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NHS England: Improving eye health and reducing sight loss – A Call
to Action
Response from: VISION 2020 UK, led by
The VISION 2020 UK Ophthalmic Public Health Committee
Date:
10th September 2014
Contact details:
Miss Parul Desai
Chair, VISION 2020 UK Ophthalmic Public Health Committee
[email protected]
Matt Broom
VISION 2020 UK, UK Operations Manager
[email protected]
VISION 2020 (UK) Ltd is a registered charity and supporting member of the WHO
“VISION 2020: The Right to Sight”, global initiative for the elimination of avoidable
blindness1.
The membership of the VISION 2020 UK Ophthalmic Public Health Committee includes
all the major stakeholders and professional bodies involved in eye health and social
care in the UK. These are •
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Association of Directors of Adult Social Services
British and Irish Orthoptic Society
Certification of Vision Impairment Steering Committee
Faculty of Public Health
Local Optical Committee Support Unit
Royal College of General Practitioners
Royal College of Nursing (Ophthalmic Section)
Royal College of Ophthalmologists (including paediatric representation)
Royal National Institute for Blind People
The College of Optometrists
The Optical Confederation
UK Vision Strategy
VISION 2020 UK
1
Our response to this Call focuses on the domain of healthcare public health and health
services.
Our key priorities for change are –
1.
The UK Vision Strategy2 provides a framework for change and was formed
following consultation with over 650 eye health and sight loss organisations and
stakeholders. It was first published in 2008 and refreshed in 2013. NHS England
together with the Department of Health and Public Health England should visibly
support and promote its implementation and progress towards achieving its objectives
for preventing sight loss and improving population eye health and well-being.
2.
Consistency in:


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procurement of services
clinical pathways
professional competencies to support co-management and autonomous working
in the community
quality standards for care and services provided
The current NHS organisational arrangements have resulted in fragmentation of
commissioning, provision and delivery of primary and secondary sector eye health
services, with immediate implications for care pathways, ongoing social care support,
and the equitable introduction of new interventions or services. Community optometric
practices serve patients from multiple Clinical Commissioning Groups (CCGs), with
each CCG often having their individual requirements for referral, refined or co-managed
care.
Collectively these pose considerable clinical and bureaucratic barriers for developing
and delivering services and community pathways effectively, are responsible for
endless duplication of effort and resources and result in variations in standards and
quality of care. Additionally, interventions and services for small or specific groups of
patients, those with rare conditions, or those with ocular and systemic comorbidity, are
at particular risk of being overlooked and thereby also introducing inequalities in access
to health and care.
3.
Information and Intelligence to:
2
•
•
monitor population eye health and services
inform the commissioning process
Improve quality of Hospital Episode Statistics (HES) for eye care: These routine
operational data are generated from the provision of NHS care in hospitals (admissions
and out-patient care). The quality of these HES data for out-patient attendances is
incomplete, inconsistent and inaccurate, yet these data represent the national record of
this type of activity and are used as proxies for need, for service development and
commissioning decisions. Improving the quality of data on out-patient attendances
coded by diagnosis and procedure should be a reasonable and deliverable short to
medium term action.
Address the gap in data from community services – activity, quality and
outcomes. Services provided by community optometrists should provide data flows
for national aggregation along the lines of HES. The infrastructure to provide this is not
insignificant, but unless addressed there is no information on returns of the investment
(financial or otherwise) in the value and potential of the activity provided in this sector
either for NHS GOS services or other enhanced, shared or co-managed care.
Certification of Vision Impairment (CVI) The CVI is an important population eye
health indicator and some specific causes (DR, glaucoma and AMD) are included in the
Public Health Outcomes Framework. There is an immediate risk to the ongoing data
collection and collation for this indicator as the funding for this currently provided by
charitable sources ceases in January 2015. In the medium to longer term there is a
need for mainstreaming this national data collection and its management within a
national repository to ensure ongoing access, availability, analyses and application of
these data.
4.
Sharing of data and information for direct patient care:
Good communication and secure sharing of relevant information between health and
care professionals, and their patients, at each stage of the patient’s pathway, facilitated
by electronic patient records and underpinned by community optometric connection to
N3 and NHS mail, to support:
•
•
•
patient self-management, particularly for chronic diseases
care pathways across sectors and co-management (where applicable and
appropriate)
educational - greater awareness of impact of eye health (risks, management,
well-being) amongst health and care professionals, improve quality of referrals
and patient care
3
5.
