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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 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