Download SCHEDULE 3

Service Specification for Optometry Services
SCHEDULE 3
Service Specification
Title:
Red Eye Scheme in Primary Care
Scope:
Primary Care Commissioning Optometry Provider Services
Period:
March 1st 2011 to March 31st 2013
Commissioner Lead
Karen O’Brien – Associate Director of Commissioning
NHS Manchester
Service Specification
Red Eye Scheme
in Primary Care
Page 1 of 13
Service Specification for Optometry Services
CONTENTS
1.0 Purpose
1.1 Aims
1.2 Evidence base
1.3 General Overview
1.4 The Pathway
1.5 Objectives
1.6 Expected Outcomes including improving prevention
2.0 Scope
2.1 Service Description
2.1.1
Accreditation
2.1.2
Equipment
2.2 Accessibility / Acceptability
2.3 Whole System Relationships
2.4 Interdependencies
2.5 Relevant networks and screening programs
3.0 Service Delivery
3.1 Service Model
3.2 Care Pathway
4.0 Referral, Access and Acceptance Criteria
4.1 Geographic coverage / Boundaries
4.2 Location(s) of Service Delivery
4.3 Days / Hours of operation
4.4 Referral criteria & sources
4.5 Referral Route
4.6 Exclusion criteria
4.7 Response time & detail and prioritisation
5.0 Discharge Criteria and Planning
6.0 Prevention, Self-Care and Patient Carer Information
7.0 Continual Service Improvement/Innovation Plan
8.0 Baseline Performance Targets
9.0 Activity
9.1 Activity
9.2 Activity Plan / Activity Management Plan Hours
9.3 Capacity Review
10.0
Financial Details
10.1
11.0
Financial Matter
Appendix 1 – Patient Pathway
NHS Manchester
Service Specification
Red Eye Scheme
in Primary Care
Page 2 of 13
Service Specification for Optometry Services
PURPOSE
1.0
_____________________________________________________________________________________________
1.1
Aims
Using the skills of primary care optometrists to triage, manage and prioritise
patients presenting with a “red eye” condition. Patient care will be improved by;

Providing a timely assessment of the needs of a patient.

Reducing the number of GP appointments.

Reducing the number of inappropriate referrals to secondary care.

Reducing the level of activity at secondary care.

Ensuring the patient pathway is as short as possible whilst offering choice of
service access.
1.2
Evidence Base
The evidence base for the service is contained in:

World Class Commissioning and the Darzi review (2008)

Creating a patient-led NHS: Delivering the NHS Improvement Plan (March
2005)

Commissioning Framework 2007-8

Implement care closer to home; convenient quality care for patients (April
2007)

Commissioning Framework for health and well being (March 2007)

Trust, Assurance and Safety - The Regulation of Health Professionals
(February 2007)

Safeguarding patients ( February 2007)

Revision of The NHS in England: operating framework 2010-11

Practice based commissioning: practical implementation (November 2006)

Health reform in England: update and commissioning framework (July 2006)

Tackling hospital waiting: the 18 week patient pathway (May 2006)

Standards for Better Health (April 2006)

White Paper: Our Health, Our Care, Our Say (January 2006)

