SCHEDULE 2 THE SERVICES A. Service Specificatins Mandatry headings 1 4. Mandatry but detail fr lcal determinatin and agreement Optinal headings 5-7. Optinal t use, detail fr lcal determinatin and agreement. All subheadings fr lcal determinatin and agreement Service Specificatin N. Anti-cagulatin Initiatin Service Cmmissiner Lead Prvider Lead NHS Wyre Frest Clinical Cmmissining Grup Perid 30/09/2014 30/09/2015 Date f Review 30/09/2015 1. Ppulatin Needs 1.1 Natinal/lcal cntet and evidence base All practices are epected t prvide essential and thse additinal services they are cntracted t prvide t all their patients. This enhanced service specificatin fr the prvisin f anti-cagulant mnitring utlines the mre specialised services t be prvided. The specificatin f this service is designed t cver the enhanced aspects f clinical care f the patient, all f which are beynd the scpe f essential services. N part f the specificatin by cmmissin, missin r implicatin defines r redefines essential r additinal services. 2. Outcmes 2.1 NHS Outcmes Framewrk Dmains & Indicatrs Dmain 2 Dmain 3 Dmain 4 Dmain 5 Enhancing quality f life fr peple with lngterm cnditins Helping peple t recver frm episdes f illhealth r fllwing injury Ensuring peple have a psitive eperience f care Treating and caring fr peple in safe envirnment and prtecting them frm avidable harm
2.2 Lcal defined utcmes This service is designed t encurage and supprt cmpetent and trained Practitiners t initiate anti-cagulatin therapy in newly diagnsed patients. This service recgnises the time required t ensure that the patient receives the ptimum dse necessary t keep INR levels within acceptable levels. The service is pen t any Practitiner with the necessary skills and equipment t manage patient care. It is epected that prviders will als prvide the Anticagulatin Mnitring (Level B) Service. Dser means any persn wh is suitably trained and qualified wh, upn receipt f relevant infrmatin frm labratries r near- patient testing equipment r therwise, with r withut cmputer- assisted decisin- making equipment, determines as the relevant service may require, the anticagulatin dsage fr patients f practitiners in a practice. 3. Scpe 3.1 Aims and bjectives f service The service is designed t: - i. Fund suitably skilled and qualified practitiners t initiate anticagulatin treatment within defined and agreed prtcls; ii. Prvide a primary care based service s patients have access t a lcal and cnvenient service withut the need fr hspital visits, ecept in eceptinal circumstances; iii. Ensure that patients receive a safe and apprpriate level f care fr their cagulatin difficulties. 3.2 Service descriptin/care pathway The Service will fund: - The identificatin f patients requiring t be started n anticagulatin therapy r review f indicatin fr initiatin if referred frm anther lcal practice; The cmmencement f Warfarin therapy and review, dsing and prescribing as recmmended by the clinical sftware and until a stable INR is achieved. Once a stable cltting time is achieved it is anticipated that the patient will then mve t care under the Service fr anti-cagulatin maintenance. This may be at the same practice r the patient may be transferred with apprpriate infrmatin t either their wn practice r t anther mre lcal practice prviding maintenance.
All practitiners will wrk within the mst recent guidelines f the BCSH and NICE guidelines and adhere t the CCG Oral Anticagulant guidelines. All practices prviding this treatment will be epected t use the cmputerised dsing sftware e.g. INR Star r Dawn. In supprt f this Service, the fllwing wuld be required: The develpment and maintenance f a register. Practices shuld be able t prduce an up-t-date register f all patients started n anticagulatin therapy, indicating patient name, date f birth, the indicatin fr treatment, target INR and date f transfer t maintenance; Referral Plicies; Educatin f Newly Diagnsed Patients: T ensure that all newly diagnsed patients (and / r their carers and supprt staff when apprpriate) receive apprpriate advice n management and avidance f cmplicatins frm their medicatin including the prvisin f a patient-held bklet; T prepare an individual management plan with each patient, which gives diagnsis, planned duratin and therapeutic range t btained; Recrd Keeping t maintain adequate recrds f the perfrmance and results f the service prvided including recrding all cmplicatins f treatment, including bleeding and relevant hspital referrals r admissins; Audit T carry ut clinical audit f the care f patients against the abve criteria, including untward incidents. This shuld als review the success f the practice in establishing an INR within the planned range within 3 mnths cmmencing f treatment; Training Each practice must ensure that all staff invlved in prviding any aspect f care under this scheme will have the necessary training and skills t d s as detailed in Anti-cagulatin mnitring Service; Review All practices invlved in this scheme shuld perfrm an annual review, this shuld include: Infrmatin n the number f patients initiated n t anticagulatin therapy, the indicatins fr anti-cagulatin therapy
and lengths f treatments until stable INR achieved; Brief details as t arrangements fr each f the aspects highlighted abve; Details f training and educatin relevant t anti-cagulatin mnitring services received by practitiners and staff; Access t vitamin K therapy t deal with INR significantly abve the target range which pses the risk f bleeding. Receipt f referral and the date f the initial cnsultatin shuld be cmmunicated t the referring practice. All clinical cntacts will be dcumented and faed r e-mailed t the referring practice s that they are aware f bleeding risks. The timing f the initial appintment will depend upn the clinical urgency. New patients with DVT will need t be seen quickly (nrmally within 2 t 3 days). Referrals may riginate frm hspitals, A&E r ther practices. Patients identified fr warfarinisatin due t atrial fibrillatin shuld be seen within 2 weeks. 3.3 Ppulatin cvered The registered ppulatin f all patients within the Practice. Any treatment fr patients, utside f this definitin, will nt be paid fr by NHS WFCCG. 3.4 Any acceptance and eclusin criteria and threshlds There are n specific acceptance r eclusin criteria fr this service. 3.5 Interdependence with ther services/prviders 4. Applicable Service Standards 4.1 Applicable natinal standards (eg NICE) Cmpliance with relevant guidance and plicy The service must cmply with the guidelines prduced by the fllwing rganisatins (where applicable): Rules f Prfessinal Cnduct http://www.gmc-uk.rg/guidance/inde.asp NICE Guidance and recmmended pathways http://guidance.nice.rg.uk/ Applicable plicies prduced by NHS WFCCG and any adaptatins t these plicies as adpted frm the 1st April 2014.