Governance and Quality Assurance
The commissioning process should ensure that eye care is delivered safely, by
appropriately trained professionals, is compliant with NICE guidance, and audited for
outcomes and value for money. As such there is a pressing need for clarity in the roles
and responsibilities of all players in the processes of commissioning and provision of
care, to ensure safe, effective care based on clinical need.
Nationally, accredited professional training and continuing professional development for
extended clinical roles (optometrists, nurses, and orthoptists) for shared or co-managed
care, is essential and should be addressed as an urgent priority, in consultation with the
relevant professional bodies responsible for setting standards of practice.
Call to Action: Improving eye health and reducing sight loss
Survey questions
Financial investment
1.
How can we secure the best value for the financial investment that the NHS
makes in eye health services?
1.1
Avoid duplication of effort and resources, and unnecessary bureaucracy through
a strategic, consistent, evidence-based, and needs-based approach to
commissioning for:
•
•
•
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Procurement of services
Clinical pathways
Quality standards for care and services provided
Managed introduction on new interventions/ therapies through pro-active
dialogue and planning between clinicians, providers and commissioners, to
ensure timely, equitable and accessible care and services are available to meet
new needs
4
For example - A disproportionate amount of time, resource and budget is spent
on commissioning repeat intra-ocular pressure (IOP) measurements using
Goldmann applanation tonometry and repeat visual fields for refinement of
glaucoma referrals. The costs of procuring this service at local (CCG) level far
outweigh those for providing the service itself 3, 4.
It is proposed that this repeat measurement (with IOP measurement using
Goldmann applanation tonometry) should be included within the routine GOS
service. This would standardise practice and coverage, and, enhance skills in
the community supported through the provision of additional refresher training,
on what is core competency. It would improve quality of the care provided and
the more appropriate onward referral for specialist opinion. It would also improve
patient experience by removing the additional step in the pathway currently
imposed in some areas by such referral refinement by another practitioner.
1.2
Eye health should not be considered in isolation of wider health and well-being.
Public health has a key role in ensuring this through its role in Local Authorities,
CCGs, Health and Wellbeing Boards, and working with Local Eye Health
Networks; by providing objective dialogue and interpretation of eye health needs,
information and intelligence in the context of broader population health and public
health interventions for health improvement.
Pathways, prevention and integrated services
2.
How can we encourage a more preventative approach to eye disease to
reduce the burden of blindness and vision impairment?
2.1
Primary prevention of sight impairment –– there is no good, robust evidence
for the primary prevention of ocular disease. There is good epidemiological
evidence on the association of sight impairing conditions with chronic systemic
diseases (e.g. cardio-vascular disease, hypertension, stroke, diabetes)
responsible for premature mortality and morbidity5-16, so any generic public
health interventions (e.g. for smoking cessation, improving diet, reducing obesity,
increasing physical activity), designed to modify risk of these will also have a
beneficial impact on eye health and prevention of sight loss. Raising general
awareness of these associations with eye health among health and social care
staff, and community pharmacists, is important and necessary for aligning key
messages in health education and assessment of high risk and vulnerable
groups in the population.
5
2.2
Secondary prevention: early detection of disease
2.2.1 Population-based screening
i.
Children : The UK National Screening Committee’s policy recommendation
(December 2013) for a systematic population screening programme for
vision defects in children, aged between 4 and 5 years, offered by an
orthoptic-led service, should be implemented.17 Implementation of a national
programme could be readily supported by robust high level indicators such as
population coverage of the screening programme; proportions offered screening;
proportion taking up screening offer, without posing great additional burden for
data collection.
ii.
Diabetic Retinopathy Screening - The national diabetic retinopathy screening
programme was established in England in 2006, with supporting national quality
standards and tools for implementation. Variation in coverage of the screening
service exists18, and the underlying causes for this should form the basis of
regular local review and action, together with monitoring of its quality assurance
and outcomes of referral for specialist care.
The NSC shall be reviewing the current screening intervals and its
recommendations, when published, should be implemented in full.
iii.
