Primary Care Ophthalmology confrence 2103

www.primarycareophthalmology.co.uk©

Andrew Partner

&

Paul Jewitt

Oxfordshire Commissioning Group Experience

Discussion not lecture!!

1. The problem identified by the data

2. Plan

3. Implementation

4. Barriers

5. Discuss!

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Working together in eye care

• Shift in the balance of care - “the right patient needs to go the right place”

• Improve Optometric referral quality• Maximise optometry skills and resources

with community services • Reduce unnecessary GP referrals through

electronic triage and referral feedback.

Liberating the NHS: Eye careNick Bosanquet

The way forward• A defined and purposeful partnership

between community based optometry/ophthalmic services and hospital based ophthalmology services.

1. Shift in the balance of care - “the right patient needs to go the right place”

2. Improve Optometric referral qualityProblem

• 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

2. Improve Optometric referral qualityPlan

• 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

2. Improve Optometric referral qualityBarriers

• 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

2. Improve Optometric referral qualityImplementation

• Electronic GOS has been circulated • Paper form of redesigned GOS18. • Training Videos produced.

• NHS net as of October 2013……….

3. Maximise Primary Care Ophthalmic skills and recourses with community services

3. Maximise Primary Care Ophthalmic skills and recourses with community services

OMP's

Optometrists

Oph-thal-mol-

ogists

General Practioners

OMP's

Optometrists

Ophthalmologists

General Practioners

The steps

1. The problem identified by the data

2. Plan

3. Implementation

4. Barriers

5. Discuss!

Breakdown in 1st Outpatient appointments by typeUnfortunately 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)

30%

20%20%

15%

15%

GlaucomaCataractAMD and otherAnterior segment Casualty

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%)

3. Maximise Primary Care Ophthalmic skills and recourses with community services

The steps

1. The problem identified by the data

2. Plan

3. Implementation

4. Barriers

5. Discuss!

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

3. Maximise Primary Care Ophthalmic skills and recourses with community services

Steps

1. The problem identified by the data

2. Plan

3. Implementation

4. Barriers

5. Discuss!

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What are the barriers for Optometrists?

Barriers perceived by UK-based communityoptometrists to the detection of primary openangle glaucomaJoy Myint1, David F. Edgar1, Aachal Kotecha1,2, Ian E. Murdoch3 and JohnG. Lawrenson

Discuss

3. Maximise Primary Care Ophthalmic skills and recourses with community services

• How are you maximising the skills and resources of the Primary Eye Care

practitioners in you area?

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