Dudley Eye Care Services From 3 rd September 2018 Speakers Charles - PowerPoint PPT Presentation

Dudley Eye Care Services From 3 rd September 2018

Speakers Charles Barlow (Director PEHWM) Rosie Birhah & Paul Sidhu (Dudley LOC) Webstar Health

Introduction There will be a lot of information tonight ……its all in your info pack Key Points Service Specifications & pathways Patients Questionnaires Policies & Guidance Sign Up Forms & Guidance Stationery Before you go fill in our Delegate attendance & Training Form

Tonight's Running Order Part 1 - Overview Part 2 - The Services Part 3 – Training & Governance Part 4 - Software

Part 1 Dudley CCG are launching 3 new eye-care services :  Cataract  IOP Repeat Reading (IOPRR)  Minor Eye Conditions (MECS) These are to be provided by GOS practices in Dudley Launching on 3 rd September 2018

NHS Contract awarded to PEHWM who Directors subcontract to all Charles Barlow practices. Ian Hadfield Peter Rockett Peter Bainbridge Dan Sanders Webstar provide and Aisha Jeewa support the software that underpins the servcie The LOC communicates with PEC (HWM) Ltd both giving CCG and receiving feedback. Webstar LOC PEHWM Ltd PEHWM are responsible for all practices contract compliance. Monitored by a network of CG&PL This makes us pretty tough on Practices who Practice Practice Practice Practice Practice Practice Practice don’t perform.

Your commitment  Information Governance  Accreditation  Infection control  Safeguarding  Patient care Provide the right care at the right time [follow the protocols]

Everything is done via Webstar, Optomanager Software. Eliminating administration, generating insight The package of web platforms called OptoManager has been developed for Local Optical Committee Support Unit (LOCSU) by Webstar Health. The technology virtually eliminates manual administration of optical services, helps with data collection and generates insightful performance reports.

When we say everything, we mean everything All clinical records - you enter the data into dropdown boxes or text boxes All referrals – referral are sent automatically to ophthalmology with copies to GP All patient satisfaction questionnaires are provided by the system All patient information leaflets are downloaded from the software Governance – all documentation is uploaded to the software Invoices and payment – all managed by the software – no paper returns

Who is entitled to these services? The services are commissioned for patients registered with a Dudley CCG GP You will only be paid for appropriately registered service users. We will not pay for people who just live in Dudley, or have a Dudley Postcode, - it all depends on their GP If their GP is from another West Midlands CCG, they may still be entitled to a service – check whether a service is available on Webstar and then check the service specifications as they can all differ slightly.

Part 1 Summary • Dudley CCG have commissioned a Cataract, IOPRR & MECS service from 3 rd September 2018 • Your LOC Company PEHWM are contracting with the CCG for the service • All practices will need a contract with PEHWM • Any practice can provide the service as long as they comply with the governance requirements • The service is managed by an Webstar software online • The service is just for patients of Dudley CCG GPs . Don’t forget to fill in our Delegate attendance & Training Form before you leave

Part 2. Cataract Referral Pathway To provide assessment and management of patients presenting with signs and/or symptoms of cataract in either eye It includes: ▪ Pupil dilation and examination by indirect ophthalmoscopy in order to establish whether there are any co-existing ocular disorders as well as cataract. ▪ Discussion of the health questionnaire and any outstanding issues dealt with. ▪ Communicating the potential advantages and disadvantages of cataract extraction ▪ Ascertaining the patient’s willingness for surgery including a patient self- assessment questionnaire

Cataract Referral Patient meets eligibility Offer Choice of provider Complete Optomanager record and Optomanager will send referral to chosen provider and copy to GP for information You can print off the record and referral for your records

IOP Repeat Measures Service The IOP repeat measures service provides primary care repeat readings to deflect unnecessary referrals to secondary care. Patients who are identified as having IOP ≥ 24 mmHg and no other signs of glaucoma during a GOS or private sight test will have immediate slit lamp GAT or Perkins tonometry. If IOP still ≥ 24mmHg patient returns within 1 month for second repeat. Complete Optomanager record and where required Optomanager will send referral to chosen provider and copy to GP for information

