Download Children`s Vision Service Specification (rev Nov 2013)

LOCSU Community Services
Service Specification
Children’s Vision Screening
Issued by
Local Optical Committee Support Unit
October 2011
[Revised November 2013]
Service Specification – Children’s Vision Screening
1
Service outline
1.1
The service provides for the referral, management and treatment of
children who have suspected amblyopia following school screening. This
eliminates the requirement for a visit to the Hospital Eye Service. Early
diagnosis and commencement of treatment in the management of these
conditions is critical to avoid the development of amblyopia or reduce its
severity.
1.2
The service is provided by accredited local ophthalmic practitioners who
have a range of equipment to facilitate a detailed examination of the eye.
1.3
The service is accessed by patients direct from the local ophthalmic
practitioner.
1.4
The service is available to all persons registered with a GP practice located
within the geographical area of [insert name of CCG].
2
Service aims
2.1
The service aims to improve eye health and reduce inequalities by
providing increased access to eye care in the community and reduces the
number of visits to the Hospital Eye Service.
2.2
The service utilises the knowledge and skills of primary care optometrists
to manage and prioritise the care of the patient.
2.3
The service is expected to reduce the number of visits to the Hospital Eye
Service for the patient and to reduce the likely waiting time for the patient
who can have their treatment and care managed in the community, closer
to home.
LOCSU Children’s Vision Screening Specification.
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2.4
Relationships between ophthalmic practitioners, the Hospital Eye Service
and the Clinical Commissioning Group will be further developed.
3
Service provision
3.1
The service shall be provided during normal practice hours.
3.2
Referrals to the service shall be made in accordance with paragraph 4.9.
4
Service specification and criteria
4.1
Symptoms at presentation included in the service
4.1.1
This service provides for the assessment and management of patients
presenting after failing the school screening programme.
4.1.2
An NHS sight test will also be included in the check.
4.1.3
The ophthalmic practitioner will measure unaided vision with crowded
LogMAR using a patch on either eye, a cover test, measuring near and
distant vision and stereopsis. Also included is a full cycloplegic refraction
and a fundal examination.
4.1.4
It may be necessary to prescribe glasses to correct refractive error if
appropriate.
4.1.5
The patient will then either be discharged, referred to the Hospital Eye
Service or may need to return after 6 weeks for the optometrist to check
progress or monitor changes.
4.1.6
An 18 week review may also occur which will include a GOS sight test to
check compliance with glasses and reassess acuity with crowded LogMAR
test.
LOCSU Children’s Vision Screening Specification.
Copyright © LOC Central Support Unit. Oct. 2011. All Rights Reserved. [Rev Nov 2013].
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4.2
Procedures
4.2.1
Such procedures shall be undertaken as deemed clinically necessary by
the relevant ophthalmic practitioner after assessment of the patient’s
History and Symptoms
4.2.3
All tests undertaken and results obtained must be recorded on the
Optometric Patient Record, even if the results are normal.
4.2.4
All advice given to the patient (verbal or written) must be recorded on the
Optometric Patient Record.
4.2.5
The level of examination should be appropriate to the reason for referral.
All procedures are at the discretion of the optometrist; however the
following guidelines should be adhered to:

Pupil dilation and examination by indirect ophthalmoscopy in order
to establish whether there are any co-existing ocular disorders.

Discussion of the health questionnaire and any outstanding issues
dealt with.
4.3
Clinical protocol (see appendices)
4.3.1
All clinical decisions and advice given to patients must be recorded on the
Optometric Patient Record.
4.4
Equipment
4.4.1
The Contractor shall have the following equipment:

Crowded LogMAR acuity chart

Stereopsis Chart

Age appropriate trial frame

Appropriate ophthalmic drugs
- cycloplegic
LOCSU Children’s Vision Screening Specification.
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4.5
Competencies – education and training
4.5.1
The Contractor and all ophthalmic practitioners employed or engaged by
the Contractor in respect of the provision of the community services are all
included in the core competencies as defined by the General Optical
Council (GOC)
4.5.2
Participating Optometrists must be registered with the General Optical
Council and be on the performers list of NHS [insert CCG area] (or
neighbouring CCG).
4.5.3
Ophthalmic practitioners will be required to attend a training session run
by the LOC and CCG, primarily to cover the admin procedures and
protocols involved in providing the community service. The training
session will cover:

