Date: 16 January 2017
NHS Bromley Clinical Commissioning Group has been shortlisted for a Health Service Journal Value in Healthcare Award for its community anticoagulation service. The service, which has been shortlisted in the ‘Community health service redesign’ category, offers patients with atrial fibrillation (AF) a range of treatment options in the community, rather than having to go to hospital. People with atrial fibrillation are at increased risk of having a stroke. In extreme cases, atrial fibrillation can also lead to heart failure. The service is one example of how the CCG is moving more care into the community when it is safe and appropriate to do so, to allow hospitals to focus on providing more specialist services.
The Bromley community anticoagulation service is provided by Boots pharmacists, and endorsed by the Royal Pharmaceutical Society. Clinics are available seven days a week from nine convenient locations across the borough. Patients are seen much quicker for initial assessments and ongoing monitoring and treatment. Those who are more vulnerable and often house bound are treated at home. Patients with more complex anticoagulant needs are still treated at the hospital where clinically appropriate.
Many areas of the country offer a similar service, but the Bromley anticoagulation service goes further. Two years ago, in order to meet revised NICE guidance, it was redesigned so that patients could be offered an even better service with more choice and convenience. The redesigned service uses independent pharmacist prescribers to jointly decide with patients what treatments are provided. Those who are prescribed warfarin are treated and managed in the community anticoagulation service provided by Boots pharmacists. Those who choose a ‘Direct Oral Anticoagulant’ are monitored for three months by the community service before their care is transferred back to their GP.
Patients who may be at risk of AF are also being proactively identified by pharmacists and GPs to see if they would benefit from anticoagulation treatment.
Clinical Lead and Local GP Dr Mark Essop said: ‘We are delighted with the positive impact our community anticoagulation service is having on the lives of our patients. Their feedback has been excellent. The vast majority are very happy with the quality of service as well as the choice, speed and convenience on offer. Patients are seen in clinics within days of the referral being received which means that therapy can start quickly.'
General training sessions for GPs have also taken place to improve their skills in managing AF and anticoagulation medication. A Prescriber Toolkit has been developed with input from a Consultant Hematologist, Consultant Pharmacist for Cardiovascular disease, GPs and a prescribing advisor.
 In a recent survey of 423 patients, 397 were ‘very satisfied’ and 20 were ‘satisfied’. This satisfaction has been attributed not only to the ease of access to the service, but also because of the continuation of care, as patients see the same clinician as often as possible, at a location closer to their home.
The CCG has been shortlisted for a 'Health Service Journal Value in Healthcare Award' for its community anticoagulation service