Most of the stimulants used for excessive daytime sleepiness are “shared care” drugs and would not normally be suggested or monitored by GPs.
A shared care drug is one that:
- must be initiated by a hospital consultant/specialist and
- requires a period of stability and monitoring under the care of the hospital consultant/specialist (Secondary Care) prior to transferring the responsibility for prescribing to the GP (Primary Care).
The impact for the patient is that initial prescriptions will be provided by the hospital consultant/specialist.
Monitoring of the drug and/or condition is shared between the hospital consultant/specialist and the GP. However, the patient remains under long-term review with the hospital consultant/specialist.
Shared Care Protocols (SCPs) are developed by the Area Prescribing Committee. They provide clear guidance to GPs and hospital consultant/specialist prescribers regarding the procedures to be adopted when clinical prescribing responsibility for a patient’s treatment with a shared-care drug is transferred from a hospital consultant/specialist to the GP and a small amount of funding for the GP in recognition of the extra workload.
There are lots of Shared Care Agreements already in existence for stimulant drugs but these have usually been created for ADHD rather than narcolepsy. This can mean that GPs are reluctant to take over prescribing of stimulant drugs used in narcolepsy.
Where this causes a problem for people with narcolepsy, Narcolepsy UK offers support through its volunteer Shared Care Advisor who can sometimes help smooth out the arrangements between specialist and GP to make obtaining prescriptions easier.
Please e-mail: sharedcareadvisor@narcolepsy.org.uk