Responsibility for determining the overall national approach to improving clinical outcomes from health care services lies with NHS England. There are a range of anticoagulant treatments available, including Warfarin and novel anticoagulants. It is for individual clinical commissioning groups (CCGs) to commission treatment and services for patients, as they are best placed to identify what is needed in their local areas. It is the responsibility of NHS England to support CCGs and ensure that they are safely and effectively discharging their commissioning responsibilities, and are making progress in delivering excellent outcomes for patients. This support may include providing commissioning resources, tools or guidance. NHS England advises that it expects practitioners to consider anticoagulant treatments in conjunction with National Institute for Health and Care Excellence (NICE) guidelines and to discuss treatment options with the patient before deciding on the most appropriate course of action. The Department has made no assessment of the use of self-monitoring technology in the national health service. Under its Diagnostics Assessment Programme, NICE is developing guidance on self-monitoring coagulometers for self-testing or self-managing coagulation status in patients with atrial fibrillation or heart valve disease for whom long-term vitamin K antagonist therapy is intended. NICE expects to issue guidance in July 2014. NHS England advises that it will then consider what action, if any, is required, taking this guidance into account.