1. Dudley Direct Cataract Referrals
Optometrist Accreditation for Cataract choose and book
Presented by:
Sue Lane, Dudley PCT
Humphrey Yorke, Dudley LOC
Charles Barlow, Dudley LOC
19th April 2005
Welcome to the first Optometrist accreditation session for the Dudley Direct Cataract Referral Scheme.
This evening is the result of extensive negotiation and co-operation between your LOC & the local PCTs resulting in a new patient referral pathway for cataract referral.
This pathway has been agreed over the whole of the Birmingham and Black Country Region, so this scheme will be very similar to ones run in other areas.
I have provided print outs of all the presentations for your reference.
On the top of these is a form for you to fill in to confirm your attendance for accreditation purposes.
Please fill the form in as accurately as possible, listing all the practices in Dudley that you supply GOS.
Please ensure you hand these in to me before you leave.

2. Direct Cataract Referrals
Understanding “Choose and book”
Assessing Patient eligibility
Patient Choices
Administration
Following up the booking
Payments
Our first session is Understanding “Choose and book” this will be presented by Sue Lane from the PCT
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Assessing Patient eligibility will be discussed by our very own Humphrey Yorke
I shall be presenting the remainder, including
Patient choices
Administration
Following up the booking
Payments
But first over to Sue for “Understanding Choose and Book”

3. Patient Choices What? Where? When? Patient choice if they want surgery
Patient choice of provider
Patient choice of appointment date
Before we discuss Helping the patient to choose, let us remind ourselves of the choices we have to offer the patient
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What -
The patient needs to know What is a cataract & what the treatment entails before they can make an informed decision.
A general discussion of cataracts and the potential benefits of surgery is exactly what you do at present
Where-
The patient now can choose which hospital they want to be referred to – see your patient packs for all the hospital information.
When-
The patient books their own appointment, so they then choose when it suits them.

4. Patient Choice Decisions
Patient Does Not want to proceed with surgery
Choice of provider not required
Noted in records (including score from clinical guidelines)
GP informed
Patient Wishes to proceed with surgery
Choice of provider offered
Patient wishes to take time to consider surgery
Having Gone through your general chat about cataracts the patent will have three possible courses of action.
1 obvious
Informing the GP is required under current College guidelines. 2
Next 3
So now you know what choices the patient has, you are now able to further help them with their choice

5. Helping the patient to choose
Discuss general information on cataract surgery
Issue RNIB leaflet Understanding Cataract.
Issue NHS Leaflet A Guide to Choice & Booking in Cataracts
Issue Cataract Provider Information Leaflets
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In most cases you will already have done this
Provide the patient with the the information in the packs provided
The patient now has all the information they need to make their choices.
Well Done – You have now provided patient choice
If the patient decides what they want to do straight away, your job is almost finished,
however they may want to go away and think about it –

6. Patients wanting to choose later
Ensure patient’s contact information is correct
Patient goes away and discusses with family and friends and thinks about choice
Patient then contacts Optometrist with choice
If patient has not chosen after 7 days – Optometrist must contact patient for decision
If patient cannot be contacted or fails to choose, then annotate records accordingly
Under this pathway, every patient has the opportunity to go away and think about it, so before they go away
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Don’t forget to get all their information as you will need to contact them later.

7. Patient Chooses Provider
Referral Form C1 Completed
Patient completes and signs reverse of C1
Optometrist advises patient to telephone provider and book their own appointment at a suitable time.
Patient contacts chosen hospital for appointment.
The patient having chosen the provider, the following procedure is followed
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The patient must sign the reverse of the C1 to confirm choice has been offered.
If the patient has gone away to think about their decision and informs you of their choice by telephone this could easily be forgotten. The patient must sign the C1 before you Fax it to the provider. So they will either need to come in and sign it or you will have to post it to them for signing.
The PCTs will be carrying out extensive audit checks, any C1s submitted for payment not counter signed by the patient will not be eligible for payment, as there is no evidence that choice has been offered.
You must reinforce to the patient that they have to book telephone to book the appointment.

8. Administration
Completed C1 is faxed to provider ASAP after choice decision
Completed C1 is also faxed to GP
GP will then complete form C2 & forward to provider
C1 is photocopied for payment submission
Original C1 is stored with the patient record for audit purposes.
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Discuss the photocopied C1 at the payment slide.

