American in....the UK

Hello, have been on here since the beginning I think but don't think I have ever posted. I live in the US and had a PE in 2010 and was diagnosed in late 2011 after 2 positive tests for aps.

I have not been on a plane in years.

I am hoping to retire in a year or a little more, and have a dream of traveling to Ireland and Scotland to do genealogical research and experience living there = thought I might be able to afford monthly rates of airbnb

If I go I would like to try and stay 6 months. How do I get tests and how do I get refill prescription of warfarin. How much would test and medicine be for foreigners?

thank you

14 Replies

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  • Can't help with the cost of meds as I'm not in UK but you would probably be better off having your own machine to self test for INR. Usually if you're going to be away for a while you should be able to get extra doses of whatever you regularly take. Make sure you have travel insurance to cover you for the length of time you are away -VERY important!

    Otherwise it sounds a great trip! :)

  • I don't know but would have thought you'd just register with a GP and take it from there. I don't pay for my Warfarin as I'm over 60 but Warfarin is a cheap drug anyway.

  • HI the machine is a good idea, and I expect there are others from the USA who have travelled who will give you an idea about keeping up with medication. MaryF

  • Nhs is not free for American citizens generally but ìf you came over on a legal research visa valid for over 6 months from the UK you would be able to register with a General Practitioner and access the NHS and their anticoagulation services.

    The coagucheck machine strips are prescribable but cost £28 a box retail. You would need to check if your insurance will support inr testing locally but there isn't really a private inr service unless you can find a pharmacist trained then the charge is up to them.

    Not sure what the nhs would charge.

    Warfarin is around £5 - £8.40 per prescription depending on pharmacy, which you would need to pay for if you go the private route. The private prescription and consultation will also cost.

    Your USA consultant could write to the local APS consultant to ask if they will take you on for the duration of your stay as my cousin does when over from Canada for his heart condition.

  • Prescription charges in England are £8.40 for each drug. The number of tablets doesn't matter, so if a Doctor prescribes 30 tablets or 90 tablets of a drug the charge will be £8.40. If there are 2 different tablets on the prescription then the charge will be £16.80.

    As a visitor you can register as a temporary patient at a GPs surgery and the care (but not prescription drugs) will be free, however it's up to the individual surgery whether they chose to accept you. A GP surgery can do a INR check, but it will probably be an intravenous sample which gets sent to the local hospital laboratory. GP surgeries don't have their own labs. There will be a delay of around 24hrs in getting the INR result.

    Most hospitals now have Anticoagulation clinics run by the Haematology services.

    If you call a local hospital then they should be able to give you the contact details so you can arrange to go for an INR test, which will probably be done via a capillary (finger prick) blood test and you'll get the result there and then, and if they have Specialist Nurses they would be able to advice regarding the warfarin dose. Sometimes the hospital websites will have contact details for the anticoag' service. I would think that they would just do it and there wouldn't be a charge as it's a primary care service which happens to be located in secondary care facility, and it costs pennies any way.

    They wouldn't be able to give you a prescription for warfarin though, but they would be able to help you locate a "helpful" GP surgery and even call them to ask if they would accept you as a temp patient and give you a prescription.

    Some, but not many, pharmacies (drug stores) have anticoagulation services, but it would be a lot more difficult to locate these, as there's not a register, or not that I'm aware of anyway and they probably wouldn't be able to prescribe warfarin either.

    You could also (as our patients did when travelling) get an INR test locally and then contact your normal AC service in the USA and ask them to advise re warfarin dosage, but with all the litigation in the USA I'm not sure if they would do that without site of a written INR result on the correct piece of paper with a HCP signature!

    As everyone says, you could get your own machine, but seems a shame to pay for machine and strips if it's not neccesary.

    Could you get 3-6 months of warfarin before you travel? I guess that depends on how often you get tested at the moment.

  • If you go to this site

    nhs.uk/service-search

    you can enter Haematology in the search box and the place name and it will tell you locations within a certain radius and you can view them on a map. It's unfortunate that you can't search for anticoagulation services.

    This is similar site for Scotland, but it took me a while to find it, and you need the postal (zip) code for the area

    nhs24.com/findlocal/

    Hope these help. This way if you plan your route you can plan and set up where you're going to have your INR checks done in advance.

  • I don't know if you are a pharmacist or gp misswoosie but my advice was based on the English system. Things are a little different in Scotland as all prescriptions are now free there. However my prices were for private prescription costs due to the above.

    Very few hospitals are providing the finger prick option for inr in London but I don't know about Scotland.

  • Hi, Yissica. I used to be a Cliinical Nurse Specialist in a hospital based anticoagulation service in England.

    We managed 2000 outpatients on warfarin and all the inpatients in the hospital. We would never have managed unless we did finger prick tests as we were doing about 400 INR's a week. Some clinics were at the hospital, some we did at GP surgeries.

    When you say very few hospitals are providing finger prick option for INR, do you mean anticoagulation clinics within hospitals? I would think that any anticoagulation service, whether it be hospital or community based (and I don't just mean someone getting an appointment with a nurse to have a blood sample taken for INR, I'm talking about an INR clinic that takes place on a regular basis)

  • Sorry- I would imagine that they're all doing capillary blood tests and POC testing with instant INR. I found a document regarding the management of antiocagulation in Tower Hamlets in London, and they were certainly doing capillary blood tests. When I say they do finger prick tests, I don't mean they use the coagucheck strips-way too expensive.

  • Yes none of the North London hospitals or gp services use this and are also very sceptical of its efficacy. I had to switch hospitals to central London justto have my coagucheck readings recognised and not visit weekly hospital clinics which were over subscribed and impossible to speak to.

    It's just my personal experience but I am a community pharmacist in North London and have seen the poor uptake of finger inr testing in London. I hope the service is better elsewhere in the country.

  • Yessica, but I think you're talking about the person doing finger prick tests using the coagucheck strips and the machine ie self monitoring and then calling the hospital/ GP for dosage advice.

    I'm talking about staff at the specialist Anticoag clinics doing capillary samples ( finger prick and then blood into a glass capillary tube) which then goes into a rotating pot with reagent in a machine (name escapes me). When the blood clots, the machine stops and gives a read out in seconds (the prothrombin time-PT). The INR is then calculated from the PT (there's a chart).

  • Here is the information that you need:

    anticoagulationeurope.org/a...

  • Thank you so much for all the replies. It seems doable. I would think my coumadin clinic would go for the dr.s office or walk in clinic more so than the self = testing. I currently buy my warfarin without insurance for 3 months as it is cheaper and easier, and if you all have Wall Marts? Or do your Costcos have pharmacies? They could just call in my prescription to the local place maybe and it would get picked up in the system, maybe?

  • We have Costco but you need to be a member. Walmart is part of Asda in the UK. Not sure that would work. I suspect accepting a US prescription in a UK pharmacy no matter who its from may be an issue as its the same if I was to walk into a US pharmacy with a british script it would not be accepted. May have to check that one out a bit more as private scripts may be different.

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