This document discusses strategies for improving eye care services in Oxfordshire.
1. It aims to shift more appropriate patients away from hospitals and into community-based optometry and ophthalmic services through better defining partnerships between community and hospital services.
2. It also seeks to improve the quality of optometric referrals by transitioning to an electronic referral form and implementing feedback. Barriers include lack of computer access and technical ability.
3. Another goal is to maximize skills and resources of community optometrists by having them take on services like glaucoma monitoring, pre- and post-cataract care, and refining referrals through expanded tonometry and visual field testing skills. Identifying barriers
5. 1. Shift in the balance of care - “the right patient
needs to go the right place”
Liberating the NHS: Eye care
Nick Bosanquet
The way forward
• A defined and purposeful partnership
between community based
optometry/ophthalmic services and hospital
based ophthalmology services.
6. 2. Improve Optometric referral quality
Problem
• Current GOS 18
– Legibility problems
– Problems with patient ending up in wrong
clinic or just general clinic.
– Passing on additional information for the
benefit of the Consultant
• Snail Mail
• Feedback mechanism
7. 2. Improve Optometric referral quality
Plan
• Electronic redesigned GOS 18 (PDF)
– Legibility problems
– Problems with patient ending up in wrong clinic or just
general clinic.
– Passing on additional information for the benefit of the
Consultant
• NHS net
– Passing on additional information for the benefit of the
Consultant
– Snail mail
– Feedback mechanism
8. 2. Improve Optometric referral quality
Barriers
• Electronic redesigned GOS 18
– Lack of access to computer
– PMS interference
– Technical ability
– Apathy
• NHS net
– All of the above but to the power of 20
– HES .net addresses
– GP willingness to receive email referrals
9. 2. Improve Optometric referral quality
Implementation
• Electronic GOS has been circulated
• Paper form of redesigned GOS18.
• Training Videos produced.
• NHS net as of October 2013……….
10. 3. Maximise Primary Care Ophthalmic skills and
recourses with community services
11. 3. Maximise Primary Care Ophthalmic skills
and recourses with community services
OMP's
OMP's
Optometrists
Ophthalmologists
Optometrists
General Practioners
Ophthalmologists
General
Practioners
12. The steps
1. The problem identified by the data
2. Plan
3. Implementation
4. Barriers
5. Discuss!
13. 3. Maximise Primary Care Ophthalmic skills and
recourses with community services
Breakdown in 1st Outpatient appointments by type
Unfortunately Hospital Episode Statistics (HES) data are worthless for understanding N:F
ratios according to disease category because in 97% of OPD hospital visits disease is
unspecified (RCOphthal)
15%
30%
Glaucoma
15%
Cataract
AMD and other
Anterior segment
20%
20%
Casualty
14. 3. Maximise Primary Care Ophthalmic skills and
recourses with community services
Community Services
• Glaucoma (30%)
–
–
–
–
Repeat IOP and fields
Glaucoma referral refinement
OHT monitoring
Stable Glaucoma monitoring
• Cataract (20%)
– Pre-Op refinement
– Post Op
•
•
•
•
Learning Disabilities
Low Vision
Children's Vision Post Screening
PEARS/Minor Eye conditions/Other Community based
referral pathways (30%)
• Ophthalmology Referral Triage (Catchall 100%)
15. The steps
1. The problem identified by the data
2. Plan
3. Implementation
4. Barriers
5. Discuss!
16. 3. Maximise Primary Care Ophthalmic skills and
recourses with community services
LOCSU – Referral Refinement
•
Level 1a Goldmann Applanation Tonometry
– If IOP >21 mmHg at GOS or private sight test, Optometrist carries out Goldmann
applanation tonometry and repeats on a separate occasion if necessary
•
Level 1b Visual Field Refinement
– If suspicious visual field at GOS or private sight test, optometrist carries out
repeat measurement on a separate occasion
•
Level 2 OHT Monitoring
– Patients who are diagnosed by secondary care (or specialist practitioner) as
having OHT which does not require treatment will be referred for monitoring in
the community at intervals specified by NICE
17. Steps
1. The problem identified by the data
2. Plan
3. Implementation
4. Barriers
5. Discuss!
18. What are the barriers for Optometrists?
60
50
Percentage
40
30
20
10
0
Barriers perceived by UK-based community
optometrists to the detection of primary open
angle glaucoma
Joy Myint1, David F. Edgar1, Aachal Kotecha1,2, Ian E. Murdoch3 and John
G. Lawrenson
19. 3. Maximise Primary Care Ophthalmic skills and
recourses with community services
Discuss
• How are you maximising the skills and
resources of the Primary Eye Care
practitioners in you area?
Now those of you who were lucky(or unlucky) enough to hear me talk last year would have seen this slide. I ran though how we looked at gathering data. I showed that although it is a pretty difficult task, it is a vitally important task in identifying the inefficiencies in the provision of Ophthalmic services. As I said then….it is easy to just bury your head in the sand and say “no data” no problem”…….But we went to all the effort as the OCCG in gathering the data and identifing the areas that needed work. Now it is just as easy at this time to get back into this position and say “no the pathways fine.” CHANGE IS DIFFICULT
Now I am not going to run though all the data gathering that I presented last time (as there was quite a bit of it) As the dreaded after lunch session when everyone's eyes are getting a little heavy, we wanted to keep this session interactive , more a discussion than a lecture, so we are going to do is tell you is The problem the data identified our plans, how we are implementing them, the barriers and then we would really welcome you input on prehaps how things are going in you area.
So these are some of the thing we will chat about
So numerouno that Andrew was really keen on was not so much a problem identified but rather a Goal that we would be aiming at when looking at the provision of Ophthalmic services. “ right patient /right place… and this is pretty much a no brainer. Nick B in his paper on liberating the NHS identified the way forward as “A defined and purposeful partnership between community based optometry/ophthalmic services and hospital based ophthalmology services” Primary care setting /Secondary care setting So as I said rather than a problem this would be our Goal.
Now from last years slide I put up this map, which identifies all the community or enhanced services in eyecare in each area….and as you can see Oxford has just one. Explain slide . As you can see some area are good and some like Oxford not so good. So the problem we identified was #2 Maximise Primary Care Ophthalmic skills and recourses with community services
Now in the initial slide we had put optometry skills…. But you will note that I changed that here to Primary Care Ophthalmic Skills….. As there is more than just the Optometrists involved , there are GP’s, there is most of you as GPSI’s, there are community Ophthalmologists and eye care charities that can all play a role in provision of primary eye care.
So what was our plan
So if we look at a breakdown of the Outpatients …. And where improvements can be made , you’ve got the BIG 5
If we then look at Community services what we could provide. Started with IOP repeats