Care Quality Cmmissin registratin requirements. 4.2 Applicable standards set ut in Guidance and/r issued by a cmpetent bdy (eg Ryal Clleges) 4.3 Applicable lcal standards Equal Opprtunities The service prvider must demnstrate hw they meet equal pprtunity requirements in the fllwing areas: They must be cmmitted t equal pprtunities and must nt discriminate in perfrmance f the service twards service users r members f staff in any way; The service prvider must be able t prvide chapernes at the patient s request; The service prvider must als be able t prvide premises, facilities and treatment rms that are cmpliant with disability legislatin The service prvider must be able t prvide access t freign language interpreter if necessary. Clinical qualificatins Staff invlved in the delivery f this service will be apprpriately trained and cmpetent in the prvisin f the services ffered. The services prvided and scpe this service will be reviewed with staff as part f the annual appraisal prcess The service prvider must prvide evidence t the CCG that their healthcare prfessinals have the apprpriate knwledge, skills, eperience, qualificatins and cmpetency t prvide the service. This must include but wuld nt be limited t the fllwing requirements: Enhanced Disclsure and Barring Service (DBS frmally Criminal Recrds Bureau CRB) checks have been cmpleted; Where applicable staff will be fully registered with the apprpriate Prfessinal Bdy; All staff will be able t prvide evidence f their cntinuing prfessinal develpment pst qualificatin. The service prvider must cmply with all relevant plicy and prcedure as cntained in the NHS Standard Cntract including but nt limited t; safeguarding f vulnerable patients (including children), health and safety, marketing and branding and insurance requirements (prfessinal, public and prduct and emplyers liability). The service prvider must als cmply with all relevant guidance and referral prtcls prduced by the CCG. The aim f these prtcls will be t ensure
that patients are treated by the mst apprpriate prfessinal, in the mst apprpriate lcatin with the mst effective treatment. Patient transprt arrangements d nt frm part f this service specificatin. Patients will be epected t make their wn transprt arrangements. Thse patients wh are entitled t assistance with transprt under eisting NHS arrangements will be able t access this thrugh their GP Practice as per lcal arrangements. Clinical Gvernance The service prvider will be respnsible fr their wn system f clinical gvernance. This will include but nt be limited t the fllwing: An appinted Clinical Gvernance Lead; Develpment and implementatin f Clinical Gvernance plicies; Adherence t the Serius Untward Incident reprting and investigatin prcess. It is a cnditin f participatin in this Service that practitiners will prvide ntificatin t the CCG Risk Manager and t the referring practice f all significant events, including emergency admissins r deaths f patients using this service, where such admissin r death is r may be due t usage f Warfarin. Deaths must be reprted within 72 hurs f the infrmatin becming knwn t the practitiner and admissins ntified within ne week. This is an additin t the practitiner s statutry bligatins. If a practice has referred a patient int the service and is aware f a significant related event then all effrts shuld be made t keep the INR mnitring dctr aware f the events; Cmpliance with Infectin Cntrl plicies. The service prvider will have secure IT systems in place which enable the capturing f patient infrmatin and activity reprting. They will ensure that all infrmatin relating t patients is safeguarded and cmplies with the Data Prtectin Act (1998), the Access t Health Recrds Act (1990), the Freedm f Infrmatin Act (2000) and the Caldictt Principles. Activity reprting will be submitted by the service prvider thrugh a secure nhs.net email address. 5. Applicable quality requirements and CQUIN gals 5.1 Applicable quality requirements (See Schedule 4 Parts A-D) 5.2 Applicable CQUIN gals (See Schedule 4 Part E)
N/A 6. Lcatin f Prvider Premises Within the GP practice r ther apprpriate rm. 7. Individual Service User Placement Practices cntracted t prvide this service will receive: Prpsed Payment: - Fr each new patient cmmenced n an initiatin package f care t establish a stable INR, a payment f 110 will be reimbursed (fr the first three mnths f treatment). A secnd payment f 174.28 will be reimbursed fr maintenance fr the remainder f the year and each year thereafter in accrdance with the Anticagulatin Maintenance Service. The prvider will need t prvide the patient s NHS number.