1. Governance and Ophthalmology Tier 2Service Mike Broadhurst - Optometrist PCT Optometric Advisor – 5 PCTs Secretary North West Lancs LOC 3 Practices in 3 different PCTs

2. Governance Clinical Governance Clinical Audit Professional Development Professional regulation

3. Ophthalmology Tier 2 Service Identification of need Increase primary care based care Areas of good practice

4.  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

5. 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.

6. Fylde Intermediate Clinics - Fylde PCT  Referral and Operation  GPs refer to approved group of Optometrists for assessment and opinion  Patients could also “self-refer”

7. 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

8. 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

9. First Choice Eyecare-Blackpool  Blackpool Victoria Hospital currently has an ongoing capacity gap of approx 1500 out-patient appointment slots per annum

10. 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))

11. 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

12. Results  30% Ophthalmology Consultant  45% Optometrist  11% Cataract Pathway  4% Orthoptist  3% DRSS  1% Other  6% Not enough information

13. 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

14. 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 = £28,200 45% Optometrist 450 x £64 = £28,800 25% Inappropriate referrals= £00 Total= £57,000 Potential Saving per 1000 patients £37,000

15. Next steps  Redesign patient journey  Clinical group  Analyse current patient pathway  Identify areas for improvement  Agree organisational pathways  Implement new service

16. 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

17. 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.

18. 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

19. 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

20. Any Questions ? Thanks for listening