Quick wins for the new contract
Aspirin exception reporting
nTo err is human, but to really foul things up requires a computer. You might think that if your stroke patient had nearly died from an aspirin-induced GI bleed and you conscientiously added the recommended 'aspirin contraindicated' code to the patient's record, the Q&O software would no longer flag them as potentially needing aspirin. Incredibly, you would be wrong. I found 12 patients on our Population Manager list for those not meeting CHD 9 who had had adverse reactions to aspirin relating to GI upset, one of whom had ITP and a GI bleed.
nWhy is this? Because, in order to trigger an exception report the rules governing CHD 9 and Stroke 9 exception reporting also require the presence in the record of an approved contraindication code to both clopidogrel and warfarin in addition to the aspirin contraindication.
nPerhaps the Department of Health wants to ensure all patients get some kind of anticoagulation. But this is unlikely as I know of no guidelines suggesting warfarin in CHD if both aspirin and clopidogrel are contraindicated. It's more likely to be a question of trust: the department does not trust GPs to use the exception reporting system properly and so it is putting as many obstacles in the way as possible.
nSo check your aspirin-contraindicated patients are contraindicated to clopidogrel too, or put them on it, and that the warfarin not indicated code is added also, as appropriate. No doubt the department will exhort GPs to take care when prescribing or castigate the system suppliers for providing lists of patients who do not meet the audit criteria. But a dangerous system is a dangerous system, whoever the fall guy is.
David Shepherd is a GP in Leicester