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Shared care
Shared care: step down or step up?
  1. E J Maher,
  2. D Millar
  1. Mount Vernon Hospital, Northwood, Middlesex HA6 2RN, UK
  1. Correspondence to:
 Dr E J Maher, Mount Vernon Hospital, Northwood, Middlesex HA6 2RN, UK; 

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Shared care arrangements between hospitals and primary care for the management of patients with cancer must be seen as a step up from “usual” care in general practice rather than a step down from hospital practice.

Formal “shared care” in cancer remains controversial. It is promoted as offering patients care closer to home while, at the same time, reducing the burden on specialist services. Primary care practitioners are divided on the issue, some viewing shared care as enhancing their practice and others as another example of hospitals offloading work onto an already overloaded primary care sector. There is some evidence to suggest that primary care based follow up alone is acceptable to patients and provides similar outcomes to specialist follow up in breast cancer,1,2 although this is disputed by others who cite patient preference3 or difficulties …

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