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Governance and
Ophthalmology Tier 2Service
Mike Broadhurst - Optometrist
PCT Optometric Advisor – 5 PCTs
Secretary North West Lancs LOC
3 Practices in 3 different PCTs
Governance
Clinical Governance
Clinical Audit
Professional Development
Professional regulation
Ophthalmology Tier 2 Service
Identification of need
Increase primary care based care
Areas of good practice
Areas of good practice
PEARS –WALES
Fylde Intermediate Clinics - Fylde PCT
Direct Referral to ophthalmologist -Blackpool
Blackpool Glaucoma Discharge Scheme
First Choice Eyecare – Blackpool, Fylde and Wyre
Preston 6 week Post Operative Cataract discharge
Blackpool Fylde Wyre Preston Chorley and South
Ribble LVA scheme
 Preston Chorley and South Ribble Diabetic Retinal
Screening programme
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PEARS –WALES -2003
 The Primary Eyecare Acute Referral
Scheme (PEARS) allows GPs to refer
patients for same-day eye examinations
to a local accredited optometrist. From
there patients can be sent directly to
the Hospital Eye Service - but with the
benefit of a well informed referral which
makes more effective use of
consultants’ time.
Fylde Intermediate Clinics Fylde PCT
 Referral and Operation
 GPs refer to approved group of
Optometrists for assessment and
opinion
 Patients could also “self-refer”
Fylde Intermediate Clinics Fylde PCT
 85% of patients seen at community
optometrists were either managed
within the optical practice, or referred
back to their own GP with advice on
suggested best treatment
Blackpool Glaucoma Discharge
Scheme 2003
 Patients with stable glaucoma being
seen at BVH discharged to an
accredited group of Optometrists.
 1300 patients now being managed by
community optometrists
 Saving to PCT ~£52k per annum
First Choice Eyecare-Blackpool
 Blackpool Victoria Hospital currently has
an ongoing capacity gap of approx 1500
out-patient appointment slots per
annum
First Choice Eyecare-Blackpool
Patients are given the option of attending one of
the Community Optometrists within the scheme
or attending the Hospital Eye Dept. If the
former, the patient is given a list of participating
Optometrists along with their addresses, and
contact details. The patient then makes DIRECT
contact with the optometrist of their choice and
arranges an appointment which will be within 3
weeks of referral for non-urgent cases (85%
seen within 3 days, <10% referred onward))
Identify potential impact (RPH)
 Referral audit on 1 month referrals to
Ophthalmology Department at LTHTR –
210
 Audited by 2 Optometrists
Consultant Ophthalmologist
Optometrist
 Condition groups
Results
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30% Ophthalmology Consultant
45% Optometrist
11% Cataract Pathway
4% Orthoptist
3% DRSS
1% Other
6% Not enough information
Optometrists Pathways
 Blepharitis
 Watery eye
 Macular
Degeneration
 Abnormal fundus
 Floaters
 Red eye
Ingrowing lashes
Ocular hypertension
Fields
Glaucoma
assessment
 Dilated fundoscopy
 Prescription monitor
 Corneal assessment
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Projected savings – per 1000 pts
Current pathway
Adult First OPA Tariff £94
Total Cost £94,000
Tier 2 potential pathway
30% Consultant 300 x Tariff
=
45% Optometrist 450 x £64
=
25% Inappropriate referrals
=
Total
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Potential Saving per 1000 patients
£28,200
£28,800
£00
£57,000
£37,000
Next steps
 Redesign patient journey
Clinical group
Analyse current patient pathway
Identify areas for improvement
Agree organisational pathways
 Implement new service
Preston 6 Week Post Cataract
scheme
At Day 1 post op appointment
patients identified as being
appropriate to allow accredited
optometrists to perform the 6 week
appointment
Blackpool Fylde Wyre Preston
Chorley and South Ribble LVA
scheme
Patients seen for LVA assessment at
locally accredited optometry
practices without the need to be
registered via the hospital. Optoms
paid for assessment and dispensing
of aid and for follow-up. Annual
exams with their own optometrist.
Preston Chorley and South Ribble
Diabetic Retinal Screening
programme
Patients given the option of being seen at one
of 25 community-based practices. Images
taken and graded by practice, and then sent
on to Diabetic Retinal Screening Service for
consolidation of records. Patient can be seen
in community setting 6 days per week.
Technical failures dealt with in-practice, and
most patients attend for the DRSS at the
same time as their routine Eye Examination.
Makes best use of optoms equipment,
primary care based and conforms to NSF
guidelines
Preston Chorley and South Ribble
Diabetic Retinal Screening
programme
~8000 Pxs seen in community
(75%)
Excellent coverage
Excellent use of community optoms
skills
Primary care based
Cost per Patient £26.50
Any Questions ?
Thanks for listening