I have changed my gp

Please i could do with some advice. For reasons i wont go into I changed my gp and where i am now are excellent so i thought. I had a new patient exam all sorts of blood test everything OK. My inr was a bit unsettled so they have done it every 3 days its not settled at 2.4 good next test in 7days. So i then asked if i could carry on doing my own tests and ring in with results and the nurse said she don't think i can as the strips are too expensive too give on prescription.When i was looking for new gp i ask if they would be happy for me to self test they said yes now i feel they are changing their minds. I struggled to buy the coaguchek but i done it. Nurse said they don't now if my machine is collaborated . I just don't know what to do next. Does anybody know if i could maybe have strips prescription off arrhythmia nurse or even cardiologist. My inr can be very unstable for no reason that was why i bought my own machine. I am sorry to babble on I have no one else. I always read but have never written before. I just needed to talk to someone. Thank you very much for listening

12 Replies

  • Hi and sorry to hear you are having problems with this. If I was you I would make an appointment with your doctor and discuss it with him.. you may find that if you remind him or her that you were told you could self test they may be more obliging. Sometimes it all feels an uphill struggle doesn't it? X

  • I think sometimes the nurses can vary so I would make an appointment with the GP and discuss this - say you were told you could self test and it's important as your INR is variable.

    The nurse should check your machine by taking some blood which goes both on her machine and yours.If the results are the same that's fine.This is what my surgery did.

    If all else fails, maybe you could get tested in the clinic and also do some home testing- it would mean buying some strips- £2-£3 each.

    Some people have approached their CCG to ask about strips and have been allowed to do it.

    It is cheaper for your surgery to let you have strips than to put you on the new anti coagulants which don't require the tests so I think you may find the GP more receptive.Hope all goes well.

  • Why not ask the surgery where they get their won machines checked, and when they were last done !!!

    You dont wanna calibrate yours against one that you THINK is correct

  • But how reliable are these machines anyway? My local hospital wouln't accept the result and insisted on a blood sample before a biopsy this week. I have been at 2.5 for ages yet their result came in at 1.5. Would a 2.5 result mean that the reality is anywhere between 2 and 3?

  • I know someone who worked for a health charity. They adopted the slogan "trust me doctor, I'm a patient", turning the "trust me I'm a doctor" phrase on its head. I guess they would hide behind the fear of litigation issue in the guise of patient safety if you challenged them.

    I have also heard, but have no personal experience of, that it is the CCGs who are stopping the doctors giving strips on prescriptions. Apparently GPs are paid a per capita sum for each patient on warfarin, which includes the costing of testing and they won't pay a second sum for a prescription.

  • Jenny we had a presentation about INR at last years HRC just because of this . I had been in correspondence with various luminaries about INR testing and the reliability thereof so it was thought a good idea to have it from the leading expert. The facts are that INR testing is NOT an exact science at all. and depends on an awful lot of variables.. You could take the same blood sample to three different labs and get three different results and in the same way your INR* testing (Coagucheck machine ) will seldom agree with a blood draw test. There could be differences of as much as 1/2 across the board which was why we were told that we should ignore the 2 to 3 range and aim for 2.5 to 3.5. We were also told that there was no increased risk of bleeding up to an INR of 5.

    I'm sorry to say that people to get rather precious about their INR number thinking it is gospel whereas you can see it is a guide really. You won't get many phlebotomy girls agreeing with this as they all trust their machines and blindly follow the computer dosage and re-test dates. Don't blame them they have to believe in something

    There are new NICE guidelines on AF due out on 18th June and it would be a lost opportunity if this wasn't addressed in some way but we must wait and see.


  • Gee, thanks, Bob! I'm quite unsettled about having an INR falling from 2.3 to 2.1 and being sent away for 6 weeks on the same dose, but as I'm very unsettled about warfarin anyway, a 'good' INR would not give me a lot of confidence either.

  • Carol, you should ask your Dr for the strips as they should be available . I had to self test and be checked each week at clinic , who had replaced their old machine with a cougacheck , before having a cardio version. My doctor works on the idea that keeping the patient calm is the best way to help with the AF . Hope it works for you. Good luck Terjo

  • Anything that you use to self test is an aid not a calibrated piece of equipment. Whenever I have gone to a different hospital in another trust area my INR has been .2 different every time. They told me that this should mean that all tests are the same as they are testing random samples from different hospitals at a central testing centre.

    Can you ask your doctor for a private prescription and pay for them your self? I have been tested by extracting from the vein since 1992.

  • I used to self test before moving on to rivaroxiban. I took phenindione because of an allergy to warfarin. The cost of the phenindione was £670 per month to the NHS for 7 x 10mg tablets daily.

    The cost of the warfarin, the INR testing, the strips, the manpower and appointment system. The cost for an INR appointment ranges from. £20-£40 per visit depending on where you live.

    It costs around £35 per month to the NHS for some of the new anti-coags which don't need monitoring. They offer statistically better protection albeit smaller increase.

    I got my strips on the NHS for 7 years and rang the hospital every week or two weeks. The manufacture service the machines every year which was a condition of self monitoring.

    My INR varied considerably and this is a genetic factor on how well you clear the warfarin from your system and also the rate drug metabolism. We have no control other these aspects.

    With the new drugs we don't need to worry about it.

    Perhaps press your new GP with a case to prescribe the new anti coags because otherwise in your case the NHS would need to find 3-5 INR tests a month costing £60 - £100 alone.

    Good luck

  • Hi CarolBic, where do you live because it's a postcode lottery for getting your strips on prescription? Sadly in Dorset I have to pay for my own as the CCG policy doesn't support self testing or management. I have campaigned long and hard and have now put my name forward to the CCG as a patient representative for when they do update their policy. The latest consultative document from NICE supports self management as all the studies show that people have less strokes when they do this. It's not my GP's fault he won't prescribe them as his hands are tied. I have checked my machine against the practice one, and my surgery makes every 25th patient have a venous sample sent to the lab too. The machines also have a quality control for each strip so I feel it's as accurate as it can be.

    I'm not at home at the moment but when I am on Monday and can get on my main computer I could send you the link for the NICE info and you could print it and wave it under your GP's nose. It might help.

    Good luck, Liz

  • A very big thank you to all who answered. I am sorry I didn't respond sooner. I made appointment with new GP and she said of course I can self test the strips are already on my repeat prescription. There is no reason at all why i cannot self test and she apologized for the wrong information I received from the nurse. Many many thanks for all your support I panicked when the nurse said no. We are not very well off and struggled to pay for machine and was afraid it would have been wasted money , but all is well again I cant say thank you all enough i am very grateful for your support and advice.

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