1. Optometric Enhanced Services Andrew Kaye Chair Wakefield Local Optical Committee

2. The Schemes Primary Eyecare Acute Referral Scheme (PEARS) Intra-ocular Pressure Refinement Scheme Choice Cataract Scheme

3. The first PEARS scheme was designed and set up by Ted Arbuthnot in 2001 PEARS (A bit of history)

4. The first PEARS scheme was designed and set up by Ted Arbuthnot in 2001 Launched initially in the Bro Taf Health Authority area in South Wales. PEARS (A bit of history)

5. The first PEARS scheme was designed and set up by Ted Arbuthnot in 2001 Launched initially in the Bro Taf Health Authority area in South Wales. The reason for the scheme was the level of unnecessary referrals passing from GPs to the hospital eye department. PEARS (A bit of history)

6. The first PEARS scheme was designed and set up by Ted Arbuthnot in 2001 Launched initially in the Bro Taf Health Authority area in South Wales. The reason for the scheme was the level of unnecessary referrals passing from GPs to the hospital eye department. GPs were encouraged to send acute eye problems to an optometrist instead of the hospital subject to PEARS protocols. PEARS (A bit of history)

7. The initial scheme was a great success with a 76% reduction in acute referrals to the eye department to such an extent that the devolved Welch Assembly then floated the scheme nationally.

8. The initial scheme was a great success with a 76% reduction in acute referrals to the eye department to such an extent that the devolved Welsh Assembly then floated the scheme nationally. In England the uptake of enhanced eyecare services has been left to individual PCTs to float and negotiate locally.

9. PEARS Scheme Basics The scheme is designed for people who present at the optical practice with a recent onset eye problem.

10. PEARS Scheme Basics The scheme is designed for people who present at the optical practice with a recent onset eye problem. The patient may have been referred by their GP, a pharmacist or another optometrist. The patient may also be self referred.

11. PEARS Scheme Basics The scheme is designed for people who present at the optical practice with a recent onset eye problem. The patient may have been referred by their GP, a pharmacist or another optometrist. The patient may also be self referred. Practices in the scheme agree to see the patient ideally with 48 hours and if they can't they should refer a patient on to another scheme practice who can.

12. The PEARS examination does not involve a GOS sight test although we can, as a result of what we find, recommend one.

13. Should a referral be required it can be made direct to the hospital.

14. The PEARS examination does not involve a GOS sight test although we can, as a result of what we find, recommend one. Should a referral be required it can be made direct to the hospital. Those practices taking part need a minimum level of equipment and agree to work to an agreed protocol.

15. From a GP point of view, what eye conditions are suitable for referral on through the scheme?

16. Acute conditions should still be sent to the hospital as further delay may put the eyesight at risk.

17. From a GP point of view, what eye conditions are suitable for referral on through the scheme? Acute conditions should still be sent to the hospital as further delay may put the eye sight at risk. Sudden loss of vision Suspected corneal ulcer Acute dacryocystitis Temporal Arteritis Visible retinal detachment Orbital Cellulitis

18. PEARS conditions should be of recent onset :

19. Blepharitis Entropion Ectropion In-turning lashes Foreign body Corneal abrasions Red eyes Conjunctivitis

20. PEARS conditions should be of recent onset : Blepharitis Entropion Ectropion In-turning lashes Foreign body Corneal abrasions Red eyes Conjunctivitis Scleritis & episcleritis Flashes & floaters Any visual distortion Diabetic maculopathy Recent onset field defects Vessel occlusions Circum limbal injection Allergic problems

21. What about other longstanding eye problems?

22. These can still be referred to an optometrist but would be seen as part of a normal sight test or assessment. This might be free under the NHS or the patient may have to pay a fee.

