAQ sheet to explain the pathways involved in the process and to provide contact details in the event that problems are encountered in the pathway.