March 2016 – Reimbursement application for Coaguchek XS system
ACSMA’s primary objective has always been for self-monitoring INR devices, or coagulometers, to be made available to patients on an NHS prescription, instead of patients having to purchase their own device. Late last year, the manufacturers of the Coaguchek XS system, Roche, submitted a formal application to the NHS Business Services Authority for reimbursement under the national NHS tariff of medicines and other services. The reimbursement process is complex, lengthy and involves multiple parties. In March this year, however, we received the great news from the Department of Health that the Coaguchek will formally be considered for inclusion in the NHS national drug tariff. If the application is successful, it means that a patient will be entitled to have a Coaguchek system on prescription, instead of paying the full cost him or herself.
December 2015 – Embedding self-monitoring into NHS practice
Over the last year, ACSMA has participated in several pieces of work, all designed to help encourage and support the implementation of standards, guidelines and guidance into real-life clinical practice. The 2014 NICE Diagnostics Guidance DG14 recommends two different INR monitoring devices (known as coagulometers), concluding that they are both clinically and cost-effective for use by adult patients with AF or heart valve disease. However, it is for each Clinical Commissioning Group (CCG) to decide how best to implement this guidance. NICE Quality Standard 93 for atrial fibrillation (AF) treatment and management (QS93) was published in July 2015. Statement 6 of QS93 says that adults with AF who are taking warfarin long-term should be supported to self-manage with a coagulometer. However, this is what is known as a “developmental” standard, which means that it is something that the NHS must work towards, but is not expected to achieved from day one. We have been working with individual patients, CCGs and Trusts to encourage and support the implementation of these two pieces of guidance, wherever possible. We have also been in discussions with senior representatives of NHS England, sharing examples of best practice in places like Bury CCG and County Durham and Darlington NHS Foundation Trust, as well as example of areas where patients are not receiving adequate (or any) support to self-monitor their INR. ACSMA has also responded to an NHS consultation about the potential for self-monitoring to be used as a performance measurement for GP practices and CCGs. North East and North Cumbria Academic Health Science Network (AHSN) has introduced an AF programme, one aim of which is to reduce the number of strokes as a result of undiagnosed or untreated AF through better treatment with anticoagulants. We are supporting the AHSN to raise the profile of the latest NICE guidance and the benefits of self-monitoring, both for patients and for the NHS.
May 2015 – Scottish Parliament Petition
In May 2015, ACSMA was one of a number of stakeholders that wrote to the Convenor of the Public Petitions Committee of the Scottish Parliament in support of a petition on warfarin self-testing. Petition PE01566, ‘A National Service Delivery Model for Warfarin Patients’, called on the Scottish Parliament “to urge the Scottish Government to implement a National Service Delivery Model to ensure that all NHS boards have the resources to assess warfarin patients who request (i.e. self-present) for self-testing and/or self-management their condition”. The petition appears to have yielded positive results following the presentation of evidence by patients, Mary Hemphill and Ian Reid, and by John Fegan, Chairman of the Scottish Association for Children with Heart Disorders. On 25th June 2015, the Public Petitions Committee agreed to write to both the Scottish Government and the regional NHS boards about this topic. At the Committee’s request, the Scottish Government has subsequently agreed to meet with the petitioner, Mary Hemphill, and NHS Greater Glasgow and Clyde on the local self-management model they have developed.