An introduction to the service

Administration of the service including protocols, processes and
paperwork
4.5.4
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.
4.6
Patient eligibility
4.6.1
The service is available to all children who fail school screening and upon
receipt of referral from the school screening service.
4.7
Referral and patient pathway
4.7.1
Accredited optometrists will receive referrals from the school screening
standard referral form (Appendix 1a).
4.7.2
Each patient requiring an assessment and/or treatment under the service
will be provided with an Information Leaflet describing the service and
including a list of contractors. (As drafted by the CCG.)
LOCSU Children’s Vision Screening Specification.
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4.7.3
Patients shall make a mutually convenient appointment with the
Contractor, and shall be encouraged to telephone the practice premises.
4.7.4
If the Contractor is unable to provide for the assessment and where
appropriate, the treatment of the patient the Contractor, ophthalmic
practitioner or other responsible person shall direct the patient to an
alternative provider of the services, by way of the list of contractors
supplied by the CCG.
4.7.5
The ophthalmic practitioner shall seek written consent from the patient to
the assessment and, where appropriate, treatment. For the purposes of
this paragraph, "written consent" shall mean the recording of consent
obtained on the patient’s Optometric Patient Record.
4.7.6
If onward referral is required the ophthalmic practitioner will notify the
school screening service.
4.7.7
The Contractor, ophthalmic practitioner or other responsible person shall
provide the patient with a paper copy of their Optometric Patient Record
Card, if requested.
4.7.8
The Contractor shall provide all appropriate clinical advice and guidance
to the patient in respect of the management of the presenting condition.
4.7.9
Should a patient fail to arrive for an appointment, the optometrist must
contact the patient within 24 working hours, informing them that they
have missed their appointment, and ask them to arrange a further
appointment.
4.7.10
Should a patient fail to re-arrange an appointment within 7 working days
of contact being made (or fails to attend their re-arranged appointment)
then the optometrist will inform the patient’s GP.
4.8
Record keeping and data collection
4.8.1
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.
LOCSU Children’s Vision Screening Specification.
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4.8.2
The Contractor, ophthalmic practitioner or other responsible person shall
also maintain a summary of:

The number of patients for whom an appointment was booked

The number of appointments booked for patients who did not
attend ("DNAs")
4.8.3
Performance reporting and audit
4.8.4
A report on activity and patient outcomes shall be forwarded by the
Contractor to the CCG's payments agency by the 25th day of the month
following the month in which the patients received the service.
4.8.5
Clinical Governance issues shall be reported by the Contractor to the CCG
by exception, in accordance with paragraph 5.5.
4.8.6
Complaints shall be reported quarterly by the Contractor to the CCG
4.8.7
Other relevant information in relation to this service required from time to
time by the CCG shall be provided by the Contractor in a timely manner.
4.9
Service review
4.9.1.
The Contractor shall co-operate with the CCG as reasonably required in
respect of the monitoring and assessment of the services, including:

Answering any questions reasonably put to the Contractor by the CCG

Providing any information reasonably required by the CCG

Attending any meeting or ensuring that an appropriate representative
of the Contractor attends any meeting (if held at a reasonably
accessible place and at a reasonable hour, and due notice has been
given), if the Contractor’s presence at the meeting is reasonably
required by the CCG
LOCSU Children’s Vision Screening Specification.
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5
Clinical governance
5.1
Safeguarding Children
5.1.1
The Contractor must complete Level One of Safeguarding Children and
within the specified timescale and provide evidence of this to the
commissioner if requested to do so.
5.2
Significant incident reporting
5.2.1
A record of all significant incidents (SI), near misses and potential incidents
must be maintained. SI must be reported to the designated quality lead
within 24 hours.
5.3
Infection control
5.3.1
Premises must be kept clean; this includes all areas of public access.
5.3.1.1 In all consulting and screening rooms used, hard surfaces should be regularly
cleaned using appropriate hard surface solution / wipes.
5.3.1.2 Hand washing facilities must be provided in, or near, to consulting /
screening rooms.
5.3.2
Hot and cold water should be available, and liquid soap and paper
towels provided.
5.3.3
All equipment that comes into contact with patients must be cleaned a
after each patient. This may be by using antiseptic wipes (or similar)
for head / chin rests or by using disposable chin rests.
5.4
Waste management
5.4.1
Used tissues and paper towel can be disposed of in your normal ‘black bag’
waste.
LOCSU Children’s Vision Screening Specification.
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5.4.2
Part-used (or out of date) minims need to be incinerated, and can be
discarded in a medicine disposal box.
5.5
Clinical audit
5.5.1
The Contractor shall participate in any clinical audit activity as reasonably
required by the CCG, and maintain appropriate records to evidence and
support such activity, including an electronic spreadsheet showing patient
outcomes.
5.6
Patient experience
5.6.1
The Contractor will participate in an annual patient survey by engaging
patients in the completion of a patient questionnaire, if required by the CCG.
6
Payment
6.1
Payment for the service is on a cost per case arrangement. The CCG shall
pay the Contractor £ [insert figure] for each first patient appointment and £
[insert figure] for each follow-up appointment. (For the avoidance of doubt,
though, no payment shall be made by the CCG in respect of DNAs.)
6.2
Payment will be made to the Contractor monthly based on activity reports
submitted by the Contractor to the CCG to be received by the [insert date]
day of the month following the month in which the patients received the
service. Payment shall be paid by the CCG to the Contractor on the [insert
date] day (or, where such day is not a working day, the next working day) of
the following month.
LOCSU Children’s Vision Screening Specification.
Copyright © LOC Central Support Unit. Oct. 2011. All Rights Reserved. [Rev Nov 2013].
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7
Participating accredited optometrists
The ophthalmic practitioners named below have successfully undertaken
accreditation and will provide the Children’s Vision Screening community
service for patients presenting at the practice premises.
The ophthalmic practitioners named below declare that they have read and
understood this service specification.
Name
Signature
Dated
Name
Signature
Dated
Name
Signature
Dated
LOCSU Children’s Vision Screening Specification.
Copyright © LOC Central Support Unit. Oct. 2011. All Rights Reserved. [Rev Nov 2013].
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Appendix 1
Clinical Guidelines for Children’s Pathway
Children failing age 4–5 years school vision screening will be referred to community
optometrist unless:
1.

