Greenwich Community Anticoagulation (Warfarin) Service

NHS South East London (SEL) Integrated Care Board (ICB) (hereafter referred to as the "The Relevant Authority"), invites Providers to submit Expressions of Interest (EOI) for the delivery of the Community Anticoagulation Service (Warfarin only) in the Royal London Borough of Greenwich.

The service will be closer to patients' homes, using less invasive point-of-care testing. This allows a one-stop service including initiation, monitoring and optimisation of warfarin treatment for patients who are registered with a Greenwich GP Practice. The service must be delivered at a site within the Royal London Borough of Greenwich, or at the patient's home (if they are housebound). This community service aims to release the pressure of Queen Elizabeth Hospital anticoagulation clinic so that the hospital service is reserved for managing complex patients who require the multidisciplinary discussion between different specialists. The point-of-care test (using a finger pricking device) will reduce the burden on pathology laboratory for processing venous sample and improve patient experience with less venepuncture.

Warfarin has a narrow therapeutic window, and is affected by dietary intake of food and alcohol, as well as other medication. It is considered as a high risk medication. Patients who are on warfarin require regular blood test monitoring to ensure the international normalised ratio (INR) is within therapeutic range. Out of range INR leads to complications such as bleeding or blood clots. Providers involved in delivery of the service require additional training and have their competency signed off to meet the requirement of their role. Providers must be adequately trained to provide effective education and support to patients and carers. Providers must also ensure that there is a mechanism for ongoing continued professional development for all professionals involved in an anticoagulation service.

In order to provide a high quality and safe care to patients who are on warfarin, Providers will need to have robust governance and quality mechanisms put in place, including subscription to computer clinical decision support software (CDSS), access to a point-of-care testing device such as Coagucheck® and register with an external quality assurance scheme such as the UK National External Quality Assessment Service (NEQAS), therefore Providers are expected to receive adequate tariff to reimburse for their service.

This is a cost and volume contract, with no minimum activity guarantee.

Tariffs:
£60 for a new patient warfarin initiation appointment
£30 per INR monitoring appointment
£15 supplement for home visits