The aim of the Direct Oral Anticoagulant (DOAC) Locally Commissioned Service (LCS) is to improve the quality of DOAC initiation and monitoring in primary care.

• Improve patient access to safe and effective anticoagulation initiation through collaboration between the patient’s GP and a consultant anticoagulation specialist.
• Offer a cost-effective, standardised, and clinically effective service for Enfield patients requiring a DOAC.
• Ensure that practices have a register of patients on DOAC therapy. This will consist of all patients either initiated on, or who have a current prescription for, a DOAC.
• Provide patients with structured, high-quality, evidence-based information to enable them to make fully informed decisions regarding their treatment.
• Ensure patients are initiated (and maintained) on DOAC therapy in a safe and timely way in line with best practice.
• Identify and manage appropriately patients with specific needs such as co-morbidity, frailty and other factors resulting in vulnerability.
• Provide an annual review for monitoring as a minimum. More frequent reviews may be needed dependent on clinical factors. Monitoring includes reviewing the need for continuation of therapy as well as changing therapy if clinically appropriate.