Reasoning GP Clinic reference Shared-care monitoring
Clinic reference · SPS · BSR 2025 · NICE · MHRA

Shared-care monitoring — which tests, how often, what to act on

Baseline tests, ongoing monitoring and the warning signs for the drugs GPs most often prescribe under shared care. Filter by group or search a drug or test. Your local shared-care protocol takes priority over this summary.

Last checked: October 2026 · SPS drug monitoring · BSR 2025 csDMARD guideline · NICE · MHRA
The 2025 change to know. The BSR 2025 csDMARD guideline (November 2025) replaced BSR/BHPR 2017 with risk-stratified monitoring: close checks while starting, then usually 3-monthly, with the interval set by each person's toxicity risk and reviewed at least yearly. Local shared-care protocols are being updated to match — until yours is, follow the protocol you signed up to.
Shared care basics. Only take on prescribing after specialist initiation and stabilisation, with a written shared-care protocol you have accepted. Record hospital-only drugs (clozapine, biologics) on the GP system so interactions and toxicity are visible. If monitoring is not done, do not keep issuing — contact the patient and specialist. Typical action thresholds and full schedules are in the protocol and the SPS drug monitoring pages.
DrugBaselineOngoing monitoringWatch for / act on

Sources (checked October 2026)

  1. British Society for Rheumatology. 2025 guideline for the prescription and monitoring of conventional synthetic DMARDs. Rheumatology 2026;65(2):keaf522. academic.oup.com
  2. NHS Specialist Pharmacy Service. Drug monitoring pages (methotrexate, sulfasalazine, leflunomide, azathioprine, lithium, amiodarone, DOACs, testosterone and others; being aligned with BSR 2025). sps.nhs.uk
  3. Royal College of Ophthalmologists. Hydroxychloroquine and chloroquine retinopathy: recommendations on monitoring (2020). rcophth.ac.uk
  4. NICE CG185 Bipolar disorder (updated 2023); NICE CG178 Psychosis and schizophrenia in adults (2014); NICE NG87 ADHD (updated 2019). nice.org.uk
  5. MHRA Drug Safety Updates: denosumab — multiple vertebral fractures after stopping or delaying treatment (2020); clozapine — constipation and plasma level monitoring (2020); mycophenolate — pregnancy prevention; leuprorelin — reconstitution errors (2021). gov.uk/drug-safety-update
  6. NICE NG196 Atrial fibrillation (2021); NICE NG131 Prostate cancer (2019, updated 2021). nice.org.uk
  7. British Society for Sexual Medicine. Guidelines on adult testosterone deficiency (2023). bssm.org.uk
Educational reference only — not a substitute for the source guidance or clinical judgement. Summarised in our own words from the national sources listed, last checked October 2026. Rules, eligibility and thresholds change, and local commissioning (ICB) arrangements vary: always check the live guidance, the product SPC, the BNF/BNFC and your local formulary or protocol before acting. No patient-specific dosing is given here.