Unable to perform crowded LogMAR test

Visual acuity <6/19 (0.5) in one or both eyes

Non accommodative strabismus

Other pathology
Initial referral visit to community optometrist (including GOS sight test)
The following will be performed at the child’s first visit to the community
optometrist:

Measure unaided vision with crowded LogMAR test with patch on either
eye

Cover test (distance and near) and stereopsis

Cycloplegic refraction 25 mins after instillation of G. Cyclopentolate 1%

Fundal examination – either BIO 20D or 90D or direct ophthalmoscopy

Prescribe glasses if appropriate

Inform screening admin and GP that child has been seen and of outcome
by completing Paediatric Optometry Report
Outcome

Outcome : discharge/refer/6 week check

If vision is ≥ 6/9.5 (0.2) in both eyes discharge to GOS

If vision is < 6/19 (<0.5), non accommodative strabismus or other
pathology refer to secondary care (prescribe glasses where required)

If vision between 6/9.5-1 and 6/19 (0.225 and 0.5) prescribe glasses and
review at 6 weeks
2.
Six-week check (no GOS sight test)
The following will be performed at the child’s 6 week check by the community
optometrist:

Check compliance with glasses and fit

Reassess acuity with glasses with crowded LogMAR test
LOCSU Children’s Vision Screening Specification.
Copyright © LOC Central Support Unit. Oct. 2011. All Rights Reserved. [Rev Nov 2013].
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Outcome

Outcome : discharge/refer/18 week review

If acuity is ≥ 6/9.5) in both eyes discharge from pathway and arrange 6
month GOS review

If acuity is < 6/9.5 (0.2) in either eye review in a further 12 weeks
If discharged inform screening admin by completing the Paediatric Optometry
Report
3.
Eighteen-week review (includes GOS sight test)
The following will be performed at the child’s 18 week review by the community
optometrist:

Check compliance with glasses and fit

GOS sight test

Reassess acuity with glasses with crowded LogMAR test
Outcome
 Outcome : refer/6 month GOS
 If acuity is ≥ 0.2 (6/9.5) R & L* discharge from pathway and arrange 6
month GOS review
 If acuity is < 6/9.5 (0.2) R & L refer to secondary care
(* or 6/9.5 in best eye with less than one line difference in acuity between the eyes)
Inform screening admin of outcome by completing the Paediatric Optometry Report
LOCSU Children’s Vision Screening Specification.
Copyright © LOC Central Support Unit. Oct. 2011. All Rights Reserved. [Rev Nov 2013].
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Appendix 2
Orthoptist
Screening
Defect
Strabismus
Pathology Vision
≤ 6 / 19
(0.5)
N
Discharge from pathway
Y
Vision 6 / 9.5-1
to 6 / 19
(0.225 to 0.5)
Refer to
Optometrist
Secondary
Care
Strabismus
Pathology
vision ≤ 6 / 19
(0.5)
Y
1st Appt
Defect
N
Y
Prescribe Glasses
if necessary
Vision 6 /9.5-1 to 6 / 19+1
(0.225 to 0.475)
Prescribe Glasses
only
6 week check
Acuity ≥ 0.2
(6/9.5) R&L
Y
N
N
18 week check
Acuity ≥ 0.2
(6/9.5) R&L
Y
LOCSU Children’s Vision Screening Specification.
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