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