23. What about other longstanding eye problems? These can still be referred to an optometrist but would be seen as part of a normal sight test or assessment. This might be free under the NHS or the patient may have to pay a fee. Longstanding dry eye Drooping eyelids Persistent watering Eyelid lumps & bumps Cataract Longstanding diplopia Suspect glaucoma Gradual onset vision problems

24. Guidance A clinical guidance sheet has been produced for professional staff

25. Local Optometrists have also produced a symptom based guide for non- professional staff

26. Examples from non-professional guidelines Sudden onset double vision, painful loss of vision in one eye, sudden reduction in visual field Acute hospital referral

27. Examples from non-professional guidelines Sudden onset double vision, painful loss of vision in one eye, sudden reduction in visual field Flashes, floaters, red eyes, foreign body sensation, infections, distorted vision PEARS referral Acute hospital referral

28. Examples from non-professional guidelines Sudden onset double vision, painful loss of vision in one eye, sudden reduction in visual field Flashes, floaters, red eyes, foreign body sensation, infections, distorted vision Blurred vision, longstanding watery or dry eyes, lumps and bumps on eyelids General referral PEARS referral Acute hospital referral

29. Objectives Utilise the skills within primary care

30. Objectives Utilise the skills within primary care Reduce referrals into hospital services

31. Objectives Utilise the skills within primary care Reduce referrals into hospital services Direct referral to appropriate service

32. Objectives Utilise the skills within primary care Reduce referrals into hospital services Direct referral to appropriate service Patient choice

33. Objectives Utilise the skills within primary care Reduce referrals into hospital services Direct referral to appropriate service Patient choice Free up GP appointments!

34. Objectives Utilise the skills within primary care Reduce referrals into hospital services Direct referral to appropriate service Patient choice Free up GP appointments! Manage patients in primary care if appropriate

35. Cost to patients?

36. Free!

37. How will GP’s be kept informed?

38. Every PEARS event will involve a automatic report to the patients GP practice. (but the GP copy is yellow)

39. How do you refer a patient into PEARS?

40. The PCT have created a small referral form (as ever!)

41. How do you refer a patient into PEARS? The PCT have created a small referral form (as ever!) Just tell your patient to visit one of the optical practices in the scheme!

42. Which optical practices are in the PEARS scheme? Most practices are in the scheme but the PCT amd LOC are constantly trying to encourage those not already participating to take part.

43. A C Smith Opticians Aldred Opticians Auckland Opticians Barbara Watson Eyecare Boots Opticians Brosgill Opticians Date Opticians D Bank Opticians D G Opticians J R Morton McCormack Opticians Moorhouse Opticians Patterson Opticians Pearl Eyecare Pollards Optical Clinic Pollard Optical Premier Vision Wakefield South Elmsall Ackworth Wakefield Pontefract Wakefield South Elmsall Normanton Wakefield Hemsworth Havercroft Castleford Featherstone Normanton Hemsworth Wakefield South Elmsall Wakefield Knottingley Wakefield We are hoping that eventually all practices will join the scheme Premier Vision Rayners Opticians Ruth Perrott Specsavers Vision Express Visionicare Vision Value Yager Opticians Castleford Wakefield Castleford Wakefield Upton Castleford Pontefract

44. Will GP’s still get referrals from Optometrists?

45. Yes!

46. Will GP’s still get referrals from Optometrists? Yes! Referrals from normal sight tests still have to go via the GP unless they are acute.

47. Will GP’s still get referrals from Optometrists? Yes! Referrals from normal sight tests still have to go via the GP unless they are acute. If a PEARS referral involves a patients general health then it needs to go to the GP

48. Can any patient be seen under PEARS?

49. No Only those patients who are registered with a GP under Wakefield District PCT

50. If a GP receives an Optometrists referral that they are unsure about, can they get it refined under PEARS?

51. No Referrals received should be processed in the normal way.

52. If a GP encounters a contact lens problem can it be referred on under PEARS?

53. No Unless there are exceptional circumstances, they should return to the original provider for assessment.

54. Patient Surveys

55. Results so far?

56. Very good

57. Results so far? Very good Hospital referrals are down

58. Results so far? Very good Hospital referrals are down Patient feedback has been described by the PCT as excellent

59. Results so far? Very good Hospital referrals are down Patient feedback has been described by the PCT as excellent A deflection rate of 62% has been achieved across the scheme since it started.

60. Results so far? Very good Hospital referrals are down Patient feedback has been described by the PCT as excellent A deflection rate of 62% has been achieved across the scheme since it started. The scheme has been extended for another year

61. Any Questions?

62. Herpes Simplex Keratitis Acute referral to Mid Yorkshire