Shared care registers and shared care plans

A shared care register is usually a computerized record of all patients jointly cared for by the two services. It might consist of all those who have been discharged from hospital in the past 2 years, all those who have been on a psychotropic drug for longer than a year, and all psychotic patients known to the GP who have not had an admission to hospital. The record gives information about the key worker, outpatient clinics are held in the surgeries, and 'good practice protocols' can be developed, so that the case register can be audited against what other teams agree is good clinical practice. (50)

Shared care plans follow on from this development. Such a plan gives the primary care staff information about symptoms which they may expect while the patient is well, likely symptoms in relapse, the name of the key worker, and full details of who to contact in an emergency both during the day and at night. The plan makes clear who is responsible for medication, and gives an acceptable alternative should the GP find it necessary to vary the medication. It is essential that these plans are mutually agreed between the two teams, rather than being imposed by one team on the other.

A recent multiprofessional working group published consensus views about the shared care of schizophrenia (51) whether in a crisis or in planning shared care. Another expectation is of shared training and transmission of skills (e.g. in training and supervising primary health care staff in administering depot medication and assessing mental state concurrently). One way of highlighting skills deficits is to use critical incident analysis (e.g. discussing suicides or suicide attempts). Mental Health Trusts are also increasingly appointing GPs onto their boards to ensure better communication.

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