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