Medication Requests following Hospital Appointments
Please see the attached document for NHS England procedures following hospital discharge or a hospital appointment:
If medication is required following your outpatient appointment with the consultant, please note the following information:
It is the responsibility of the hospital (and in line with their policy) to give 1 months supply of the medication where the patient:
Should commence immediately
- Requires a new medicine or a change of dose of existing medication within 2 weeks of the hospital appointment.
Any medication which falls within the above categories MUST be collected from the hospital pharmacy. This is to ensure the patient receives their treatment on time and to allow time for the consultant(s) to send a typed report to the practice detailing the outcome of the hospital consultation.
If the consultant requires you to continue the medication after the initial supply has run out he will inform the practice via this report.
To request further supply of the medication you must submit a written request to the surgery stating the name, strength and dose of the medication; plus details of the consultant/hospital clinic who issued the initial prescription.
The practice will supply further prescriptions as long as we have received the appropriate typed report from the hospital consultant.
You must allow 2 working days for your prescription request to be processed.
Medication required on discharge from hospital
If medication is required on discharge from hospital, please note the following information:
It is the responsibility of the hospital and they have agreed to:
Issue a minimum of 14 days medication
- Issue the complete course, if a course of medication is required eg. Antibiotics or steroid reducing medication
- Prescribe enough drops to cover treatment following ophthalmic procedures
Some medication can only be supplied by the hospital
Medicines that are not available outside the hospital eg clinical trial, hospital only or unlicensed drugs:
- Medicines for which safe and effective prescribing depends on knowledge or experience unlikely to be possessed by the GP eg chemotherapy or TB treatment
- Medicines for which it has been agreed that the hospital clinician is responsible eg. some drugs for rheumatoid arthritis or psychiatric problems
If your medication falls into one of these categories then you will be asked to contact the hospital for a further supply.
Warrington CCG - Guidance on Prescribing following a Private Consultation
Prescription requests should comply with Pan Mersey Area Prescribing Committee (APC) guidance (Pan Mersey)GP's will not issue prescriptions outside of this guidance.
Prescription requests resulting from outpatient appointments will be processed within 48 working hours of receipt of request from clinician.
Urgent prescriptions are the responsibility of the prescribing clinician.
If you are transferred to another department within the hospital
If your consultant decides to refer you to another department within the hospital and you do not hear anything further regarding this, please direct your queries to the consultant’s secretary at the hospital.The practice secretary will not be able to answer any queries relating to such matters.
Shared Care Agreements
Changes to Shared Care Agreements (SCA) at Culcheth Medical Centre
At Culcheth Medical Centre, we are committed to providing the best care for our patients. We want to inform you of some important changes regarding Shared Care Agreements (SCAs) and how this may affect your care.
1. What is a Shared Care Agreement (SCA)?
A Shared Care Agreement is an arrangement between your GP practice and another healthcare provider, such as NHS hospital specialist or private provider with an agreement to manage your care together. Agreeing to undertake NHS or private shared care agreements is not contractual for GP practices and they are not required to accept any requests for shared care.
2. Why have shared care agreements changed?
You may be aware of the recent announcement of Collective Action proposed by the British Medical Association (BMA). This is in support of the concerns of the ongoing and proposed level of funding to Primary Care GP Practices, which is degrading our ability to provide safe and effective care to our patients.
Culcheth Medical Centre is actively participating in BMA Collective Action and as of 1st October 2024 has taken the decision that we will continue to engage in Shared Care Agreements (SCA) with our NHS colleagues but will no longer agree to Shared Care Agreements (SCA) with private providers.
This means that, for some patients, we can no longer act as the coordinating healthcare provider between specialists and GPs for ongoing treatment.
The main reason for this change is lack of commissioning or funding from NHS bodies to cover the costs and resources needed to maintain these agreements. Shared Care Agreements often involve a significant amount of time and coordination between multiple healthcare teams. Without proper funding, we are unable to continue offering this service for non-NHS providers.
3. What does this mean for you as a patient?
If you are currently part of a Shared Care Agreement, this change will not affect you. All Shared Care Agreements that have been signed by the practice prior to 1st October 2024 with NHS and private providers will be honoured.
All requests for a private provider Shared Care Agreements on/after 1st October 2024 will be declined.
This may mean the following for patients:
- Prescription Management: Your GP will not prescribe medication or manage treatment requested by a private provider under a Shared Care Agreement. You will need to work with your specialist or provider directly for medication adjustments or renewals.
- Direct Contact with Specialists: You will need to manage appointments and care directly with your specialist. This may involve more frequent follow-up with them and there will be no involvement from our practice in coordinating care.
- Care Coordination: It will be the responsibility of the specialist or hospital team to provide you with the necessary care instructions and treatment plan.
4. Why is this happening?
The decision to stop providing Shared Care Agreements is driven by changes in NHS funding and commissioning. The NHS relies on allocated budgets to manage the resources needed for various services, and unfortunately, Shared Care Agreements are not funded in the GP contract.
This does not reflect a lack of commitment to your care; it is a result of systemic changes in how healthcare services are organized and funded.
5. What are our alternatives for you?
Although Shared Care Agreements are no longer available for some conditions, our practice is still dedicated to supporting your health in the following ways:
- Continuing GP Care: For ongoing management of your health, we will continue to provide you with primary care services. If you need regular check-ups or minor issues related to your condition, we are still here to support you.