Minor Eye Conditions Service (MECS) Purpose of Service Using the skills of primary care optometrists to triage, manage and prioritise patients presenting with an eye condition, To deal with recent onset eye problems that are not appropriate for sight tests and to reduce referrals by GPs and Optometrists to secondary care Experience elsewhere shows 70-80% deflection It is no good seeing patients and referring most anyway This will be monitored closely

MECS You will need to provide  Triage [staff training, forms available]  Same day appointments  48 hour appointments  Full recording of all contacts  Provide advice and guidance & information on self-care  Therapy via pharmacists  Report to GP or Referral if required - auto-generated

MECS - criteria for inclusion of patients Loss of vision (inc transient loss) Epiphora (watery eye) Sudden onset of blurred vision Trichiasis (in growing eyelashes) (unless a sight test reqd) Differential diagnosis of lumps and Ocular pain or discomfort bumps in the vicinity of the eye Systemic disease affecting the eye Recent onset of Diplopia Differential diagnosis of the red eye Flashes/floaters Foreign body & emergency contact Retinal lesions lens removal (not by the fitting Patient reported field defects practitioner) GP referral Dry eye

MECS Triage

Take care Flashes and Floaters in particular VA Dilate Check for Schafer’s sign and record Indirect exam, 8 directions of gaze, wide field Volk Careful record Give F & F advice sheet Give drops advice sheet

MECS is for All (relatively urgent) minor eye conditions BUT NOT FOR: Wet AMD found during ST Refining referrals from a ST (e.g. glaucoma/cataract) But can use for F & F F & F stable for >3m 2 nd incident of F & F within 1 month of 1 st (follow up) Repeated dry eye within 4 months of 1 st MECS Repeated removal of lashes within 4 months of 1 st MECS Where a sight test would be more appropriate

Take care More not for… Adult squints Longstanding diplopia Yet more not for… Repeat field tests AMD Where other enhanced Previously identified: serviced are appropriate Severe eye conditions needing HES Cataract referral Herpes Zoster Cataracts post-op Tumours Repeat IOP Diabetic retinopathy

MECS outcomes GP report Treat and discharge Reassure and discharge [patient leaflets available] Advise Therapy Follow up Refer to GP Routine referral Urgent referral Emergency referral

Direct referral to eye casualty clinic If your patient requires Eye A&E or fast track Wet AMD Make sure everyone in the practice has a copy of the protocol from Russells Hall & BMEC for out of hours For A&E Telephone first  Triage options are same day or urgent clinic 24/48 hours  Patient contact details (telephone numbers) and brief referral details . Give patient a copy to take with them.  Fax Wet AMD to the fast track clinic

Part 2 Summary • The three new services are Cataract, IOP RR & MECS • Follow the service specifications • Record all patient contacts on Webstar. • All MECS enquiries must be Triaged and where required be seen by optometrist: • Within 24hrs for urgent • Within 48hrs for routine • Optometrists must, within reason, be able to offer a MECS examination within 48 hours of the day that the appointment has been requested (excluding weekends and public holidays) unless it is for routine assessment. • You must manage DNAs • If you don’t have an appointment you must find them one elsewhere Don’t forget to fill in our Delegate attendance & Training Form before you leave

Part 3 - Optometrist Accreditation: • GOC Registered • Cataract - Completion of Wales Optometry Postgraduate Education Centre (WOPEC) Cataract Services Online Distance Learning • IOP RR - WOPEC Level One of the Glaucoma online distance learning programme relating to IOP and Visual Field Refinement. Also show that they can demonstrate the technique competently (through practical demonstrations). • MECS - WOPEC Distance Learning modules (Part 1), and the associated Practical Skills Demonstration (Part 2 - OSCEs). • Safeguarding level 2 certification (DOCET)

LOCSU training provided by WOPEC Request your unique WOPEC authorisation code from the LOC , website (contact us) or directly form Paul Sidhu at whitestar123@hotmail.com Go to the WOPEC website www.wopec.co.uk and choose to either ‘Register’ or ‘Login’. In the green ‘Code’ box on the website’s homepage enter your code. This will be made of two parts, a prefix (example: LOCSU) and a code (example: 1234567).