Other conditions – Any new population-based screening activities for other eye
conditions should be evidence-based and only be introduced with the approval
and support of the National Screening Committee.
2.2.2 Opportunistic case detection for high risk population groups
There exists in eye care, an established primary care (optometric) service
providing opportunistic case detection of disease (early stages or otherwise) and
primary prevention through health education on modifiable risk factors. Making
better use of this service, informed by epidemiological evidence on high risk
groups (including vulnerable groups such as the elderly in care homes, people
with dementia, or learning disabilities19 etc.), for more consistent, targeted
availability of these primary care services, would improve quality of care and
patient experience, contribute to preventing sight loss and raise public
awareness. (please see our responses below to Questions 4,5 also)
6
2.3
Tertiary prevention – to be effective this implies that there is timely access to
and availability of appropriate care, intervention and rehabilitation. Services
should be commissioned from, and coordinated across all relevant agencies
encompassing the whole eye health pathway, with direct input and discussion
with people with eye health problems, sight impairment and sight loss, and
underpinned by standards for professional skills, competencies and
responsibilities within the health (and care) systems.
Such pathways could be informed by, and built on the broad, core framework
provided by the Adult UK Sight Loss Pathway20, and the Guidelines and
Pathway for Children and Young People (0 to 25 years) with Vision
Impairment, and their Families21, which have been developed as initiatives of
VISION 2020 UK using the UK Vision Strategy. Embedded within these are the
principles that people with eye health problems or sight loss get the right care,
information and support at the right time and from the right person, taking into
account the patient’s needs for their routine activities and support in the
community. These pathways could also be used to develop links between
health and social care, and the role of Eye Care Liaison Officers (ECLO) and the
voluntary sector in effecting this should not be overlooked. In doing so there is
a need for standardisation of the role and responsibilities of the ECLO and
specification of the essential training, skills and competencies required for the
role22.
3.
How do we encourage individuals to develop personal responsibility for
their eye health and sight?
3.1
Information:
Effective communication and availability of assured, good quality, evidencebased and accessible information is essential to support individuals in making
healthier choices and for patient engagement in their ongoing care, ensuring that
these reach diverse communities and vulnerable groups (including carers,
supporters and associated professionals) in the population. Condition-specific
information should be aligned where appropriate, to wider messages on health
and services, and its provision be facilitated at local level through shared
resource for translation and dissemination services in connection with the new
NHS England ‘Accessible Information Standard.’
7
3.2
The Power of Information23 is the current 10-year strategy for transforming the
way patients and the public get and use information about their health. It should
be implemented, and in addition all conventional, digital, web and electronic
media for health and social care should be required to meet accessibility
standards for sight impaired people to ensure that they also realise its benefits.
3.2
NHS Choices is a key source of patient information, and for eye health there is a
need to review its scope and content, ensure its quality and evidence base, the
transparency and provenance of its sources, and the processes for providing
timely information in accessible formats in connection with the new NHS England
‘Accessible Information Standard’.
4.
How can we increase an understanding of eye health amongst health and
social care practitioners in the wider professional network, particularly
amongst those who are working with groups at higher risk of sight loss?
4.1
Eye health should not be considered in isolation of wider health and well-being.
Awareness of eye health and the implications of sight loss and its effect on those
affected, together with the healthcare services available, should be included in
the training of health, public health and social care professionals. (also please
see our response to Question 2)
4.2
It is estimated that about 40% of mild to moderate sight loss is due to
uncorrected refractive error, and particularly amongst those of 65 years of age
and older24. Enquiry on whether a person has up to date glasses or refraction
check in routine general practice would be a pragmatic and simple inclusion in
health check assessments in this age group. During a hospital admission, routine
nursing care should also ensure that if glasses are worn that the patient has
these with them in hospital, and any topical eye medications are included in the
drug history, particularly for emergency admissions.
4.3
Eye health and sight loss is a national public health priority, but until recently, it
was an often overlooked factor contributing to population health and well-being.
As such there should be better alignment of existing public health activities with
those focusing on prevention of sight loss, with recognition of the mutual benefits
achieved in doing so, and avoid duplication of effort and resources.
8
5.
How can we ensure that all relevant NHS services identify and address
potential eye health problems for patients with long term conditions where
eye health problems are a known possible outcome?
