Download EHEW Frequently Asked Questions

Eye Health Examinations Wales (EHEW) Summary and FAQs
Summary and
Frequently Asked Questions
WECS allows the optometrist to exercise their clinical judgement to treat,
manage and refine patient referrals and to be remunerated properly. This
service does not replace GOS and should ensure that patients in Wales can
have access to the same high quality eye care wherever they may live.
Because the service is new, if unsure how or what to claim for you should
contact [email protected] or refer to the Clinical Guidance that has been
issued.
Summary
1.
The Eye Health Examination Wales - EHEW (Band 1)
This is a replacement for both PEARS and WEHE and incorporates
assessment of sudden onset eye problems and those at increased risk of eye
disease or those who would find losing their sight especially difficult.
Note that a Band 1 cannot take place on the same day as a GOS 1W.
A Band 1 should include a refraction where clinically necessary and an NHS
voucher (GOS 3W) can be issued following a Band 1 with refraction. If a
GOS3W voucher is issued following a refraction from a Band 1, it must be
issued from the private prescription (rather than from a GOS 2W) as detailed
in Making Accurate Claims (Wales) (MACW).
The same patient categories apply as previously for PEARS/WEHE with the
following new addition: ‘The patient needs investigations to comply with WG
agreed protocols’. WG agreed protocols currently include (further categories
may be added in the future):
• Dry AMD monitoring
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2.
Further Investigation/ Examination (Band 2)
A Band 2 follows a GOS or private sight test only.
Band 2 is to enable optometrists to further inform their referral or investigate
clinical findings. It is only to be used in such circumstances. It cannot, for
example, be used when dilating the pupil of a patient to get a better view of
the fundus. This would be normal practice and does not inform a referral or
investigate a clinical finding.
Examples include:
• Cycloplegic refraction of a child
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Eye Health Examinations Wales (EHEW) Summary and FAQs
Threshold testing visual field examinations for unexplained headaches
Pre-operative assessment of a patient with cataract (to include patient
counselling - handout of the cataract questionnaire and dilation)
• Repeated contact tonometry and visual fields assessment to refine a
referral based on initial findings of raised IOPs during a GOS or private
eye examination
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3.
EHEW Follow-up Examination (Band 3)
Patients may be followed-up after they have attended for a Band 1 EHEW.
Only one follow-up appointment is allowed in one calendar year. Follow-up
examinations may be used at the discretion of the optometrist and include all
clinically necessary procedures. Note that a Band 3 does not follow a Band 2
examination.
Examples of eye problems requiring follow-up for patients include:
• Investigation of dry eye (referred by GP) following treatment
• Removal of in-growing eyelashes following an initial Band 1 where
patient was referred by the GP in the first instance
• Monitoring of a corneal abrasion 48 hours after a Band 1
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Frequently asked questions
The new EHEW service is much more flexible then previous services enabling
optometrists greater clinical freedom but this brings responsibility to only do
what is clinically necessary and in the patient’s best interests.
Can I do a Band 1 and GOS 1W on the same day?
No.
A refraction can be done as part of a Band 1 so there is no need to do a GOS
1W test. Where a Band 1 is performed in acute cases (PEARS type), the
refraction part may need to be performed on a different day (e.g. after a
corneal abrasion has healed).
What if a patient has a Band 1 but cannot be dilated and needs to return
on a different day?
If the patient requires pupil dilation and needs to be seen on a different day to
do this then you cannot claim a further fee for the dilation on a different day.
There will be some circumstances where a Band 1 demands more ‘chair time’
in the form of a second patient visit.
Can I do a Band 1 and then a GOS 1W on the same patient at 6 month
intervals (i.e. 2 tests per year)?
No.
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Eye Health Examinations Wales (EHEW) Summary and FAQs
You should either manage your patient under WECS using EHEW Band 1 at
yearly intervals (with Band 3 if appropriate); or manage your patient under
GOS using sight tests at the clinically appropriate intervals in-line with the
published Memorandum of Understanding on Sight Tests Intervals (with Band
2 if appropriate); or manage your patient with private sight tests (with Band 2 if
appropriate).
If a patient attends for a sight test (GOS or private) and you determine that
they fall in to an EHEW (Band 1) category you may either:
1. Convert to a Band 1 EHEW on that day (if time permits) and recall the
patient for Band 1 EHEWs yearly in future. (In some cases, patients
may also require a Band 3 on another day after their EHEW.)
