Oxfordshire Commissioning
Group Experience
Andrew Partner
&
Paul Jewitt
www.primarycareophthalmology.co.uk
©
Discussion not lecture!!
1.
2.
3.
4.
5.

The problem identified by the data
Plan
Implementation
Barriers
Discuss!
Working together in eye care
• Shift in the balance of care - “the right
patient needs to go the right place”
• Improve Op...
1. Shift in the balance of care - “the right patient
needs to go the right place”
Liberating the NHS: Eye care
Nick Bosanq...
2. Improve Optometric referral quality
Problem

• Current GOS 18
– Legibility problems
– Problems with patient ending up i...
2. Improve Optometric referral quality
Plan

• Electronic redesigned GOS 18 (PDF)
– Legibility problems
– Problems with pa...
2. Improve Optometric referral quality
Barriers

• Electronic redesigned GOS 18
– Lack of access to computer
– PMS interfe...
2. Improve Optometric referral quality
Implementation

• Electronic GOS has been circulated
• Paper form of redesigned GOS...
3. Maximise Primary Care Ophthalmic skills and
recourses with community services
3. Maximise Primary Care Ophthalmic skills
and recourses with community services
OMP's
OMP's
Optometrists

Ophthalmologist...
The steps
1. The problem identified by the data
2. Plan
3. Implementation
4. Barriers
5. Discuss!
3. Maximise Primary Care Ophthalmic skills and
recourses with community services
Breakdown in 1st Outpatient appointments ...
3. Maximise Primary Care Ophthalmic skills and
recourses with community services
Community Services
• Glaucoma (30%)
–
–
–...
The steps
1. The problem identified by the data
2. Plan
3. Implementation
4. Barriers
5. Discuss!
3. Maximise Primary Care Ophthalmic skills and
recourses with community services

LOCSU – Referral Refinement
•

Level 1a ...
Steps
1. The problem identified by the data
2. Plan
3. Implementation
4. Barriers
5. Discuss!
What are the barriers for Optometrists?

60
50
Percentage

40
30
20
10
0

Barriers perceived by UK-based community
optomet...
3. Maximise Primary Care Ophthalmic skills and
recourses with community services

Discuss

• How are you maximising the sk...
www.primarycareophthalmology.co.uk
©
Primary Care Ophthalmology confrence 2103
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Primary Care Ophthalmology confrence 2103

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Primary Care Ophthalmology confrence 2103

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  • 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
  • implementation
  • Barriers
  • Primary Care Ophthalmology confrence 2103

    1. 1. Oxfordshire Commissioning Group Experience Andrew Partner & Paul Jewitt www.primarycareophthalmology.co.uk ©
    2. 2. Discussion not lecture!! 1. 2. 3. 4. 5. The problem identified by the data Plan Implementation Barriers Discuss!
    3. 3. 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. www.primarycareophthalmology.co.uk ©
    4. 4. 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.
    5. 5. 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
    6. 6. 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
    7. 7. 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
    8. 8. 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……….
    9. 9. 3. Maximise Primary Care Ophthalmic skills and recourses with community services
    10. 10. 3. Maximise Primary Care Ophthalmic skills and recourses with community services OMP's OMP's Optometrists Ophthalmologists Optometrists General Practioners Ophthalmologists General Practioners
    11. 11. The steps 1. The problem identified by the data 2. Plan 3. Implementation 4. Barriers 5. Discuss!
    12. 12. 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
    13. 13. 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%)
    14. 14. The steps 1. The problem identified by the data 2. Plan 3. Implementation 4. Barriers 5. Discuss!
    15. 15. 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
    16. 16. Steps 1. The problem identified by the data 2. Plan 3. Implementation 4. Barriers 5. Discuss!
    17. 17. 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
    18. 18. 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?
    19. 19. www.primarycareophthalmology.co.uk ©

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