Int J Pharm Pract 2001:9:211-216
Academic Department of Pharmacy, Barts & the London NHS Trust, West Smithfield, London, England EC1A 7BE
C. Duggan, PhD, MRPharmS, director
Kingston and Richmond Health Authority
N. Beavon, MSc, MRPharmS, pharmaceutical adviser
School of Pharmacy, University of London
I. Bates, MSc, MRPharmS, senior lecturer
S. Patel, MRPharmS, MSc student
Correspondence:
Dr Duggan
Original Papers
Shared care in the UK: failings of the past and lessons for the future
C. DUGGAN, N. BEAVON, I. BATES and S. PATEL
Aims — To explore and evaluate the implementation
of shared care in the UK, to identify failings and to make recommendations
for successful implementation of shared care in the future.
Method — The study utilised a triangulation approach,
employing three different methods to explore the production and format
of shared care protocols (SCPs) and the perceived use and future trends
of shared care. A postal survey of hospital pharmacists and pharmaceutical
and medical advisers in health authorities and interviews with health
care professionals provided insight into perceptions of shared care and
recommendations for the future. A content analysis of a sample of SCPs
in current use assessed the utility of SCPs in practice.
Results — A total of 321 SCPs were identified that
described 99 different drugs and treatments. The protocols varied considerably
with no apparent standard either within or between regions, but there
was a correlation between the patient-related information available, information
across the health care interface (r=0.355, P=0.05) and pharmaceutical
information (r=0.401, P=0.05). There were expressions of uncertainty
about the benefit of such protocols to patients. Health authority staff
in particular expressed predominantly negative attitudes in the questionnaire
whereas the pharmacists were more positive. The transfer of prescribing
and associated costs from hospital to community (described as “cost shifting”)
was repeatedly identified as a barrier, together with competing professional
interests and reluctance to change with the times. General practitioners
(GPs) were most commonly excluded from the production of SCPs, which may
enforce negative feelings around implementation of SCPs across the health
care interface. Improved information technology and better use of evidence-based
guidelines and protocols were seen as ways forward in developing shared
care.
Conclusion — Since 1991, a large number of SCPs have
been produced in the UK but the benefits to patients are not clear. There
is a general perception of cynicism about their use; “cost-shifting” is
perceived as their main purpose. There appears to have been no formal
evaluation of their use or mechanisms for their implementation, and distribution
has been erratic. This study highlights that, with greater involvement
of health care professionals, better communication systems and the removal
of identified barriers, shared care is a concept essential in the evolving
NHS.