5.1
Make every contact count – in the first instance, incorporate a public health
message on eye health at every visit to the GP and during every sight test visit.
This may happen already, but there is an opportunity here to ensure that these
messages are evidence based and supported by professional guidance, that
these are consistently provided to raise public awareness on eye health issues,
and to inform healthier lifestyle choices. Particularly ensure professionals are
aware of eye health risks amongst at risk groups such as children and those with
learning disabilities.
5.2
Community Pharmacists also have a role in health education reinforcing key
relevant messages for wider health and eye health, as well as providing
information and assistance on use of eye medications to facilitate compliance
with medication.
6.
How do we develop an approach to commissioning that makes the best use
of the skill mix that is available in hospital and community resources?
6.1
The commissioning process should ensure that eye care is delivered safely, by
appropriately trained professionals, is compliant with NICE guidance, and audited
for outcomes and value for money.
6.2
Services should be commissioned from, and coordinated across all relevant
agencies encompassing the whole eye health and care pathway, with direct input
and discussion with people with eye health problems, sight impairment and sight
loss. An integrated approach to provision of services is fundamental to the
delivery of high quality care to people with sight impairing conditions, for all levels
of prevention (primary, secondary and tertiary) of sight loss, supporting people
with vision impairment to maintain their independence and inclusion in society.
6.3
Nationally accredited professional training and continuing professional
development for extended clinical roles (optometrists, nurses, orthoptists), is
essential and should be addressed as an urgent priority, in consultation with the
relevant professional bodies responsible for standards of practice. Currently
these are piece-meal, and often locality-based with variation in the content and
evaluation of the training provided, and the need for additional training to provide
safe and effective co-managed care through extended clinical roles is often
overlooked in the drive to reduce costs.
9
6.4
With varying models of care now often involving a number of providers in a
patient pathway (shared or co-managed care, referral refinement etc.) and often
across a number of sectors, there is an urgent need for clarity in the roles,
responsibilities and accountability (both clinical and managerial) of all providers
involved in the care pathway, and for those commissioning it. The Francis
Report is clear in its requirement for demonstrable assurance of quality of care
and governance across the whole care pathway.
Specification of quality standards for the core common aspects of a pathway
across health and social care (e.g. detection, referral, diagnosis, management,
care plan, monitoring, rehabilitation), linked to professional skills, competencies
and responsibilities within the health and care systems, would provide
commissioners, providers and practitioners with a framework to support
coordination and accountability of services.
7.
Can we develop more widely the integrated role of eye health professionals
in primary care in the identification and management of chronic or acute
disease?
This will be dependent on the provision of better means of communication and
sharing of information for patient management and provision of their direct care.
This could be effected immediately if the enabling technical infrastructure was
made available, without posing significant additional burden on routine clinical
practice -
8.

Community optometric connection to N3 and NHS mail to enable direct referral,
and facilitate communication and information sharing on patient care between
hospital eye services and community optometrists.

NHS number - this should be used across all primary eye health care service
providers, and “back office” support should be extended to community optometric
practices to enable them to use it.
What can we do to relieve pressures in ophthalmology departments
because of difficulties in discharging patients back into the community?
If the term “discharge” is being used here in the conventional sense following an
acute intervention or admission to hospital e.g. following cataract surgery, then
10
we are not sure that discharging patients back into the community is a major
problem.
The more pressing issue is how best to organise and deliver ongoing routine
monitoring and review of chronic conditions in an effective, safe and quality
assured manner that is acceptable and accessible to patients. Please see our
response to Question 12a.
Access
9.
How can we appropriately increase access and uptake of timely routine
sight tests for the general population, including for people at higher risk?
We assume this question relates to both the NHS sight test service which is
available for only sections of the population, and to those sight tests for which a fee
is payable. Before encouraging any increase in the uptake of timely routine sight
tests, we propose there is a need for further discussion on, and review of:
The recommended intervals for adult sight tests so that these reflect current
evidence, health needs, standards for clinical practice and organisation of health
services in England. The recommended current interval (2 years for the eligible
population) is historic and based on achieving a pragmatic balance between
perceived clinical need and business needs.
