Phlebotomy & INR Monitoring

Our Health Care Assistants and Phlebotomy team offer a blood taking service at both the Cuckfield and Vale Practice sites.  Appointments are available on a daily basis to have your blood tests taken.  These appointments must be before 2pm as otherwise they are not collected in time and transported to the hospital.  We are only able to offer blood testing for requests that have been raised by the practice.  If the hospital have asked you to have blood tests and provided you with a form we would ask that you have this taken in the phlebotomy department at the Princess Royal Hospital, Haywards Heath Monday – Friday 8:30am until 4:30pm.

We also provide anti-coagulation monitoring appointments for patients prescribed Warfarin.  At the time of your appointment you will be provided with information on your future doses of Warfarin and when to make an appointment for your next test.

Requests by hospital services to perform bloods tests in General Practice.

The workload increases in General Practice are well documented in the media. An ageing population with multiple ailments and the development of new treatments has all led to a big increase in the need for blood tests to monitor patient’s health and effects of treatment.
The increased need for blood tests is generated both by GPs and by hospital Doctors. In recent years we are receiving increasing numbers of requests by patients for blood tests requested by hospital Doctors to be done by the surgery. This additional workload is not sustainable in the long term and we are being asked to do work that has been already commissioned for in the hospital phlebotomy department.

The system creates a lot of confusion particularly for patients and reception staff who may not have a full understanding of the clinical need surrounding the request.

To try and help clarify the situation I have divided requests for blood tests into three categories.

1. Blood tests we do:

• Any blood tests requested by GPs or Allied health professionals working at the surgery.
• Any requests made to the surgery via hospital discharge summaries when patients have been admitted to hospital as an emergency.
• Some paediatric blood tests. The hospital has a specially commissioned service for this as younger children can be difficult to get blood samples from.
Any blood tests requested under a ‘shared care agreement’ which is a signed agreement with hospital consultants, usually rheumatologists where the monitoring of certain medications is shared with GP. Patients will be advised of this arrangement when the hospital Dr commences the medication.

2. Blood tests we do not do:

• Any tests requested by hospital Doctors in outpatient departments.

3. Blood tests we may do subject to discretion
• Housebound patients: The district nurses will do these tests by request from us but it is at their discretion and whether they have the capacity to perform them.
• Blood tests requested by organisations outside the practice only with prior agreement of a GP at the surgery e.g.:
a) Blood tests requested by distant, often London based hospital where it is unreasonable to ask a patient to travel just for a blood test and no other treatment. It will then be the responsibility of the patient to arrange for the result to be sent to the requesting doctor.
b) Blood tests requested as a result of a private consultation. This has always been a grey area for the NHS as legally it should not have to do work requested by the private sector but we fully understand patients may be self-funding, not insured and modern medicine is very expensive. These requests will be considered on an individual basis. Please be aware GPs are independent practitioners and may not agree with some requests made on clinical grounds as we practice evidence based medicine and must justify NHS expenditure.
c) Individual cases where getting to the hospital to have bloods taken creates huge difficulties for a patient and common sense prevails e.g.: an elderly person, who does not drive, has no relatives or carers to assist them and it is geographically much easier to get to the surgery.

There are always exceptions to any guidelines and we are happy to look at individual requests which may not be covered by the above. Please understand we do not wish to seem obstructive to patients, we are only trying to manage an ever increasing workload by prioritising work we are commissioned to do and declining work we are not, in an effort to provide the best service we can.