NHS Plan: a plan for reform, a plan for investment (2006)
NHS Manchester
Service Specification
Red Eye Scheme
in Primary Care
Page 3 of 13
Service Specification for Optometry Services
1.3
General Overview
Most acute superficial eye infections can be treated topically. Blepharitis and
conjunctivitis are often caused by staphylococci; keratitis and endophthalmitis
may be bacterial, viral or fungal.
Most cases of acute bacterial conjunctivitis are self limiting; where treatment is
appropriate, antibacterial eye drops or an eye ointment are used.
A poor
response might indicate viral or allergic conjunctivitis. Gonococcal conjunctivitis
is treated with systemic and topical antibacterials.
GP practice prescribing data from April 2010 to March 2011 has shown that
24,910 chloramphenicol and Fucithalmic prescription items were dispensed. This
figure does not include the number of prescription items that were written but not
dispensed. Currently data is not collected routinely for patients presenting at A&E
that require treatment for a “red eye” condition.
Using the above figures it has been estimated that up to 250 appointments per
GP practice per year would be released from this scheme across Manchester
(24,910/102 practices = 250). Data is not available to calculate accurate savings
for A&E attendances due to “red eye” conditions. However, a basic calculation of
one patient with a “red eye” condition deflected a week per practice would equate
to approximate efficiency saving of £40,800.
1.4
The Pathway
The service will provide a primary care optometry service for patients referred by
General Practitioners, unaccredited (Level 0) optometrists, self referral or other
health care professionals. Community pharmacists will also be expected to refer into
the service.
1.5
Objectives

To provide a service easily accessible for a patient by an accredited
optometrist of a standard and equivalent to that provided in secondary care.

Be patient centred and sufficiently flexible to meet the disparate needs of
clients, including those with disabilities.
NHS Manchester
Service Specification
Red Eye Scheme
in Primary Care
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Service Specification for Optometry Services

Have sufficient accredited providers to ensure city wide coverage, thereby
increasing access.

To follow the service pathway as detailed in Appendix 1.

Operate using evidence based care pathways and protocols.

Be outcome based, the Commissioner will work with the Provider to agree a
list of clinical outcome measures.

Achieve patient referral in a timely manner.

Be integrated and have developed interfaces with existing Primary Care
Services, such as GPs, Community Optometrists, Secondary Care,
Community Pharmacists, Clinical Assessment and Treatment Service
(CATS).

1.6
Promote eye health within the pathway.
Expected outcomes including improving prevention
The benefits from the programme include:

Provision of care closer to home in the most appropriate setting.

Reduce the number of GP appointments.

Increased identification of need.

Appropriate and timely referrals to secondary care.

Reduced waiting times.

Reducing the burden on secondary care.

Improved patient experience, knowledge and concordance.
SCOPE
2.0
_____________________________________________________________________________________________
2.1
Service Description
The service will provide a timely assessment of the needs of a patient presenting with
a “red eye” condition. This will be undertaken by an accredited optometrist who will
manage the patient appropriately and safely; within suitably equipped premises.
Management will be maintained within the primary care setting for as many patients
as possible, thus avoiding unnecessary referrals to hospital services. Where referral
to secondary care is required it will be to a suitable specialist with appropriate
urgency.
NHS Manchester
Service Specification
Red Eye Scheme
in Primary Care
Page 5 of 13
Service Specification for Optometry Services
2.1.1 Accreditation
All optometrists providing this service must be accredited by NHS Manchester for the
OHT scheme and in accordance with requirements for the Red Eye Scheme and
includes;
1) Attendance at a lecture session by a consultant ophthalmologist on the topic of
Red Eye; and Completion of Multiple Choice Questions.
2) Attendance at a lecture session for the medico-legal aspects of a Patient Group
Direction (PGD) by NHS Manchester.
3) Re-attendance at a training session for the PGD and an update clinical session.
This will be repeated every two years.
4) The Optometry practice having completed as a minimum, Level One clinical
governance framework ‘Optomeyes’ and working towards Level Two.
5) Holding a GOS contract with NHS Manchester.
6) Optometrists providing the service are registered on a PCT Performers list.
7) Optometrists providing the service are registered with the GOC.
2.1.2 Equipment
All practices must have the following equipment available; this will be verified by the
PCT optometric adviser during the routine practice inspection.

Access to the internet

Slit lamp

Slit lamp indirect ophthalmoscopy

Contact Applanation Tonometer.