Core components and function of the sight test. New technologies for clinical
assessment and ophthalmic imaging have been taken up in community optometric
practice, and their role as an adjunct to the sight test should be reviewed, together
with the need for supporting competencies for interpreting the additional tests, if their
potential value in primary care to improve quality and timeliness of referrals, is to be
realised. Currently these additional tests attract a fee and the implications of these
on access and availability in terms of clinical and population need should also be
considered.
The implications of increased uptake of sight tests and referrals to hospitals
should also be quantified so that the appropriate services are available to
accommodate the inevitable additional volume of activity generated – both in
community optometric practice and the hospital eye service.
Routine data and gaps in information on the sight test service. Available data
are on activity but its quality and completeness could be improved. Also as with
other community services, there are no routinely available data on the quality and
11
outcomes of the service provided. The enabling infra-structure and processes
necessary to address these gaps needs to be provided.
The above reviews are necessary not only so that the sight test provides an
appropriate and relevant service for current population needs, but so that the public
can be informed of the value of sight tests and their role in eye health, and be clearly
distinguished from the commercial retail aspects of selling glasses that often pose
barriers to their uptake25, 26; as well as to address the social class inequalities in
uptake of NHS-funded eye examinations27. The output of such review could in the
first instance be directed to the population currently eligible for NHS sight tests, and
other population groups at high risk of developing disease e.g. glaucoma.
10.
How can we improve timely access to eye health treatments and sight loss
services for vulnerable or seldom heard groups?
10.1
Make better use of the primary optometric service for opportunistic detection and
referral (subject to the changes proposed in response to Question 9).
Responses to Questions 2, 4, 5 and 6 also apply here.
10.2
Ensure there is a better understanding of the risks of eye disease amongst wider
health and care professionals, through incorporation in professional development
and training, and the inclusion of vision impairment in any impact and diversity
assessments (guidelines, health policy, and service developments).
10.3
Address the gaps in existing undergraduate clinical curricula on eye health and
its associations with systemic health. In medical and nursing curricula these are
often overlooked or given a low priority, and it is likely that this applies to other
professional groups involved in providing the care services.
User involvement
11.
How do we best involve service users and their carers in the development,
design and delivery of NHS services for eye health?
11.1
The key groups to engage include:
12
•
•
•
•
people with eye conditions living with sight impairment and sight loss,
people attending hospital clinics/receiving treatment for eye conditions (but not
visually impaired)
the general public who have not had the need to access eye health services
the voluntary sector
11.2
A range of media meeting accessibility format standards should be used and this
should be in connection with the new NHS England ‘Accessible Information
Standard.’
11.3
Impact and equality assessments should specifically include vision impairment,
so that the views of this population group are both sought and recognised.
12.
In stimulating debate about the potential for transferring more elements of
eye care from hospitals to the community we want your views on:
a)
What is the evidence base to support the suggestion that providing more
eye care in the community will prevent eye disease and reduce
unnecessary expenditure elsewhere in the health and social care system,
and how do we ensure the services are safely delivered?
The available evidence does not support these assumptions. Care in the
community is not necessarily cheaper than in hospitals, and transferring care into
the community poses a real risk for increase in demand. For minor surgery and
GPSII services (other than eye care) care cannot be safely transferred from
specialists to primary care practitioners, and whilst care in the community is
perceived to be popular with patients, it may not be sustained if there are losses
in quality of care28.
Where care is provided should be based on what levels and type of care are
needed (routine monitoring, complex, chronic or acute management), patients’
expectations of their care, and the skills and competencies required to meet
these effectively, safely and responsively, using standardised clinical
assessments and measurements.
b)
What are the workforce implications (development / re-structuring /
training) to ensure safe and effective services for patients, and how would
these be delivered?
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i.
As in our response to Questions 4 and 10- Eye health should not be considered
in isolation of wider health and well-being. Awareness of eye health and the
implications of sight loss and its effect on those affected, together with the
healthcare services available, should be included in the training of health, public
health and social care professionals at undergraduate and postgraduate level.
ii.
As in our response to Question 6 - Nationally accredited professional training and
continuing professional development for extended clinical roles (optometrists,
nurses, orthoptists), for safe and effective co-management; and training of
technicians for diagnostic assessments; to contribute towards providing
additional capacity and support for delivering timely services.
iii.
Review numbers of Ophthalmologists needed to meet delivery of Consultant-led
clinical pathways, and specialist services.
iv.
