This service model is supported by the NCL Locally Commissioned Service (LCS) for primary care: please refer to the service specification for details.

1. Patients will be initiated on GnRH analogue injections in secondary care: this will be the NCL preferred choice, triptorelin, where clinically suitable. The clinical specialist team will ensure that a discussion has taken place with the patient to explain that, when their treatment is stable, their ongoing injections will be prescribed and administered by primary care. The clinical management, follow up and ongoing monitoring will remain the responsibility of secondary care and any review or follow up appointments will continue to take place in secondary care as clinically required. Blood tests/PSA monitoring remain the responsibility of secondary care and arrangements will be confirmed by the specialist team.   
2. At the point where the responsibility for prescribing and administering of these injections is transferred to primary care, the secondary care clinician will produce a treatment summary, which will be sent to both patient and GP.  This will describe the required treatment regimen, red flag symptoms and any other relevant clinical information, including the NCL Fact Sheet for GnRH analogues for prostate cancer.  If not already included in the treatment summary, the patient (and GP) will also receive a clinic letter which will detail the date of the first injection and when the second injection is due (approximately three months later
3. Patients will be managed on the basis of their individual treatment plans as drawn up by secondary care. Practices will be expected to follow these plans unless there has been discussion and agreement with their consultant oncologist to modify them. 
4. The GP will prescribe and administer the GnRH analogue injections as recommended by secondary care, who will monitor the patient’s PSA levels. Unless explicitly agreed otherwise, the patient will remain the clinical responsibility of secondary care and will not be discharged. If the GP or patient wishes to stop the medication, they must discuss this with the consultant oncologist before doing so.
5. Clinical advice and support will be provided to the GP by secondary care clinicians as required. See Contact Details: Queries/Concerns page.
6. There is a detailed supporting resource (NCL Fact Sheet for GnRH analogues for prostate cancer, see right) available which contains all relevant clinical information, as well as a detailed service specification.
7. An EMIS template has also been developed to support clinical documentation but which can also be used by practices for reporting and safety-netting. [DOCUMENT TO COME]
8. Practice clinicians are expected to reinforce the advice provided by secondary care clinicians to patients, as outlined in the clinic letter or treatment summary. This includes managing patients with the possible side effects of treatment and referring to the specialist team accordingly.