Distance test chart (Snellen/logmar)

Near test type

Appropriate ophthalmic drugs:
Staining agents
Chloramphenicol drops/ointment (PGD)
Fucithalmic (PGD)
Topical anaesthetics
In order to minimise the risk of cross-infection a new preparation should be used for
each patient episode. Any excess fluid remaining after the procedure should be
disposed of appropriately as clinical waste in line with the Infection Control policy.
NHS Manchester
Service Specification
Red Eye Scheme
in Primary Care
Page 6 of 13
Service Specification for Optometry Services
The optometrist providing the service should ensure that ‘College of Optometrists’
guidelines regarding the eye examination are adhered to at each clinical episode of a
patient’s care.
2.2
Accessibility/acceptability
There are currently 51 optometry practices that hold a GOS contract with NHS
Manchester of which XX have been accredited to provide this service.
2.3
Whole System Relationships
The Provider will interface and network with other primary care optometrists i.e. non
accredited (Level 0), accredited optometrists (Level 1 service), secondary care
ophthalmologists and optometrists and the Clinical Assessment Treatment Service
(CATS) and Manchester GPs.
2.4
Interdependencies
As detailed in clause 2 & 3 above.
2.5
Relevant networks and screening programmes
Not applicable see 2.3 above.
SERVICE DELIVERY
3.0
_____________________________________________________________________________________________
3.1
Service Model
A Red Eye examination will provide a timely assessment of the needs of a patient
presenting with a red eye condition.
This will be undertaken by an accredited
optometrist within suitably equipped premises who will manage the patient
appropriately and safely. Management will be maintained within the primary care
setting for as many patients as possible, thus avoiding unnecessary referrals to
hospital services. Where referral to secondary care is required it will be to a suitable
specialist with appropriate urgency.
Patients can self refer or be referred by GPs, Pharmacists or other optometrists.
NHS Manchester
Service Specification
Red Eye Scheme
in Primary Care
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Service Specification for Optometry Services
3.2
Care Pathway(s)
As detailed in Appendix 1.
REFERRAL, ACCESS AND ACCEPTANCE CRITERIA
4.0
_____________________________________________________________________________________________
4.1
Geographic coverage/boundaries
The patient should be registered with a GP practice within NHS Manchester.
4.2
Location(s) of Service Delivery
Primary Care accredited optometrist, holding a GOS contract with NHS Manchester
working in a practice commissioned to provide this service.
4.3
Days/Hours of operation
This service is to be provided at all times when an accredited optometrist is available.
When an accredited optometrist is not available to provide this service for a patient
who presents with a “red eye” condition, the patient must be given information and
directed to the nearest optometrist(s) accredited in the scheme.
4.4
Referral criteria & sources
Patients as detailed in 4.1 with suspected red eye and completion of the relevant
paperwork: including the following minimum data set:

Patients full name and address (including Mr, Mrs, Miss)

Optometrists name, address and accreditation number

GP name and address

Ethnicity (if given by patient)

Prescription details from current sight test, if available

Clinical information regarding the anterior segment status

Signature of patient indicating their consent for information to be shared and
used for audit purposes (Claw back of monies if no evidence at PPV)

Red Eye referral form (stored in practice for PPV)

Red Eye audit form (submitted to the PCT for payment)
NHS Manchester
Service Specification
Red Eye Scheme
in Primary Care
Page 8 of 13
Service Specification for Optometry Services
4.5
Referral route
Patients as detailed in 4.1 can be referred into the scheme by:

A Level 0 non-accredited optometrist or their staff.

A GP with a GMS /PMS/APMS /PCTMS contract in NHS Manchester.

A patient registered with a GP practice within NHS Manchester.

An optometrist from another PCT where the patient is registered with a GP
practice within NHS Manchester.

The service can be accessed by patients presenting for a GOS or private
sight test.

Self-referral by the patient

Community pharmacists / other healthcare providers.
See flow diagram Schedule 1: "Red Eye Integrated Pathway"
4.6
Inclusion criteria

Patient symptomatic with red eye

Patients registered with a GP practice within NHS Manchester

Patients over 12 years of age.
4.7
Exclusion criteria

Patients not registered with a GP practice within NHS Manchester

Children under 12 years of age

Routine case finding as part of a GOS or private eye sight test.
4.7
Response time & detail and prioritisation

From optometrist to secondary care - one working day for the referral to be
submitted by the GP or non accredited optometrist, pharmacist or other health
care professional.

