NICE guidelines for AF

Has this actually happened for any of you?

NICE guidelines CG180 August 2014 requires GP’s offer people with atrial fibrillation a personalised package of care. The package should be documented and delivered and cover stroke awareness, rate control, rhythm control, contacts for advice, psychological support, anti coagulation and support networks.

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  • No......

  • Cant even get to see a GP

  • No. We have a new GP who I have seen about my shoulder. I told him that I had AF and fully expected him to check my pulse. But, no.

    Yesterday's Daily Mail had a feature about new AF guidelines proposed by NICE. Apparently they want GPs paid a bonus for identifying patients with AF and then prescribing anticoagulation thereby cutting the number of stroke victims.

  • Link to Daily Mail article.

    dailymail.co.uk/health/arti...

    Soon GP's will be getting more bonuses than footballers just for doing their jobs.

    Extra for diabetic patients, extra for diagnosing Alzheimer's and now AF.

    Years ago the GP I had stopped me in the street and said that he was running a well man clinic and I should make an appointment. I asked him why he was so keen and he said that he was getting £25 for every patient seen. Another time I went for holiday vaccinations and he asked when I had last had a tetanus jab. When I said many years ago he promptly did one adding that he was getting £10 for every one he did this month.

    Another time I went for Lariam anti malarial tablets. He said that I didn't have to pay for mine but he did so he would add his to my prescription and phone his fellow countryman at the pharmacy to tell him to keep his for him.

  • See my comment below.

  • The article uses the words 'blood thinners'. To be pedantic it should read 'anticoagulants'. A common error.

  • That is just so stupid doctors and practice nurses understand it.

  • And flu jabs, smear tests, the list goes on....

  • The article said why should they be paid for doing what they already should be doing.

  • No doubt there will now be an "epidemic" of AF - just like there was of high cholesterol, type-2 diabetes, etc., etc.

    Will they never learn?

  • Be glad that you were found and treated before the stampede!

  • Yes but many of gp's that I have seen over the last few years only do as the cardiologist or EP say and as we know are very busy people. With any attacks I get I change my dose or get to A&E. Even when ordering medication I find it easier to order direct from the chemist. The modern GP doesn't seem to have the same time as the previous ones that always had plenty of time for the patients

  • How do you order your medication straight from the chemist?

  • My GP is at a surgery at a clinic of several surgeries with a system whereby we can order medications and appointments by phone or email. The chemist will take the order to the GP, pick up the note fill the prescription and if asked will deliver it to my home. Very handy to put it blunt.

  • The surgery I use allows me to order repeat prescriptions online through a patient plus login then once GP approves prescription it is sent electronically to my nominated pharmacy where they make up the prescription and then deliver to my home. Record from ordering to delivery was 2.5 hours but usually up to 24 hours. Electronic system has basically been in place for a couple of years plus but final link of transfer from GP to pharmacy only 12 to 18 months approx.

  • Ours is similar but I choose to collect it from the pharmacy.

    Some of it is very nit picking. The site strictly adheres to dates when you can next reorder it.

    The practice manager said that I put in a lot of prescriptions. I always ask for them on the due date even if I have a few in hand.

    They even try it with Warfarin when you never know the future number you will need. Sometimes the date gets muddled I recently had one that came up with a 2017 date.

    You can separately ask for ones that are not required on a regular basis if you give a reason.

  • Never have a problem with dates. I get given two months supply at a time and sometimes have ordered the next one a month in advance of running out.

  • No advance ordering with us. I have had to ask the doctor if going to be on holiday when next due.

    I was speaking to an Australian over here for six months and he had his whole supply with him,

  • The website I am registered through is patient. Emisaccess. Co. Uk /. Maybe it's not a common site as yet but I trust it.

  • Well each practice decides who they want to go to, what functionality, etc. Emis certainly provide the service for patient plus.

  • I was amused when at reception the other day when a member of staff from a pharmacy over the road had taken her prescription back and was telling them that it had been issued for double the strength that she takes.

    The average patient might not have noticed.

  • There is already a requirement that GPs record those patient with AF. Has been for many years. There are GPs and GPs of course. MY medical centre is very good in that respect but others may not be.

  • Never heard of it. That would be nice.

  • If only!!!!

    For me at diagnosis the most important feature would have been psychological support. The rest was like finding out the facts of life as an adolescent in the fifties. Rough idea but no detail.

  • I left school in 1950 at that time only the girls at my school had sex education classes.

  • I wasn't born then!!!

  • Trouble was the girls were not going to practice what they were taught.

  • I feel I have had quite good treatment from my G.P. but I have never been notified of a personalised package thats for sure!

  • Ditto - same as you dedeottie

  • No

  • Only in my dreams

  • I asked my GP to refer me to an EP? He said "What do they do?" 😂

  • My GP (who is really very good) was surprised when I said that an AV Node ablation would not cure my AF.

  • The vast majority of my care and investigations have been instigated by myself and/or my EP of the moment.

    My GP practice can't even co-ordinate the requirement for weekly INR tests in anticipation of my numerous ablations.

    When I tried to discuss my allergy problems associated with the glues used to monitor me during procedures the answer I got was 'do you really want to have another ablation?' Wider discussion was non existent.

    I believe that if I did not have 25 years of experience of PAF, self motivation and a reasonable level of interlect I would be left to deal with my AF alone and I would be just wondering why I, from time to time, was feeling the way I do when the AF kicked in.

  • Have to say, my practice did invite me in for a check but only started this year, letter said to attend for a review of long term condition AF so bloods, pulse check etc but that was it, so better than nothing I suppose. Gp however is pretty good but she is leaving so ????

    who knows!

    wendy

  • What?!

  • No.

  • THANKS FOR BRILLIANT POST!!!

    Given the context, how many points would you give for this doctor?

    Context includes:

    Very recent AF diagnosis. (On emergency admission to hospital, kept in 1 week, discharged 12 days ago with no guidance).

    Very confused picture re coping with AF because also have autonomic nervous system dysfunction with chronic low BP and untypical response to meds, so having very confusing symptoms...

    So both STARS (syncope trust) and (this week) paramedics had pressed me to ask for an EP who also specialises in autonomic nervous system.

    Doctor's response? Pointed at the ECG and said "See that? THAT'S Electrophysiology!"

  • No never heard of this pack. But oh boy it would be very much appreciated. I have permanent AF but after various hospital admissions cardioversion and now on a 4 month waiting list for ablation I am not much wiser as to the best way of managing my symptoms, which occur daily! Seen so many Drs with so many differing advice I am sometimes in a whirl knowing which route to take.

    Every time ive visited the GP when my symptoms have been severe, the GP has blue lighted me straight to hospital. (3 times in the last year).

    So a personal plan would be an excellent way forward

  • Try printing this out and taking it with you on your next appointment - it is a guide - but may help in some of your cases - they do change the NICE guidelines, so he may not be up on the latest version or a new guide. Can't help to give it a go? Good luck.

  • The head nurse at the practice I go always buys the Mail on a Tuesday for the health articles as she says that they always cause a surge of questions.

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