As a practising old age psychiatrist in another part of Mersey Care Trust, I read Darley et al's article on domiciliary phlebotomy for elderly patients (Psychiatric Bulletin, April 2004, 28, 120-122) with interest.

I agree with the authors’ conclusion that domiciliary phlebotomy can be a viable method of performing blood investigations in old age psychiatry. However, the financial savings demonstrated in the study might be hard to replicate in other parts of the trust or in other National Health Service trusts.

The main reason for the low cost appears to be minimum distance travelled in each visit (1.4 miles return journey). The average return journey in my patch would be 6 miles. For the 511 visits done in the study, it would mean a total journey of 3066 miles (compared with 730 miles in the study) and it would cost £1165 on travel for the service (compared with £285 in the study).

The financial savings in travel cost would therefore be only £130 (compared with £1010 in the study).

The expenses also do not seem to take into account the cost of employment of the phlebotomist. We have trained one of the support workers in taking blood who provides the domiciliary service for patients unable to attend the community clinic. He also provides the service in the clinic for other patients who attend the clinic for out-patient appointments, thus not necessitating ambulance journeys purely for phlebotomy.

Thus, we have neither needed to separately appoint a community phlebotomist and also have reduced unnecessary ambulance costs by making him available on clinic days.