There is a need for standardisation of the role and responsibilities of the Eye
Care Liaison Officer (ECLO) and specification of the essential training, skills and
competencies required for the role22. This could build on the work started by
RNIB in an attempt to address this gap (which falls short of specifying the basic
qualification or experience needed before taking up this role29, 30 ).
v.
IT and information governance training for all staff (clinical, support, technical and
administrative) in using and working with electronic clinical and administrative
management systems and software. These systems are introduced to support
and facilitate practice and improve quality and safety, but the time and the
content needed for training is often overlooked and grossly underestimated. As
such there are significant delays in their implementation, adoption and realisation
of their benefits, with implications for service delivery.
c)
What are the IT requirements to support more community care?
As indicated in see our response to Question 7 i.
NHS number - this should be used across all primary eye health care service
providers, and “back office” support should be extended to community optometric
practices to enable them to use it.
ii.
NHS electronic connectivity of community optometry practices is essential
for managing patient pathways, sharing of essential information for patient care,
and inter-professional communication and feedback.
14
iii.
d)
An e-Referral Dataset – this is currently being developed by the optometric and
optical community to address this current gap. It will be aligned to existing
condition-specific clinical datasets. The benefits are obvious, but implementation
will be dependent on availability of secure NHS electronic connectivity.
What are the information requirements to support more community care?
There are significant information requirements and gaps not just to support and
inform community care but the wider eye health services. These are essential for
monitoring the impact of these on health needs and population eye health i.
Certification of Vision Impairment (CVI)
Certification of vision impairment forms an important population eye health
indicator and some specific causes (DR, glaucoma and AMD) are included in the
Public Health Outcomes Framework.
There is an immediate risk to the ongoing data collection and collation of
certifications of vision impairment, as the funding for this currently provided by
charitable sources ceases in January 2015. In the medium to longer term there
is a need for mainstreaming this national data collection and its management as
a national data repository e.g. by the Health and Social Care Information Centre
(or equivalent) ensuring ongoing access and availability of these data.
ii. NHS Service Activity
Improve quality of Hospital Episode Statistics (HES) for eye care: ensure that
ICD and OPCS codes are provided for both admissions and out-patient
attendances. This is particularly important as much of eye health care is outpatient based. HES data represent the national record of this type of activity and
are used as proxies for need, for service development and commissioning
decisions. Improving the quality of data on out-patient attendances coded by
diagnosis and procedure should be a reasonable and deliverable short to
medium term action
iii. Community Service Activity
This represents a major gap in understanding quality and outcomes from these
services. Services provided by community optometrists should be supported by
15
data flows for national aggregation along the lines of Hospital Episode Statistics.
The infrastructure to provide this is not insignificant, but unless addressed there
is no information on returns of the investment (financial or otherwise), value and
potential of the activity provided in this sector either for NHS GOS services or
other enhanced, shared or co-managed care.
iv.
Portfolio of Indicators
This is being developed by the VISION 2020 UK Ophthalmic Public Health
Committee in order to provide a means to review and monitor population eye
health and well-being; embed eye health perspective in the use and
interpretation of mainstream Outcome Frameworks; and address current gaps in
eye health service information. This portfolio will contain the following–

Indicators identified from the existing NHS, ASC and PH Outcomes
Frameworks that would demonstrate broad overall change (if any) at
population level in those areas identified as being relevant to eye health
improvement, prevention of sight loss, and living with sight impairment.

Eye health indicators covering care across all sectors that would provide the
specialty-specific granularity to the broader Outcomes Framework indicators
identified above. Whilst these are not likely to be supported by a national
data collection infrastructure, they could serve as key core standards for local
clinical audit and service reviews that could be incorporated in service
contracts to facilitate local data collection and review by providers and
commissioners to ensure good practice, outcomes and quality of services. In
the longer term, demonstration of their local utility would form the basis of
their inclusion in the broader Outcomes Frameworks as these continue to be
developed.
This Portfolio of Indicators shall have completed consultation within the
communities of practice and be available for implementation by spring 2015.
Through this Call to Action, with the support of NHS England this could be
implemented in 2015 to realise the benefits for addressing the current gaps in
eye health information and intelligence.
e)
How do we ensure timely and appropriate access to out-of-hours services?
