Responsibilities of the secondary care clinician (consultant or specialist nurse)

1. Ask the GP if they are willing to shared care and only transfer prescribing if this is agreed in writing. Refer to appendix 1 and 2 of the shared care document for a transfer of care template letter.
2. Provide the patient with initial information regarding the treatment and possible adverse effects. This includes the incidence of depression, osteoporosis and diabetes. Diabetic patients will be counselled to increase the frequency of glucose monitoring as appropriate. Advice on diet and exercise will be given. A calcium and vitamin D supplement will be prescribed unless contraindicated.
3. Perform baseline monitoring as outlined in the attached shared care document. 
4. Initiate and optimise (stabilise) treatment and inform GP when patient is stable on the product so that the GP can continue prescribing. This will usually be 3 months after initiation of a gonadotropin releasing hormone (GnRH) agonist or usually 2 months after initiation of relugolix.
5. Change preparation if necessary and inform patient and GP of the changes.
6. Clinically supervise patient by routine clinic follow-ups as clinically indicated up to a minimum frequency of every 12 months, to include the relevant tests (such as prostate specific antigen) and assessments to monitor clinical response and toxicity. Inform GP of review and blood results after each monitoring appointment.
7. Provide emergency support for administering GnRH analogues where a practice is unexpectedly unable to provide this within a week of the date the injection is due (e.g. due to unexpected staff absence).