Eye Health Network Shifting the Balance of Care John Olson Charlotte Ward Morag Bobacka David Fowler Fiona Francey Steve Graham Jane Harcourt Caroline Hind Monica Hrabovsky Neil Lavery Malcolm McPherson Stephen McPherson Pamela Lowbridge Siene Wai Ng Gordon Porteous Marka Rifat Graeme Shand David Taylor Elaine Thompson Mohan Varikkara

A sad story

Begs the question Where should you go if you have an eye problem? – High Street Optometrists – General Practitioner – A& E Department – Hospital Eye Casualty

6,000 walk ins a year….. Average of 24 (max 33) patients per day

Eye Casualty Audit August- September 2006 (n=922) Average 24 episodes per day

Duration of Symptoms

What happened?

Where did true emergencies come from?

Who got it right?

What should have happened? 44% had ‘simple’ problems which could have been managed by optometrists in the community. An additional 37% could have been managed in the community if patient pathways involving prescription only medication had been available. Optometrists knew who to refer.

I have a dream…………..

Scottish Government’s Vision Optometry, the first port of call They have the knowledgeGive them the technology

New GOS Contract April 2006 "Anyone, whether they have red eyes, painful eyes, flashes and floaters, or just need new spectacles, will be able to access the new NHS at their local Optometry practice.“

A network in waiting

Pyramid of Eye Care Specialist led hospital clinic Triage address issues, treat and/or direct Community Optometry General Practice Community Pharmacy

Network 58 Optometry practices 58 Optometry practices Nurse led telephone triage service Nurse led telephone triage service – 0845 number Urgent Referral Clinic Urgent Referral Clinic – Every afternoon – 10 slots, directly booked – Run by experienced SPR – Directly Supervised by Consultant

Wide Consultation

Practical Issues Informing the public Informing the public – Local TV advert – Posters: GP GP eye clinic, eye clinic, hospital and hospital and A&E A&E

Professional Issues: Training Optometrists Practical Eye Casualty Sessions Practical Eye Casualty Sessions – Consultant led Patient Pathway Lectures Patient Pathway Lectures Foreign Body Workshops Foreign Body Workshops – Consultant and Optometry jointly led

Eye Health Network Audit Access database for all helpline activity Access database for all helpline activity Access database for all urgent referral clinic activity Access database for all urgent referral clinic activity Paper records for optometrist Paper records for optometrist

Was it all a dream?

Transitional Arrangements (September-October 2007)

Preliminary Data

Community Optometry Activity Nov 07 to Mar forms 52% self referred 19% from GP 7% from A&E 4% from pharmacy 76% managed by optometry 10% referred urgently to ophthalmology

Helpline Activity October 2007-August calls per day – 56% from optometry – 20% from General Practice – 6% from A&E 85% were given an urgent referral clinic appointment.

Urgent Referral Clinic 10.4 per day (24)

Ophthalmology On-call 28.4% reduction

Impact on A&E 13.3% reduction

Optometry Agreement 2% significantly different 18.6% Disagreement 81.4% Agreement

Value for money?

What happened after 2006? NewsAll Attendances % % Lothian19,83618,757566,05762,0966 Glasgow30,64527, ,419101,8589 Fife8,3026, ,74518,30413 Grampian17,43110, ,13633,55726 Scotland126,897121, ,406410,0641

What’s going on? 1.PDT for AMD DRS Cataract redesign MMC Lucentis for AMD 2007

1.DRS PDT for AMD Glaucoma refinement scheme GOS contract, OHT discharged, Post-op cataracts discharged Eye Health network, AMD injection service, MMC OCT DRS 2008 Shifting the balance of care

Gold rush?

What next for the Eye Health Network?

An Electronic Eye Health Network

Where information flows, not patients Local access Information belongs to all – Patients, primary, secondary care, boards, government An electronic cloud – Advice only, shared care, triage, appropriate referral – Clinical governance, service planning – Reimbursement Specialist role – Where information is not enough – Education, training, planning, service redesign – Public health Quality of care not dependent on where you live – Communication – Politics

Eye Health Network Shifting the Balance of Care John Olson Charlotte Ward Morag Bobacka David Fowler Fiona Francey Steve Graham Jane Harcourt Caroline Hind Monica Hrabovsky Neil Lavery Malcolm McPherson Stephen McPherson Pamela Lowbridge Siene Wai Ng Gordon Porteous Marka Rifat Graeme Shand David Taylor Elaine Thompson Mohan Varikkara