Download RNIB PowerPoint presentations

The NHS Eyecare Pathway Pilots
Andrew Kent
Anita Lightstone
NHS Eyecare Services Team
The NHS Eyecare Pathway Pilots

Plan:
–
–
–
–
–
Programme outline
Pathway principles
Where are we now?
Roles and responsibilities
What next?
The NHS Eyecare Pathway Pilots
The National Eye Care Steering Group

Set up by the Department of Health in 2002,
with representatives of:
–
–
–
–
–
–
ophthalmologists
optometrists and dispensing opticians
orthoptists
ophthalmic nurses
patient organisations
health,social care & policy organisations
The NHS Eyecare Pathway Pilots
The National Eye Care Steering Group
Group’s initial remit:


To develop proposals for the modernisation of
NHS eye care services
first priority to develop model pathways for:
– cataract
– glaucoma
– low vision
– age related macular degeneration
The NHS Eyecare Pathway Pilots
The National Eye Care Steering Group

Pathway principles:
 To develop innovative approaches, for example
partnerships with the voluntary sector
 To remove barriers to and streamline services
 To provide services where and when they can be
easily accessed
 To increase awareness of the importance of eye
health
 To make better use of professionals
The NHS Eyecare Pathway Pilots
Pathway principles
ophthalmologists
social care
third sector
orthoptists
patient
NHS
Dept of Health nurses optometrists
GPs
opticians
The NHS Eyecare Pathway Pilots
Proposed Glaucoma Pathway
Start
1. Patient attends community optometrist (CO)
•Sight test, I OP over 21 ( applanation tonometr y) and/or
visual fie ld de fect and/or excavated discs
•Patient/optometr ist makes appointment with optometr ist
with special intere st in glaucoma ( OSI) or OM P
2. Patient attends OSI or OMP
•Full histor y and assessment car ried out according
to protocol
•Dec ision taken as to whe ther patie nt ha s ocular
hypertension (OSI /OMP re views) or ca n be
disc har ged (r etur n to CO) or has glaucoma ( trea t
or ref er to H ES)
•Patient advised, give n inf or ma tion etc and further
appr opriate a ppointments ma de if needed
4. OSI/OMP
manages patient in
community setting
•Regular r eviews se t in
place
•OSI /OMP rela y da ta to
hospital if significant
progr ession f or H ES
re view if needed
3. OSI/OMP relays data to HES
•HES r evie ws data, advises OSI/OM P
re gar ding manage ment and sets up
re view at HE S i f nee ded
The NHS Eyecare Pathway Pilots
Proposed AMD Pathway
Start
1. Patient attends optometrist with special
interest (OSI)
•Differential diagnostic assessment, including full
history, clinical examination, biomicroscopy and
macular function
•Patient has non-neovascular AMD
•Patient has neovascular AMD -OSI refers directly to
HES
2. Patient attends HES
•Outpatient appointment with
ophthalmologist*
•AMD untreatable
•AMD treatable
(* flourescien angiography and further
investigation )
4. Fast access to
integrated low
vision services
•optical low vision
services
•advice and information
•counselling
•social service support
•rehabilitation
•possible certification
(CVI)
3. Patient attends HES
•Access to treatment
•Advice and information etc for patient
The NHS Eyecare Pathway Pilots
Proposed Low Vision Pathway
Start
Service enables re-access
1. Patient referred to Low Vision Service
(LVS)
•Referral may be from secondary care, GP, social
worker, rehabilitation officer, community nurse, OT etc
or may be self referral
•Patient may have an LVI, RVI or CVI
•All patients are contacted by LVS within 10 working
days
3. Patient has follow up
visits as needed
•Visits may take place in the
patient’s home or elsewhere
•Visit will be by appropriate
member of the LV team
2. Patient attends LVS
•Service is seamless across health, social care and the voluntary sector
•A full sight test forms part of assessment
•Patient is given information on eye condition, entitlements etc as well as local services
• Emotional support and advice on employment or education etc is available
•Spectacles, LV aids, advice (esp. lighting, contrast and size), equipment and home adaptations
are discussed and made available as appropriate
•Referral to other areas of health and social care as needed, including certification
The NHS Eyecare Pathway Pilots
Sites
Glaucoma:
 Peterborough, North Birmingham and East
Devon, Waltham Forest
Age Related Macular Degeneration:
 Brighton and Hove, Waltham Forest
Low Vision:
 Gateshead, Sutton, Merton and Wandsworth,
Barking and Dagenham and Havering,
Waltham Forest
The NHS Eyecare Pathway Pilots
Associate low vision sites:








Brighton and Hove
South Lincolnshire
Mid and East Devon
Hartlepool
Northumberland
South Worcestershire
Morecambe Bay
New Forest
The NHS Eyecare Pathway Pilots
Pilot update:



Several pilots now in the process of becoming
“mainstream” services
External evaluation underway and will be
completed by the end of the year
Sharing of outcomes at “Delivering the Vision,
January 2007 and looking to the future
The NHS Eyecare Pathway Pilots
Mainstreaming:



Local review of service to assess local
value/success/need
Need for inclusion by PCTs of the service into
Local Delivery Plans
Review of contractual arrangements and
agreement of new contract/handover
The NHS Eyecare Pathway Pilots
Evaluation:

Both internal (at pilot level) and external
evaluation being undertaken

External evaluation will cover:
 Pilot outcomes – did they achieve what they
set out to do?
 How effective was this?
 Patient and staff views
The NHS Eyecare Pathway Pilots
Evaluation

External evaluation will cover:
issues – e.g. training, governance,
sustainability and roll-out
 Costs
 Availability of robust data
 Associated

Comparison between pilots, where appropriate
The NHS Eyecare Pathway Pilots

Anecdotal findings
The NHS Eyecare Pathway Pilots

So where and how do
the professionals fit in?
The NHS Eyecare Pathway Pilots
what next?




Sharing of learning Delivering the Vision,
January 2007
Revision of the pathway
and guidelines
GOS review
On-going promotion of
community based
services
The NHS Eyecare Pathway Pilots
Closing thoughts




Be objective about new
ways of working
Be aware of your
patients’ fears and
concerns
Provide clear and concise
information
Work for better eye care
services
The NHS Eyecare Pathway Pilots

Thank you for your attention

Any questions?
www.eyecare.nhs.uk