Download OHT monitoring scheme notes

Ocular Hypertension (OHT) Monitoring Service – scheme notes 2014/2015
The service is available to all persons registered with a Shropshire or Telford and Wrekin CCG
GP if they are discharged onto the pathway.
Aims and objectives of the services
The Service aims to improve eye health and reduce inequalities by providing increased access to eye
care in the community. The Service shall utilise the knowledge and skills of primary care Optometrists to
manage and prioritise the care of the patient who will monitor the patient’s condition according to an
agreed management plan. The Services shall be accessed by service users following referral from the
local secondary care services or from the local community ophthalmology service. The Services shall
ensure that the service user is eligible to access the service by verifying the service users GP before
providing the community service.
Service description/care pathway
The Service allows service users with diagnosed OHT to be discharged back into Primary Care for
monitoring by Community Optometrists. Timely monitoring is critical for those diagnosed with OHT to
ensure a good visual prognosis. Management is focussed on maintaining a sighted lifetime to maximise
quality of life.
When a service user is identified within the secondary care service or community ophthalmology service
as having OHT that can safely and effectively be managed within the community, the service user will be
advised, and referred to the community optometry service with the OHT Monitoring pathway discharge
form (Appendix 1).
Accreditation
Participating Optometrists must be registered with the General Optical Council and on the CCG
Accredited List of Providers for this service. Ophthalmic practitioners will be required to undertake the
LOCSU training and accreditation package for Level 2 OHT monitoring. Ophthalmic practitioners will be
required to attend a training session run by Shropshire Local Optical Committee, Shropshire and Telford
and Wrekin Clinical Commissioning Groups and Shrewsbury and Telford Hospitals Trust primarily to
cover the administrative procedures and protocols involved in providing the enhanced service. The
training session will cover:


An introduction to the service
Administration of the service including pathway, processes and paperwork
Ophthalmic practitioners will be required to undertake appropriate Peer Review Activity in the third year
of the Contract term.
The CCG will provide the secondary care provider and community ophthalmology service with a
regularly updated list of contractors providing the primary eye care service.
The Contractor shall be responsible for ensuring that all persons employed or engaged by the Contractor
in respect of the provision of the services under the Contract are aware of the administrative
requirements of the service.
The accredited optometrist will carry out



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Slit lamp mounted Goldmann tonometry
Suprathreshold perimetry
Van Herrick’s test
Dilated slit lamp bio-microscopic examination of the optic nerve head
The Services shall ensure that service users with a change in clinical status will be referred to specialist
community services or hospital eye clinic (see Appendix 2 pathway and Appendix 3 Clinical
Management Guidelines). Procedures shall be undertaken as deemed clinically necessary by the
optometrist after assessment of the service user’s history and symptoms.
All tests undertaken and results obtained must be recorded on the Service User’s Record, even if the
results are normal. All advice given to the Service user (verbal or written) must be recorded on the
Service User’s Record. The Services shall provide the Service user with a paper copy of their Service
User Record Card, if requested. The Contractor to the Services shall provide all appropriate clinical
advice and guidance to the service user in respect of the management of the presenting condition.
Should a service user fail to arrive for an appointment, the services must contact the service user within
24 working hours, informing them that they have missed their appointment, and ask them to arrange a
further appointment. Should a service user fail to re-arrange an appointment within 7 working days of
contact being made (or fails to attend their re-arranged appointment), then the Service will inform the
patient’s GP.
All optometrists participating in the scheme will have the following available:
 Access to the internet
 Slit lamp and fundus viewing lens
 Goldman applanation tonometer
 Threshold fields equipment capable of producing a printed report
 Distance chart test
 Appropriate ophthalmic drugs (Mydriatic, Anaesthetic, Staining Agents)
Record Keeping and Data Collection
The ophthalmic practitioner shall fully complete, in an accurate and legible manner, an Optometric
Patient Record in the format provided by the CCG for each patient managed.
The Contractor, ophthalmic practitioner or other responsible person shall also maintain a summary of:
 The number of patients seen.
 The number of appointments booked for patients who did not attend ("DNAs")
Performance Reporting and Audit
A report on activity and patient outcomes shall be forwarded by the Contractor to the CCG payments
agency according to locally agreed protocols. Clinical Governance issues shall be reported by the
Contractor to the CCG by exception. Complaints shall be reported quarterly by the Contractor to the
CCG. Other relevant information required from time to time by the CCG in relation to this service shall be
provided by the Contractor in a timely manner.
Population covered
The services are available to all service users registered with a GP practice located within the
geographical area of Telford and Wrekin CCG and Shropshire CCG who have been diagnosed with OHT
and discharged onto the pathway.
Acceptance criteria
Service users diagnosed with OHT and deemed suitable for on-going monitoring in a community service
Exclusion criteria
Service users deemed unsuitable for on-going monitoring in the community
OHT Discharge Form
Hospital/Community Ophthalmology Service name and address
Consultant
Telephone number
Patient surname
Forename
Date of birth
Address
Hospital Number
NHS Number
Name of Optometry Practice for follow up
Date discharged from hospital or community
ophthalmology service
Diagnosis
Other ocular conditions
RE
LE
RE
VAs
LE
RE
IOPs
Time
Gonioscopy
RE
LE
Reliable
Variable
Normal
Defect
Central Corneal thickness
Visual Fields - attach copies
Not useful
Comments
Optic Disc Assessment information - attach photographs if available
Further comments
Threshold IOP for return referral
RE
LE
Other criteria for return referral
Review Interval
/ 12
Name of discharging ophthalmologist
Adapted from LOCSU OHT-Suspect Glaucoma Discharge Form
Signed
LE
Appendix 2
Appendix 3