Arrangements for the provision of out-of-hours services (i.e. emergency) can be
variable from formal contracts to ad hoc agreements, with uncertainties around
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service obligations and responsibilities. In the context of increasing demand for
this service, it is estimated that about a third of attendances presenting to A&E
with eye problems are likely to be suitable for a GP or optometrist to manage31.
Provision of acute eye care services in primary care for minor non-urgent care to
relieve pressure on specialist ophthalmic A&E departments and out of hours
services, are emerging in England but often these are not available out of hours,
and provide variable local population cover. To overcome this and in order to
effectively provide consistent and quality assured care any such service would
need to be provided at the level of a Local Area Team with the following prerequisites–
•
•
•
•
•
•
additional training for necessary skills and competencies in primary care
clear clinical governance and accountability arrangements for the professionals
involved in the community and specialist Hospital Eye Departments
agreed, evidence-based local protocols and pathways linked to the local
specialist Hospital Eye Department
regular audit of practice, referrals and clinical outcomes
provision of out-of-hours cover could be considered along the lines of 24 hour
Community Pharmacy services
linkage to NHS 111 directory of service
But the feasibility for providing this type of service would first need to be
evaluated together with an assessment of the supporting infrastructure that
would be required for wider implementation, before considering escalation at
national level.
REFERENCES
1. Global Initiative for the Elimination of Avoidable Blindness. WHO / PBL/
97.61/Rev 2
http://www.iapb.org/sites/iapb.org/files/VISION%202020%20Action%20Plan%20
1999.pdf
2. UK Vision Strategy 2013-18. VISION 2020 UK.
http://www.vision2020uk.org.uk/ukvisionstrategy/landing_page.asp?section=274
&sectionTitle=Strategy+2013%2D2018
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3. Parkins, D.J. and Edgar, D.F. (2011) Comparison of the effectiveness of two
enhanced glaucoma referral schemes. Ophthalmic and Physiological Optics, 31
(4), pp.343-52.
4. NHS Evidence. Avoiding unnecessary referral for glaucoma: use of a repeat
measurement scheme December 2011
http://arms.evidence.nhs.uk/resources/qipp/617475/attachment (accessed 26
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Appendix 1: Supporting Documents
VISION 2020 UK supports the cross sector response to the Call to Action from the
Clinical Council for Eye Health Commissioning
20
VISION 2020 UK also supports any and all responses from its member organisations:
1. Action for Blind People
2. AHPO (Association of Health Professionals in Ophthalmology)
3. Association of British Dispensing Opticians
4. Association of Optometrists (AOP)
5. Birdshot Uveitis Society
6. Blind Children UK
7. Blind Veterans UK (formerly St Dunstan’s)
8. BlindAid (formerly Metropolitan Society for the Blind)
9. British & Irish Orthoptic Society
10. British Blind Sport
11. British Council for the Prevention of Blindness
12. British Wireless for the Blind Fund
13. College of Optometrists, The
14. Deafblind UK
15. Federation of Ophthalmic and Dispensing Opticians (FODO)
16. Fight for Sight
17. Guide Dogs
18. Henshaws Society for Blind People
19. IMPACT Foundation
20. International Glaucoma Association (IGA)
21. Keratoconus Group, The
22. Lions Clubs International MD105
23. LOOK
24. MACS – Micro & Anophthalmic Children’s Society
25. Macular Society
26. Moorfields Eye Hospital NHS Foundation Trust
27. National Federation of the Blind of the UK
28. National League of the Blind and Disabled
29. Nystagmus Network
30. One Clear Vision Limited
31. Partially Sighted Society, The
32. Rehabilitation Workers Professional Network
33. RNIB
34. Royal College of Nursing Ophthalmic Nursing Forum, The
35. Royal College of Ophthalmologists
36. Royal London Society for Blind People
37. RP Fighting Blindness (BRPS)
38. SeeAbility
39. Sense
40. Share the Vision (Libraries) Ltd.
41. Thomas Pocklington Trust
42. TORCH TRUST for the Blind
43. VICTA: Visually Impaired Children Taking Action
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44. VIEW
45. Vision4Growth
46. Visionary – linking local sight loss charities
47. Wilberforce Trust
48. Worshipful Company of Spectacle Makers
22