9. Following up the booking
If the Patient fails to make a booking, the provider will contact the patient.
If patient declines appointment, the provider will notify optometrist.
The Optometrist must then contact the patient within 7 days to discuss re-referral.
Optometrist informs Provider & GP of new decision
Fax original C1 back to provider, clearly annotated re-referral
This is all part of the choice process and is part of the agreed pathway.
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This is to ensure that the Patient choice is being offered correctly and to minimise potential abuse of the system.
Obviously further payment will not be made, hence the need to annotate the form correctly.

10. Payment
C1 is photocopied (confidential clinical information can then be removed)
Collate C1’s in batches for forwarding to PCT with GOS1’s
Complete 2 GOS Voucher scheme forms as per GOS1’s
Post/Deliver to usual PCT address
Payment will be made the following month.
As you all know, we are being paid £18 per referral.
This is the result of extensive negotiations with the PCT’s.
It sets a new precedent for payment of NHS items of service Dudley and will last until our new GOS contract is agreed, theoretically in 2006/7.
The PCT’s are keen to ensure that the available funds are used as cost effectively as possible and therefore will be carrying out extensive audits on the scheme to ensure probity… So
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The usual GOS payment cut off dates will apply

11. Patient Choice Pathway
GP sees patient with cataract and refers them to an accredited optometrist OR
Patient attends routine eye examination with non-accredited optometrist and is referred to an accredited optometrist
Accredited optometrist undertakes sight test.
Optometrist identifies whether surgery would be beneficial & if the patient wishes to proceed with surgery and if the referral guidelines are met
Patients not wanting surgery Noted in records and GP notified
This pathway is provided in larger print with your handouts.
Patients not wishing to make choice immediately
The patient’s telephone/contact information is checked to ensure they can be contacted.
Choice information given to patient.
Patient wishes to proceed with surgery
Choice information given to patient.
Patient discusses choice with family and friends
Patient Makes choice of provider
Patient contacts the optometrist to inform them of choice.
Patient not chosen
Optometrist contacts patient after 7 days.
Optometrist completes Referral form C1 & faxes to provider ASAP
Patient signs reverse of C1 to confirm choice offered and consenting to referral & information exchange
Optometrist informs patient to book appointment directly with appropriate provider.
Patient cannot be contacted or fails to choose
Annotate records, no further follow-up required
The patient contacts the chosen hospital to book the appointment at a convenient time

12. F A Q ‘s
Does The Patient have an NHS ST if referred from a non accredited Optometrist?
Yes – If they are entitled –
Only if referred from another practice
Do they have to be dilated?
That is entirely at the discretion of the practitioner – A routine examination is required as per the College guidelines on best practice.
The next section is simply questions that we have been asked so far:
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If the patient has come from another practice of course
However-
Practices with several optometrists, should not claim for an NHS ST if referring from one practitioner to another, as all the clinical information should be on the records.
This is not a referral refinement pathway, it is purely a patient choice pathway.

13. F A Q ‘s Can we refer Diabetics?
They can be referred through the scheme if there is no Retinopathy. If there is Retinopathy they should be referred through the normal pathway explaining direct referral is not appropriate
Do I have to follow up the patients myself?
At the discretion of the practitioner – it may be delegated to a member of staff.
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We shall amend this as we recive further guidance from Mr Shafquat

14. F A Q ‘s
What happens to Optometrists new to the area or newly qualified Optometrists?
Any Optometrists can be accredited by attending an accreditation session. These will be held at least 3 times a year and details can be obtained from the PCT or the LOC
Can Locums be accredited?
Yes, as long as they attend an accreditation session.
Any Optometrist can be accredited.
The List of accredited Optometrists will be distributed to all GP and Optometric practices after the second accreditation session (date to be confirmed)

15. F A Q ‘s
What do we do for patients who come to see us who do not live in Dudley?
Exactly the same
You offer them the choice of providers in their area – on the sheet in the info pack for the whole of the BBC region.
Faxing the C1 and your claim for payment in the normal way
A knock for knock arrangement is in place for all the BBC region
For patients from a lot further away you, they will probably need to get more local onformation.

16. F A Q ‘s Why hasn’t my patient received an appointment yet?
Because they haven’t phoned for an appointment – did they forget? or did you forget to RE-INFORCE the point?
THE OPTOMETRIST MUST ENSURE THE PATIENT UNDERSTANDS THEY HAVE TO PHONE TO BOOK THEIR OWN APPOINTMENT

17. F A Q ‘s Any more questions?
Any further queries contact myself or Sue Lane
Do not forget to hand in your completed accreditation forms
Thank you & Goodnight
More questions from the floor.