One working day for referral to be submitted by level one optometrist for
secondary care diagnosis.
In summary:
NHS Manchester
Service Specification
Red Eye Scheme
in Primary Care
Page 9 of 13
Service Specification for Optometry Services

95% of patients to have completed their pathway within 1 week.

100% of patients to have completed their pathway within 3 weeks.
DISCHARGE CRITERIA AND PLANNING
5.0
_____________________________________________________________________________________________
A patient is discharged from this service after treatment and advice – follow up is
generally not expected.
The patient pathway will continue where patient presents with a condition excluded
from management by the optometrist that warrants further investigation by a
consultant ophthalmologist.
See flow diagram "Red Eye Integrated Pathway" page 13
The referral form should be stored to conform to Caldicott Guidelines and where
possible, separate from ophthalmic records for the purpose of record retrieval for
Post Payment Verification.
A copy of the referral documentation is to be provided to the patient, the patient’s GP
and to the referring optometrist.
PREVENTION, SELF-CARE AND PATIENT CARER INFORMATION
6.0
_____________________________________________________________________________________________
Prevention of infection

Where applicable the patient should also be advised on hygiene procedures to
prevent infection of others.

A patient information leaflet should be given
Self Care and Patient Carer Information

The patient should be given full advice on how to administer the preparation.

Advice should be given regarding follow up if the condition does not resolve in the
appropriate time course

Advice should be given regarding possible adverse reactions to eye drops
NHS Manchester
Service Specification
Red Eye Scheme
in Primary Care
Page 10 of 13
Service Specification for Optometry Services