2. Perform a GOS or private sight test that day (as planned, if there is no
appointment time to convert to an EHEW) and recall the patient for
Band 1 EHEWs yearly in future. (In some cases, patients may also
require a Band 2 on another day after their GOS or private sight test).
How long should a patient’s symptoms be present to be considered
‘acute’?
In most cases a Band 1 for eye problems of sudden onset should be used
only for patients who have an eye problem with symptoms/signs of less than 1
week’s duration. This may include a long-standing problem that has suddenly
got worse within the past week.
The exception to this is symptoms of flashes and floaters, which may be
considered acute if they are less than 3 months old.
See http://www.college-optometrists.org/en/professionalstandards/clinical_management_guidelines/index.cfm
If I see a patient at risk of eye disease do I have to dilate the pupil for a
Band 1?
Yes.
In exceptional circumstances if there is a legitimate clinical reason for not
dilating then annotate the record card and the claim form.
Do I have to dilate for a Band 2 if I am referring the patient for cataract?
Yes.
Dilating the pupil can ensure that you are not missing any other ocular
pathology, particularly at the macula.
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Eye Health Examinations Wales (EHEW) Summary and FAQs
In exceptional circumstances if there is a legitimate clinical reason for not
dilating then annotate the record card and the claim form.
If I get the patient to fill out a cataract questionnaire for a Band 2 and
from this find the patient actually decides against referral for the
operation, can I still claim a Band 2?
You may only claim the Band 2 fee if the patient attends for a Band 2
appointment. If the patient fills out the questionnaire and decides against
surgery and does not attend for a Band 2 appointment, you may not claim the
Band 2 fee.
However, if the patient fills out the questionnaire, attends for a Band 2
appointment and after examination and further discussion with you decides
against referral, you may claim the Band 2 fee.
What are the suggested examinations for a Band 2 in someone found to
have raised IOP following a private eye exam?
Repeated contact tonometry (Goldmann or Perkins), binocular indirect
ophthalmoscopy (through a dilated pupil in most cases) and an appropriate,
repeated visual field examination.
Can I follow up a patient with dry eye seen as a GOS 1W with a Band 3?
No.
The Band 3 is for Band 1 EHEW follow-ups only.
Can I do a follow up Band 3 to see the patient again after I have claimed
Band 2 for a cycloplegic refraction?
No.
A Band 3 can only ever follow a Band 1 examination.
If using a Band 2 for a cycloplegic refraction of a child following a GOS1W, the
GOS1W cannot be claimed until the Band 2 has been completed. At that point
the GOS1W and the WECS form can be submitted but the date of both claims
must be the date of the Band 2 examination as that is the date on which both
tests were completed.
Does the new EHEW replace the GOS?
No
It is important to remember that the new EHW does not replace the protected
GOS. There are many circumstances when only a GOS 1W should be used
such as gradual changes in vision in a patient with cataract.
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Eye Health Examinations Wales (EHEW) Summary and FAQs
Does the new EHEW replace existing local enhanced services?
If you have a locally enhanced service in operation then please contact your
Regional Optical Committee (ROC) for further advice.
www.optometrywales.com
[email protected]
Can I give an EHE to someone who lives outside of Wales?
If a patient resides outside of Wales then they are not entitled to a WECS.
However, if a patient residing outside of Wales but with a legitimate reason for
visiting Wales self-refers to your practice with an ocular emergency they are
entitled to an EHEW (similar to a patient visiting a GP practice for a health
emergency as a temporary resident).
Can other practice staff undertake elements of the examinations?
All investigations should be performed to the satisfaction of the optometrist so
that he/ she can be sure that the results are clinically accurate. Certain tests
such as visual field examinations may be delegated but optometrists must
satisfy themselves that they are accurate and free from error.
Do I have to use the WECS 2 and 3 referral forms?
Wherever possible we would like you to use the forms. We understand that
many practices will have their own templates and forms, which they will want
to use. We would ask you to highlight that it is a WECS referral at the top of
your letter if you are using your own template.
Do I have to always write to the GP following an EHEW?
Yes, you should keep the GP informed in all circumstances even if you are
managing the patient or you did not find anything of note.
Further information can be found in the service guidance
www.eyecarewales.nhs.uk or by contacting [email protected]
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