From 1 April 2015, the Clinical Commissioning Groups (CCGs) in Buckinghamshire brought in a new anticoagulation monitoring service for patients who are prescribed Warfarin. The new service has the following advantages over the old one:

  • It uses a less intrusive method of taking blood, involving just a small drop of blood taken as a finger prick test; as opposed to the more intrusive method of taking blood from a vein.
  • The greater number of providers of the service means patients now have a choice where they go for their anticoagulation monitoring. Patients are now able to choose a service provider, which may be closer to where they work or to home.
  • All providers of the service are working to an improved, standardised delivery of monitoring. This should remove any inequalities or differences in the level of services across the county.
  • All providers give a “one-stop-visit” which means that testing, obtaining the results and adjustments in dose are done in the same visit, with an opportunity for patients to discuss this at the same time.
Why is my GP surgery no longer providing International Normalised Ratio (INR) Monitoring or Warfarin regulating services?

Not all GP practices have chosen to become providers of the new service. Since we have found that fewer practices have chosen to adopt the new service than we expected, we have been working to assist the practices that need support to find services close by. We are making every effort to close any gaps in service and are confident that this will be remedied by the end of our implementation period on 30 September 2015.

Why don’t you create a mobile service for INR?

A peripatetic service is in place for housebound patients. Where practices are unable to, or have chosen not to, provide a local testing service, we are trying to ensure that there is a qualified provider within or close by the practice. We recognise that some patients may not receive their service at their practice.

Has this change in the service been made to save money?

Whilst value for money is always a factor in commissioning health services, it is rarely the top consideration. Clinical considerations and patient care outcomes are always the priority and the anticoagulation service was reconfigured to raise the standard of the service and make it consistent across the county. There were fluctuations in the standard of service being offered before and we are confident that, when the service is fully implemented, we will see a clinical improvement in the outcomes for our patients.

There is no service close by to me and we would have to travel to Wycombe or Aylesbury to have the testing done – why is this the case?

We had expected that increasing the number of qualified providers who could bid to offer this service, would lead to better access to treatment. On the whole, this has proved to be the case, but in small areas of the county there has been less interest from providers and we are working hard to fill any gaps in service. We are confident that this will no longer be an issue by the time the implementation process is completed at 30 September 2015.

Are there any other alternatives to this testing?

You could ask your GP to review your case to see if you are eligible or appropriate for other drugs which work in the same way as Warfarin but do not require the same level of monitoring. Please bear in mind that this may not turn out to be a viable option.

Anti-Coagulation Service

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