{"id":3631,"date":"2025-02-12T13:12:43","date_gmt":"2025-02-12T13:12:43","guid":{"rendered":"https:\/\/nhsdorset.nhs.uk\/medicines\/?page_id=3631"},"modified":"2025-09-30T09:47:31","modified_gmt":"2025-09-30T08:47:31","slug":"best-value-doac-ipoc","status":"publish","type":"page","link":"https:\/\/nhsdorset.nhs.uk\/medicines\/best-value-doac-ipoc\/","title":{"rendered":"Best Value DOACs (Incentivisation for Pace of Change) in primary care"},"content":{"rendered":"

Best value direct oral anticoagulant (DOAC) prescribing<\/h2><\/div>

<\/i><\/i><\/span>What are the ICB contracting me to do?<\/span><\/a><\/h4><\/div>
\n

In line with NHS England Best value DOAC recommendations<\/a> switch, all clinically appropriate, existing edoxaban patients with non-valvular atrial fibrillation (AF) to either generic apixaban or generic Rivaroxaban.<\/p>\n

Content is available on the PQS 24\/25 webpage, to support the management of newly diagnosed AF patients or those prescribed branded Apixaban or Rivaroxaban.<\/p>\n<\/div><\/div><\/div>

<\/i><\/i><\/span>Why is this part of the contract? <\/span><\/a><\/h4><\/div>
\n

As per the NHS England commissioning recommendations for the national procurement for direct-acting oral anticoagulants<\/a> (DOACs), generic apixaban and generic Rivaroxaban offers best value treatment for atrial fibrillation.<\/p>\n<\/div><\/div><\/div>

<\/i><\/i><\/span>How do I do it? <\/span><\/a><\/h4><\/div>
\n

Run the SystmOne search provided to identify existing patients prescribed edoxaban who are eligible for a switch to best value DOACs under the IPoC scheme:<\/p>\n

Dorset SystmOne GPs> Best Value DOACs> Work to do: clinically review edoxaban for switch<\/p>\n

Invite patients for a clinical review of their Edoxaban, using the template letters and text messages provided.<\/p>\n

Where clinically appropriate, after a shared decision-making process with patients, recognising their preference in choice of either apixaban or Rivaroxaban, switch existing patients prescribed edoxaban for non-valvular AF to either generic apixaban or generic rivaroxaban.<\/p>\n

Where it is not clinically appropriate to switch patients to a best value DOAC from edoxaban, the patient should remain on edoxaban, but the relevant exemption code must be added to the patient record, which will remove them from the SystmOne search.<\/p>\n\n

\n\n\n\n\n\n\n\n\n\n\n\n\n
Code<\/th>\nTerm<\/th>\n<\/tr>\n<\/thead>\n
XaLTs<\/td>\nAnticoagulant therapy stopped<\/td>\n<\/tr>\n
Xad9s<\/td>\nApixaban not tolerated<\/td>\n<\/tr>\n
XadAI<\/td>\nApixaban contraindicated<\/td>\n<\/tr>\n
Xad9m<\/td>\nApixaban adverse reaction<\/td>\n<\/tr>\n
Xad9t<\/td>\nRivaroxaban not tolerated<\/td>\n<\/tr>\n
XadAK<\/td>\nRivaroxaban contraindicated<\/td>\n<\/tr>\n
Xad9n<\/td>\nRivaroxaban adverse reaction<\/td>\n<\/tr>\n
XaPT9<\/td>\nNot suitable for switch to generic medication e.g. due to disability and self-administration of medicines e.g. visually impaired, explicit secondary care request to remain on edoxaban<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n\n<\/div><\/div><\/div>

<\/i><\/i><\/span>What resources are provided to help me deliver this?<\/span><\/a><\/h4><\/div>
\n

SystmOne search:<\/strong><\/p>\n

Dorset SystmOne GPs> Best Value DOACs> Work to do: clinically review edoxaban for switch<\/p>\n

Template text message:<\/strong><\/p>\n

\u201cNHS Dorset have asked GP teams to review the prescribing of Edoxaban in line with NHS England recommendations. Please book an appointment at the surgery when convenient to discuss this further\u201d<\/em><\/p>\n

Template patient letter<\/a><\/p>\n

For further details regarding the scheme please see the following document:<\/p>\n

Incentivisation Pace of Change – Best Value DOACs in Primary Care FAQ<\/a><\/p>\n

Incentivisation Pace of chance scheme in primary care: best value DOACs<\/a><\/p>\n

NHS England commissioning recommendations for the national procurement for direct-acting oral anticoagulants<\/a><\/p>\n

Relative associated major gastrointestinal bleeding risk of best value DOACS – graphic<\/a><\/p>\n<\/div><\/div><\/div><\/div><\/div>

NHSE atrial fibrillation first line DOAC choices<\/h2><\/div>

<\/i><\/i><\/span>What are the ICB asking me to do? <\/span><\/a><\/h4><\/div>
\n

When initiating a DOAC for a new case of atrial fibrillation, prescribe generic apixaban or generic Rivaroxaban.<\/p>\n<\/div><\/div><\/div>

<\/i><\/i><\/span>Why are you asking me to do this? <\/span><\/a><\/h4><\/div>
\n

As per the NHSE Commissioning recommendations for national procurement for direct-acting oral anticoagulant(s) (DOACs) generic apixaban or generic Rivaroxaban offers best value treatment for atrial fibrillation.<\/a><\/p>\n<\/div><\/div><\/div>

<\/i><\/i><\/span>How do I do it? <\/span><\/a><\/h4><\/div>
\n

Run the SystmOne search provided to identify any patients newly initiated on DOAC therapy for atrial fibrillation and ensure that generic apixaban or generic Rivaroxaban has been issued.<\/p>\n<\/div><\/div><\/div>

<\/i><\/i><\/span>What resources are provided to help me deliver this?<\/span><\/a><\/h4><\/div>
\n

SystmOne searches: Dorset SystmOne GPs\/PQS Finance 2526\/F5 Apixaban\/Rivaroxaban in new AF.<\/p>\n

NHSE Commissioning recommendations for national procurement for direct-acting oral anticoagulant(s) (DOACs)<\/a><\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-3631","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/nhsdorset.nhs.uk\/medicines\/wp-json\/wp\/v2\/pages\/3631","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/nhsdorset.nhs.uk\/medicines\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/nhsdorset.nhs.uk\/medicines\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/nhsdorset.nhs.uk\/medicines\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/nhsdorset.nhs.uk\/medicines\/wp-json\/wp\/v2\/comments?post=3631"}],"version-history":[{"count":25,"href":"https:\/\/nhsdorset.nhs.uk\/medicines\/wp-json\/wp\/v2\/pages\/3631\/revisions"}],"predecessor-version":[{"id":4079,"href":"https:\/\/nhsdorset.nhs.uk\/medicines\/wp-json\/wp\/v2\/pages\/3631\/revisions\/4079"}],"wp:attachment":[{"href":"https:\/\/nhsdorset.nhs.uk\/medicines\/wp-json\/wp\/v2\/media?parent=3631"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}