2. ANTICOAGULATION IN PRIMARY CARE The Sea-Urchin Model !

3. Who am I ? Dave Bottoms, Pathology Services Manager South Durham Health Care Teespath IT Project Manager

4. THE HUMBLE SEA-URCHIN

6. Pressures on Anticoagulation Control Services Too Many Patients Overcrowding Delays Angry Patients Stressed Staff H&S Issues Complaints Mistakes Litigation

7. ALTERNATIVE SOLUTIONS Improve Secondary Care –More clinics –Faster clinics Use of NPT More staff (phlebotomists, practitioners) Take the patients out of the Secondary Care –Dosage at Home by healthcare workers Self-control –Dosage in Primary Care In the GP Practices ? Other locations Change the anticoagulant drug to one that does not need blood test monitoring

8. BENEFITS OF DOSING IN A PRIMARY CARE SETTING 1.Patient Access – closer to home 2.Less delay 3.Less hurried appointments 4.? More flexibility on dates 5.? Clinician better briefed on holistic care 6.? One-stop visit

9. DISADVANTAGES IN TRANSFER TO PRIMARY CARE 1.? Less control/ standardisation of treatment 2.Fragmentation of DAWN Database 3.? Results do not get into Pathology Database 4.? Need to move to NPT 5.? INR results less accurate 6.Training Demands 7.Cost 8.Manpower Resource

10. PRIMARY CARE OPTIONS Option 1. DAWN AS STAND-ALONE IN EACH LOCATION Benefits Comprehensive In-house Control Drawbacks Very expensive Fragmentation of Database

11. PRIMARY CARE OPTIONS Option 2. DAWN PROVIDED AS SECONDARY CARE LAP-TOP Benefits Retention of centralised database Affordable Drawbacks Involves travel time for key staff Exposes data to risk (while in transit)

12. PRIMARY CARE OPTIONS Option 3. TRANSFER OF INFORMATION VIA DISC/ CD Benefits Retention of centralised database Affordable Drawbacks Involves travel time for key staff Exposes data to risk (while in transit)

13. OPTION URCHIN Electronic upload of data from central database through Dial-up link (NHS Net) Manipulation/ update in primary care Electronic download back to central database through Dial-up link (NHS Net)

14. Option : Urchin Benefits Retention of centralised database Affordable No staff travel required Far less risk with no-risk potential Drawbacks ? PRIMARY CARE OPTIONS

15. Set up across Co Durham and the Tees Valley in 2001/2002 includes : South Tees Acute Hospitals NHS Trust –James Cook University Hospital –Middlesbrough General Hospital –Friarage Hospital, Northallerton North Tees and Hartlepool NHS Trust –University Hospital of North Tees, Stockton –Hartlepool General Hospital Durham and Darlington Acute Hospitals NHS Trust –Darlington Memorial Hospital –Bishop Auckland General Hospital –University of Durham Hospital A PATHOLOGY CLINICAL NETWORK

16. Teespath Projects Anticoagulant Dosing in Primary Care Lab to Lab Links Anglia ICE Requesting Better Blood Transfusion Telepathology Document Management

17. North Yorks Moors S Tees Northallerton N Tees Darlington Bishop Auckland Durham Hartlepool THE HOSPITALS

18. North Yorks Moors S Tees Northallerton N Tees Darlington Bishop Auckland Durham Hartlepool HOSPITAL CATCHMENTS AN IDEALISTS VIEW

19. North Yorks Moors S Tees Northallerton N Tees Darlington Bishop Auckland Durham Hartlepool FUTURE SAMPLE TRANSFER The North The South HOSPITAL CATCHMENTS THE TRUE PICTURE

20. Nursing Homes RESULT AVAILABILITY Mental Health Cancer Centre(s) Primary Care Tertiary Care / Referral Labs DMH HA

21. Darlington Memorial Hospital OUR PRIMARY CARE SECTORS Darlington PCT The Dales PCT Sedgefield PCT

22. ANTICOAGULANT DOSAGE IN PRIMARY CARE Reduce Clinic Overload Improved patient access Sustain single database Standardise dosing procedures DMH BAGH Shildon S Tees N Tees Hartlepool Friarage

28. Reduce Clinic Overload Improved patient access Standardise dosing procedures DMH BAGH Shildon S Tees N Tees Hartlepool Friarage