Health services

Description

The City and Hackney GP Confederation is now commissioned to act as the lead provider of community based Anti-coagulation services to patients registered with practices in City and Hackney, aside from a small number of patients with complex medical problems whose care remains in secondary care. The GP Confederation has sub-contracted provision of this Anti-coagulation service to a range of Anti-coagulation Centres across the geography. Some of these Centres care for their own registered patients only; others provide care for patients from “linked” practices. Whilst there is seldom need for specialist support, when is it is required by GP practices, for safety reasons it is crucial they can access highly skilled secondary care input. The Confederation is therefore commissioning a specialist support service to provide this secondary care level of input to support delivery of the overall anti-coagulation contract. The City and Hackney GP Confederation is commissioned to act as the lead provider of community based Anti-coagulation services to patients registered with practices in City and Hackney, aside from a small number of patients with complex medical problems whose care remains in secondary care. The GP Confederation has sub-contracted provision of this Anti-coagulation service to a range of Anti-coagulation Centres across the geography. Some of these Centres care for their own registered patients only; others provide care for patients from “linked” practices. Many of the C&H GPs and their practice staff have over 10 years of experience in providing this service, and as a consequence, seldom need specialist support. However when they do need it, for safety reasons it is crucial they can access highly skilled secondary care input. The Confederation is therefore commissioning a specialist support service from a suitably qualified secondary care provider. Service specification — areas of support: 1) Telephone and /or email support/advice to the GP Confederation Clinical Lead on clinical issues (a) this service will operate Monday – Friday, 9:00 a.m to 6:30 p.m, with a turnaround time of 1 hour. The overall amount of support required will vary depending on need and is expected to reduce over the course of the year. In general the amount of time expected to deal with the queries listed below should not be more than 12 days per year i.e. approximately one day per month. The volume is likely to be higher in the absence of the Anti-coagulation Service Clinical Lead; (b) this service will cover: (i) bleeding management N.B. any episodes of uncontrolled bleeding must be referred to A/E; (ii) reversal of INRs of more than 8 and for any problematic patients whose INR is persistently above 5; (iii) vitamin K dosage that needs to be different to that included in the flowchart for dealing with high INRs in the patient specification; (iv) restarting warfarin following Vitamin K reversal; (v) new referrals with medical queries; (vi) patients who develop cancer when on anti-coagulation; (vii) DOAC initiation – best choice of drug (viii) side effects advice; (ix) bridging advice: e.g. perioperative and dental advice, stopping (or not) aspirin, prior to major and minor procedures, advice around vaccinations, skin biopsy, joint injections; (x) travel advice; (xi) cardioversion/ablation advice; (xii) major drug interactions; (xiii) managing unstable INRs; (xiv) DOAC switches for poor warfarin TTR; (xv) any other complex clinical queries 2) training support and updates: (a) 2 half days of training and two half day updates per year: (i) twice yearly training for new members of staff (only if needed); (ii) twice yearly update courses for staff involved in providing service. (b) these to be developed as bespoke based on local need and to cover future service developments. 3) audit support: (a) discussion of practice audits with the Centre Clinical Leads and input in to any Anti-coagulation Centre where there is evidence they need extra support. 4) patient complaints/medicolegal advice (a) expert support for clinicians where a complaint is received that requires specialist clinical input.