I just registered with the British General Practitioner website PULSE
An article about a top-down effort to get GPs to initiate and manage anticoagulants in atrial fibrillation caught my interest.
Some doctors are saying they are not ready to address populations of patients, like those with atrial fibrillation, without special funding. Others are saying anticoagulation management may be too complex for General Practitioners.
“Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, told Pulse GPs should feel they can refer patients on if they are not able to deal with all the changes as part of annual reviews.
Dr Green said: ‘I would expect GPs as part of their normal work to consider whether [atrial fibrillation] patients not on anticoagulation should be, in the light of the new guidance. If they should be, then the choice is between anticoagulation with warfarin or one of the newer agents, and if GPs do not feel they have the expertise or resources to do this properly, they have a duty to refer to someone who can.’
He added: ‘Commissioners need to predict this activity and may want to commission a service specifically for this which is more cost-effective than a traditional out-patient referral.’
Local GP leaders told Pulse practices would not take a systematic approach to reviewing and updating patients’ medications unless the work was specifically funded.
Dr Peter Scott, a GP in Solihull and chair of the GPC in West Midlands, said: ‘It’s not going to happen unless it’s resourced and incentivised as part of a DES or LES, or through the QOF – until then I don’t think a systematic approach to this will happen.’”
Dr Fay said:‘I think anticoagulation is an intimidating topic for clinicians – both in primary and secondary care. I would suggest one person in each practice one clinician is involved with the management of the anticoagulated patients – whether that’s keeping a check on them during the warfarin clinic or being the person who initiates the novel oral anticoagulants.
‘If GPs feel uncomfortable with [managing anticoagulation] then they should be approaching the CCG executive to say, “we need a service to provide expert support for this”. The CCG may choose to come up with an enhanced service – but then whoever is providing the service needs to make sure they are well versed in use of the latest anticoagulants.’”
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