Specialist medication monitoring and prescribing in primary care: case study of shared care agreements in Northern England, UK

Introduction
Shared Care Agreements (SCAs) in the UK enable general practitioners (GPs) in primary care to take over the monitoring and prescribing of specialist medications for patients under agreed protocols. While SCAs are intended to improve access and continuity of care, concerns regarding their implementation and adherence to safety protocols persist. This study aims to explore the mechanisms, challenges, and risks associated with SCAs, focusing on their impact on patient safety and primary care capacity.

Methods
A case-study approach was employed to investigate the implementation of SCAs, incorporating mixed methods to provide a comprehensive understanding. Data triangulation included document analysis of policies, cross-sectional review of medication monitoring and prescribing practices across 37 GP practices, and key informant interviews with stakeholders. Logic and dark logic models were iteratively developed to map the intended and unintended outcomes of SCAs.

Results
The monitoring and prescribing review revealed 32.3% of prescribed medications under SCAs lacked up-to-date monitoring data, with ADHD medications showing the highest rates of non-compliance. Interviews highlighted systemic challenges, including unclear responsibilities, inadequate patient involvement, fragmented communication between primary and secondary care, and insufficient integration of digital systems. These gaps contribute to patient safety risks, particularly for high-risk medications requiring stringent monitoring.

Conclusions
SCAs hold potential for improving care continuity but face significant operational and systemic barriers that undermine their safety and effectiveness. Findings evidence the need for clearer role delineation, robust communication frameworks, enhanced patient engagement, and integrated digital solutions. Policymakers and healthcare leaders must address these challenges to ensure SCAs deliver on their promise of seamless, safe, and sustainable care. Future research should focus on incorporating the perspectives of secondary care providers and pharmacists to develop more inclusive solutions.