- Referral to Specialists: If your condition requires specialist input, we will continue to refer you to the appropriate NHS specialist. We will ensure you are connected to the right team for your care. Unfortunately, the waiting times to be seen by these services are not within our control.
- Clear Communication: While we can no longer coordinate care as we once did, we will provide you with any necessary information to ensure your care continues smoothly. You will be informed of how to reach your specialist or what steps to take in managing your condition moving forward.
6. What should you do if you need assistance?
If you are unsure about how this change affects your care or need assistance managing your treatment, we encourage you to contact our practice. We will help you understand how to navigate this shift and guide you in getting the support you need from your specialist or other healthcare providers.
We understand that these changes may feel unsettling, but please know that our priority is to make sure you continue to receive the best care possible, even if the way we provide that care has changed.
7. In conclusion
While we can no longer provide Shared Care Agreements with private providers due to the lack of NHS commissioning, we remain committed to supporting you in other ways. We will continue to provide high-quality primary care, ensure you are connected with the appropriate specialists, and guide you through any changes in your care. Please don’t hesitate to reach out if you have questions or concerns about how these changes may affect you. Your health remains our top priority.
Thank you for your understanding,
Right to Choose - ADHD
Please visit the following page to view the NHS England guidance on your choices in the NHS: https://www.nhs.uk/using-the-nhs/about-the-nhs/your-choices-in-the-nhs/
Important notification regarding ADHD Service right to choose:
Under the NHS Right to Choose, you have the option to select a provider for your ADHD assessment, including private providers offering NHS-funded services. While this offers greater choice and flexibility, it is important to understand the implications for your ongoing care should you receive a diagnosis and begin treatment.
If you are diagnosed with ADHD and medication is recommended you will be monitored by your chosen service until titration and dose stabilisation, the ongoing prescribing and monitoring of ADHD medication should be carried out under a Shared Care Protocol arrangement with your chosen service and your GP Practice.
You must remain under the care of the provider who initiated your treatment. This ensures continuity of care and allows for appropriate monitoring of your condition. Unfortunately, we have found that some providers discharge patients after diagnosis and initial medication prescribing. When this happens, the GP practice is unable to continue issuing medication without input from the ADHD specialist care provider, as per NHS prescribing guidelines.
To avoid disruption in your treatment, we strongly advise checking with your chosen provider about their long-term care arrangements before proceeding with an assessment. Specifically, you should confirm:
- Whether they will continue overseeing your ADHD treatment and medication management.
- If they facilitate shared care agreements with GP practices.
- The process for ongoing prescriptions and follow-up appointments.
If a provider does not offer long-term support and a shared care agreement, you may need to explore alternative options to ensure you receive the necessary ongoing care.
If you have any questions or need further guidance, please do not hesitate to contact us. We are here to support you in making an informed decision about your ADHD care.
PRIVATE PRESCRIPTIONS
If a private consultation identifies a long-term condition or a need for medication which is available as routine NHS treatment, this should be provided as such by the patient's usual primary care prescriber if they are satisfied it is appropriate, and the private provider issues the first prescription.
The GP should be asked to take over prescribing only when the patient is stabilised on the medication. Patients who present at reception with a private prescription will be directed back to the private consultant's pharmacy or to their own nominated pharmacy, where they will have to pay the private prescription charge.
This applies whether the referral was by an NHS clinician or the patient self-referred. The responsibility for prescribing rests with the prescriber who has clinical responsibility for a particular aspect of the patients' care. There is no obligation on behalf of the primary care prescriber to prescribe the recommended treatment if it is contrary to his/her normal clinical practice. If the private/consultant prescribing recommendation does not follow Pan Mersey Area Prescribing Committee (APC), local or national guidance or policy, then the primary care prescriber may substitute a medicine with a clinically appropriate alternative
Private prescription requests for medicines resulting from outpatient appointments will only be considered after receipt of a full clinic letter and will take a further 2 working days to process.
Urgent prescriptions are the responsibility of the prescribing clinician.
When a patient is seen privately by a specialist or GP for a single episode of care any short-term medication required (a course of treatment or up to 28 days acute treatment) should be paid for by the patient as part of that package of care.
Hospital Expedite Letters
Due to increased waiting times for outpatient appointments, GPs have seen a rise in patient requests to “expedite” their appointments. We urge all our patients awaiting hospital appointments to be patient and wait to be contacted.
Patients are often requested by the Hospital to obtain a letter from the GP so their appointment can be expedited. This is frustrating for you and for us and rarely results in your appointment being brought forward. If your condition has worsened and you feel you need to be seen sooner than other patients on the waiting list, this is not something a GP can measure - only the hospital can compare your needs with those other patients on their waiting list.
We are unable to write letters to expedite your appointment for this reason.
As a GP surgery, we are not notified of any waiting times for clinics or provided with hospital hotline numbers. If your appointment has been delayed please contact your consultant secretary for any updates. If you are waiting for your first appointment with a consultant and have not heard for a long time, please contact the outpatient department in the first instance and then the consultant secretary.
If you have been unable to contact outpatients or the secretary, please contact PALS (Patient Advice and Liaison Service).
If you are experiencing worsening of your symptoms, we advise you to contact your specialist directly so they can assess your condition. If you need interim management or feel acutely unwell, please contact our surgery and our clinical team will try our best to help you. However, we will not be able to write a letter of expedition.
If you wish to inform the hospital in written format, please download the template letter below, completing your details and symptom change. Once you have completed this, you can post your letter to Outpatient Appointment (for first appointments) or your consultant secretary (for follow up appointment).