Shared care: a qualitative study of GPs' and hospital doctors' views on prescribing specialist medicines

Background: Shared care schemes have mainly centred on chronic diseases such as asthma and diabetes. However, with increasing government emphasis on primary and secondary care integration and the effects of budget restraints, general practitioners (GPs) have been asked Co take on the prescribing of specialist medicines. Aim: To elicit the views and experiences of GPs and hospital doctors about existing arrangements for shared care applied to the prescribing of specialist medicines. To identify a set of quality indicators for prescribing specialist medicines at the interface between primary and secondary care. Design of study: A qualitative study based on semi-structured interviews. Setting: Forty-eight GPs and 13 hospital doctors in the former South Thames region. Method: The interviews focused on how far experiences with shared care compare with the arrangements currently in place for prescribing specialist medicines and identified the barriers to facilitators of effective shared care. Results: A number of key themes were identified and these formed the basis for eight quality indicators relating to the prescribing of specialist medicines where treatment is shared between primary and secondary care. The themes centred around issues ef clinical responsibility, 'cost-shifting', availability of medicines GP satisfaction, and the nature of the prescribing relationship. Conclusion: Overall, GPs appeared dissatisfied with arrangements for prescribing specialist medicines, while hospital doctors were generally satisfied. The quality indicators will form the basis of a more extensive quantitative survey of GP's perceptions of the arrangements for prescribing specialist medicines.