Patient information leaflet(s) should be given

A direction to discard the eye drops on completion of treatment and not to exceed
use.
CONTINUAL SERVICE IMPROVEMENT / INNOVATION PLAN
7.0
_____________________________________________________________________________________________
Description of
Scheme
Milestones
Expected Benefit
Confirmation of
Red eye by Level 1
% reduction in referrals to
Annual
secondary care
Optometrists
Confirmation of
Red eye by Level 1
% increase in referrals to
Annual
CATS
Optometrists
Frequency of
Timescales
Monitoring
6 months
3 monthly
6 months
3 monthly
BASELINE PERFORMANCE TARGETS
8.0
_____________________________________________________________________________________________
Quality performance & productivity
Quality
Performance
Indicator
Indicator
Threshold
Method of
Frequency of
Measurement
Monitoring
Compliance
College of
College of
Optometrists
Undertake clinical
Clinical Audit of 5%
Optometrists
management
audit
patient records per
Guidance
Guidelines
Post Payment
Service
Verification
Specification
Service User
Experience
NHS Manchester
Annual
practice
100% claims to
match activity data
Practice visit
Annual
Patient satisfaction
Annual
survey
review within
returned
% return of surveys
first year
Complaints
Service Specification
Red Eye Scheme
in Primary Care
Investigation and
thereafter
resolution within 5
every 2
working days
years
Page 11 of 13
Service Specification for Optometry Services
Infection Control
and
decontamination
Infection Control
Measures
Practices to
complete Infection
Audit or Survey
Annual
Contemporaneous
PCT Annual
records
review
6 monthly removal
PCT Annual
of waste
review
Control Audit
As per
Equipment
Calibration
Manufacturer’s
Practices to provide
guidance or MREH
evidence of regular
or PCT
quality assurance
recommendation
100% collection &
Waste disposal
disposal of waste
medicines
Performance & Productivity
Performance
Indicator
Indicator
Threshold
Method of
Frequency of
Measurement
Monitoring
No upper threshold.
Access
Number of patients
10 minimum to
seen
maintain
Audit
Annual
competency
ACTIVITY
9.0
_____________________________________________________________________________________________
9.1 Activity
Activity
Performance
Method of measurement
Baseline Target
Threshold
Indicators
Number of referrals
Activity data returned to the
from GP Practice
PCT
Number of referrals
from Level 0
Optometrists
Number of referrals
to MREH/other
providers
Activity data returned to the
PCT
Activity data returned to the
PCT
Number of referrals
Activity data returned to the
to CATS
PCT
Length of time for
Activity data returned to the
each referral
PCT
NHS Manchester
Frequency of
Monitoring
N/A
N/A
3 monthly
N/A
N/A
3 monthly
N/A
N/A
3 monthly
N/A
N/A
3 monthly
N/A
N/A
3 monthly
Service Specification
Red Eye Scheme
in Primary Care
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Service Specification for Optometry Services
9.2 Activity Plan / Activity Management Plan
This initial proposal aims to define the measures that would empower the PCT to
accurately monitor the performance of the Red Eye scheme. The style mirrors that
used by the National Screening Centre for Diabetic retinal screening and allows all
patients entering the pathway to be accounted for. These indicators are dependent
upon the final pathway to be followed and therefore may change.
Number of potential Red Eye patients seen
1
No of patients with Red Eye
2
Number of patients requiring follow up
3
Number of patients referred to MREH / other
4
Number of patients discharged from MREH
5
Number of patients DNA for MREH assessment
9.3 Capacity Review
This service will be reviewed on a monthly basis by practices submitting audit data to
the primary care commissioning optometry team; and on an annual basis via a
practice visit for post payment verification for the first two years.
Financial Matters 10.0
_____________________________________________________________________________________________
The following payment schedule is detailed as:
Level 1 service
£50.00 per patient inclusive of cost of drugs for first consultation.
£25.00 per patient for follow up consultation.
Payment will be made on submission of audit data to the Primary Care
Commissioning Optometry Team by the 25th day of each month.
NHS Manchester
Service Specification
Red Eye Scheme
in Primary Care
Page 13 of 13
Service Specification for Optometry Services
Appendix 1
Red Eye Integrated Patient Pathway
SCHEDULE 1
GP Referral
Patient self-referral
Pharmacist /other Healthcare
professional including nonaccredited optom (Level 0)
Symptomatic patient presents at a
practice accredited for
Red Eye Scheme (Level 1)
Optometrist takes history; symptoms; examines the patient; makes initial
diagnosis and decides on appropriate management as below
Managed by Optometrist:










Bacterial conjunctivitis
Allergic conjunctivitis
Non-herpetic viral conjunctivitis
Subconjuctival haemorrhage
Tear Dysfunction (Dry Eye)
Episcleritis
Blepharitis (unless severe and
doesn't resolve with lid
hygiene)
Superficial corneal abrasions
Styes/chalazia
Isolated In-growing eyelashes
Referral to Hospital by
Optometrist:
Referral to a GP by
Optometrist:












Recurrent epithelial erosion
Severe blepharitis
Recurrent eyelid gland
dysfunction
Corneal ulcers
Infective keratitis
Anterior uvetitis
Posterior uvetitis
Scleritis
Acute glaucoma
Traumatic injuries
Marginal keratitis
Superficial corneal foreign
bodies


Action:
Treatment and Advice:







Antimicrobials
Mast cell stabilisers
Ocular lubricants
Topical antihistamines
Hot compresses
Lid hygiene
Written instructions to be given
Refer via GP on red eye form
for routine ophthalmology
appointment.
Action:
 Telephone Acute Referral

Centre at MREH (9am-5pm
M-F) on 276 5583 or Eye
Emergency Centre on 276
5597 (outside above hours).
Send report and directions
with patient.
Complete report form and copy: Opticians patient record, patient copy, GP
copy, HES copy if referral is required.
NHS Manchester
Service Specification
Red Eye Scheme
in Primary Care
Page 14 of 13