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'They have us in a pincer movement over prescribing warfarin'

Dr Simon Butler, a GP in Essex, says practices are  beign downrated by the CQC for carrying out CCG orders on prescribing high risk medicines

The CCG has told us, whether you’re monitoring warfarin or not, you have to prescribe it. They used to pay us through an enhanced service to audit the monitoring, but they withdrew funding and have refused to reinstate it.

But the CQC says if you’re prescribing it you have to be monitoring it, or be able to prove you can see the monitoring by somebody else and are making sure it’s okay. Yet in South West Essex we can’t see the hospital’s blood test results.

The CCG should recommission the enhanced service – it is not doing so. Effectively it’s putting us at risk unless we do the monitoring for free. More importantly we haven’t got the capacity to do this, irrespective of money.

The CQC now has us in a pincer movement, saying you may be doing the prescribing free as a favour to the CCG, but you’re not doing it safely.

The CCG has since sent out a prescribing newsletter saying it has agreed a new funded shared-care guideline with the LMC. However, the LMC did not agree this and the CCG has said that even if practices opt out, they’re still expected to prescribe methotrexate, despite not being funded to monitor it. It was then I told them I would no longer prescribe warfarin, or methotrexate.

They referred this straight to the medical director of NHS England and I’m waiting to hear from him. The CCG seems to expect the imminent guidance from NHS England to say GPs have to prescribe the drugs, even if they are not monitoring them.

Dr Simon Butler is a GP in Billericay, Essex

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Readers' comments (8)

  • Cobblers

    Simon. You are bound by contract. Is any shared care scheme part of your contract?

    No? Thought not.

    NHSE can whistle. Seriously.

    If you fouled up on warfarin and you did not know of or monitor the INRs then we would both expect you to be shat on from a great height.

    You cannot be forced to prescribe anything if you have good reason not to. And you have good reason.

    React to this please. Don't wait passively for NHSE. Refuse all unfunded shared care and probably all funded too (seriously underpaid). Hand it back to secondary care. Stop doing all benefits stuff, PIP forms, DVLA forms anything that you really resent.

    Free up your time a bit. Start thinking about getting out as you have to be in your late 50s. :-)

    Locum waters are fine and warm. COI early 60s and loving it.

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  • What is your indemnity company doing about this?

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  • Er I think I would call up a few newspapers too.... public interest..... the public is being put at risk by these organisations...

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  • Just day NO! SAY NO!
    Say you do not have capacity and it is not clinically safe. The CCG cannot over ride that.
    Just refer anyone that they "force" you to manage back to secondary care en masse.

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  • Spuds

    1) Warfarin patients to much more expensive NOACs

    2) MTX patients no longer receive script from GP as unresourced - have to get it frmo the specialist

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  • Doctor McDoctor Face

    You have a pincer move to. Lower your risk threshold for referrals. Send more to A&E. Stop your nurse ear syringing et etc.

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  • Rogue1

    If its not safe to prescribe it, then simple you don't. Its the CCG/hospital responsibility to sort this mess out not yours!

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  • People still use warfarin? How quaint.

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