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Anticoagulation part of our core contract? Sod off

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I have pondered, at length and in depth, the various views offered on the great, ‘Is anticoagulation management part of our core contract?’ debate and, having taken on board all the nuanced arguments, the clinical context and the historical perspective, my considered opinion is this: sod off. No way is anticoagulation management core contract. Obvs, end of, nothing to see here, as the young people say.

OK, it’s obfuscated by the fact that we’re happy to set up the repeat templates and dish out the rat poison, plus few of us have issues with NOACs, apart from the awkward nomenclature and spelling of your chosen whatthefuxaban.

But setting up blood monitoring/advising about doses/being king of the anticoagulation kingdom? Er no, absolutely not, it’s not core in the same way that repairing a leaking aortic aneurysm never has been and never will be core.

I’m not surprised those cash-strapped CCGs are trying it on, though. After all, they’re only adopting the smoke and mirrors trick whereby other enhanced services – think alcohol reduction, avoiding unplanned admissions et al – have cleverly been locked into the core contract rather than bolted on.

And it’s all entirely in keeping with other cost-conscious policies. Such as CCGs being disappointingly lukewarm about the GP Forward View’s ‘Onward with onward consultant referral’ workload promise, presumably because a bounce-back to the GP actually makes that onward referral less likely, and therefore might save some dosh. And the threat, at least in our patch, that our precious, protected and CCG funded half-a-day-per-month educational group-hug is about to bite the dust. Will they ever learn? And now, more to the point, will I?

With CCGs having to balance the books, being caught in the crossfire of these skirmishes is almost inevitable. But I can console myself with two thoughts. One, that I was, in retrospect, correct to avoid involvement in the CCG in the same way that I’m right to avoid involvement with pavement-mounds of dog excrement.  And two, at least I’m not a patient in AF who, while waiting to find out just who is running the local anticoagulation service, is feeling oddly numb down one side.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield

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Readers' comments (13)

  • Back to your usual ranty self I am happy to see!

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  • 'it’s not core in the same way that repairing a leaking aortic aneurysm never has been'

    Don't give them ideas ...

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  • really cant see the issue with initiating NOACs in primary care? its not rocket science! .....seems we just want to stick our head in the sand re new changes and developments and try and avoid responsibility for providing good medicine.

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  • It takes much more than ten minutes to do it properly. I don't mind continuing a NOAC but I don't want to be responsible for initiating it. I may save them from a stroke but I sure as hell will be blamed when they have their GI bleed or their brain haemorrhage.My indemnity premiums are quite enough already.

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  • I dont want to be the one resonsible for initiatinng it? but would rather neglect the much higher risk of thromboemboic disease? Not sure that would wash with the solicitors

    Everything takes more than ten minutes to do properly so why the angst re N/DOACS! makes me chuckle people cant embrace change...same old GP story.

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  • I think the point at issue is not how doable/learnable it is but how it's paid for as identifiably new work if we choose to.E.g if salaried GP above is req by employers todo 20 mins of checking and authorising Inrs /warfarin doses three days a week will she or he not expect another hours pay out of partners pocket as it's 'core'?

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  • Stopping high dose simavdor in favour of atorva etc...did you get funding for that? No.
    So with any changes in medical evidence based guidance we must consider it out of 'core'?
    and expect direct funding to follow? good luck with that one ;)

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  • Dear All,
    Still living the dream @ 12:33pm.
    You quote "I dont want to be the one resonsible foe initiating it" as a risible comment from a stuck in the mud GP.
    Your dream is cloud cuckoo land, correct as an employee "I dont want to be the one responsible" but your employers unfortuately are responsible for what their employee GPs do, which is why they may come to different conclusions. I prescribe a reality check.
    Regards
    Paul C

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  • Paul, who do you mean by employers? GP partners?
    What do you see as the reality?

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  • It is very easy to initiate a NOAC, but not easy to do it properly. That takes time, which is not paid for in the current GP contract.

    If we are not funded properly for this work then I want to be able to identify the need and refer on. I am capable of removing ingrowing toenails, but i don't because I have not got the time, and I am not paid for this in General Practice.

    More and more is pushed into General Practice with no funding attached.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder