1. Sandwell and West Birmingham Solihull Eye Care Services Launch Evening

2. Webster Health - Gian Celino
Guest Speakers
Birmingham LOC
Sandwell LOC
Solihull LOC
Webster Health - Gian Celino

3. We are launching 3 schemes simultaneously:
Introduction
We are launching 3 schemes simultaneously:
Cataract
IOPRR
MECS

4. Introduction Questions as we go
We will be throwing a lot of information around…
give it some time
Questions as we go

5. CCG Practice PEC(HoWM) Ltd LOC Webstar
Contract awarded competitive tender process
Clinical Governance Requirements
PEC (HoWM) Ltd are responsible for all practice owners.
Directors
Charles Barlow
Ian Hadfield
Peter Rockett
Peter Bainbridge
Dan Saunders
David Stevens
This makes us pretty tough on compliance.
The LOC communicates with PEC (HoWM) Ltd both giving and receiving feedback.
CCG
Practice
PEC(HoWM) Ltd
LOC
Webstar

6. Your commitment Information Governance Accreditation Infection control
Safeguarding
Patient care
the right care at the right time [follow the protocols]

7. Everything is done via Webstar, Optomanager Software
Everything is done via Webstar, Optomanager Software. Eliminating administration, generating insight The package of web platforms called OptoManager has been developed for Local Optical Committee Support Unit (LOCSU) by Webstar Health. The technology virtually eliminates manual administration of optical services, helps with data collection and generates insightful performance reports.

8. The Services Sandwell and West Birmingham Cataract IOP repeat measures
MECS
Birmingham Cross City
Birmingham South Central
Solihull

9. Who is entitled to these services
The services are commissioned for patients registered with either a Sandwell and West Birmingham CCG GP or a Solihull GP
We will only pay for appropriately registered service users.
We will not pay for people who just live in Solihull, Sandwell or Birmingham.
– it all depends on who their GP is not their postcode 

10. Who is entitled to these services
So a patient whose GP is in Birmingham Cross City or Birmingham South Central
CAN NOT be seen under the MECS service
You will have to manage through GOS /private sight test and any additional private services you provide.
You are advised to fully explain any fees before providing additional private services

11. Cataract Referral Pathway
Reduce unnecessary referrals to the hospital eye service and provide a more cost effective service with a greater number of patients being managed within the primary care setting.
Requires dilation appointment, separately or at the same time as eye examination
Patient Self Assessment Questionnaire
Patient Information Leaflets

12. Cataract Referral
Patient meets eligibility Offer Choice of provider Complete record online and Optomanager will Fax referral to chosen provider and copy to GP for information You can print off the record and referral for your records

13. IOP Repeat Measures Service
Referral refinement has been shown to reduce onward referrals by as much as 77% The IOP repeat measures service provides primary care repeat readings to deflect unnecessary referrals to secondary care. Patients who are identified as having IOP > 21 mmHg and no other signs of glaucoma during a GOS or private sight test will have immediate slit lamp GAT or Perkins tonometry assuming the optometrist is contracted to provide the service.

14. Minor Eye Conditions Service (MECS)
Purpose of Service
Using the skills of primary care optometrists to triage, manage and prioritise patients presenting with an eye condition,
To deal with recent onset eye problems that are not appropriate for sight tests and to reduce referrals by GPs and Optometrists to secondary care
Experience elsewhere shows 70-80% deflection
It is no good seeing patients and referring most anyway
This will be monitored closely

15. Minor Eye Conditions Service (MECS)
Patient care will be improved by:
Reduction in unnecessary referrals to eye casualty clinics thus supporting CCGs and NHS trusts to manage ophthalmology capacity
More cost-effective care
Speedier access to care
Care closer to home in a more convenient setting
Easier access for patients through self-referral
Retention of patients in primary care where possible
Reduction in antibiotic prescribing

16. MECS You will need to provide Triage [staff training, forms available]
Same day appointments
48 hour appointments
Report to GP….generated
Referral if required

17. MECS Triage

18. Take care Flashes and Floaters in particular VA Dilate
Check for Schafer’s sign and record
Indirect exam, 8 directions of gaze, wide field Volk
Careful record
Give F & F advice sheet
Give drops advice sheet

19. MECS is for All (relatively urgent) minor eye conditions
BUT Not for:
Wet AMD found during ST
Refining referrals from a ST (e.g. glaucoma/cataract)
But can use for F & F
F & F stable for >3m
2nd incident of F & F within 1 month of 1st (follow up)
Repeated dry eye within 4 months of 1st MECS
Repeated removal of lashes within 4 months of 1st MECS
Where a sight test would be more appropriate

20. Take care Yet more not for… More not for…
Adult squints
Longstanding diplopia
Repeat field tests
AMD
Previously identified
Severe eye conditions needing HES
Herpes Zoster
Tumours
Yet more not for…
Where other enhanced serviced are appropriate
Cataract referral
Cataracts post-op
Repeat IOP
Diabetic retinopathy

21. MECS outcomes
GP report Treat and discharge Reassure and discharge [patient leaflets available] Follow up Refer to GP Routine referral Urgent referral Emergency referral

22. Direct referral to eye casualty clinic
If your patient requires Eye A&E or fast track Wet AMD
Make sure everyone in the practice has a copy of the protocol
from Sandwell and West Birmingham NHS trust City Hospital
For A&E Telephone first
Triage options are same day or urgent clinic 24/48 hours
Patient contact details (telephone numbers) and brief referral details . Give patient a copy to take with them.
Fax Wet AMD to the fast track clinic

23. *If you don’t have an appointment you must find them one elsewhere
Important Points
Record all MECS patient contacts on practice record card.
All patients must be seen by optometrist:
Within 24hrs for urgent
Within 48hrs for routine
Optometrists must, within reason, be able to offer a MECS examination within 48 hours of the day that the appointment has been requested (excluding weekends and public holidays) unless it is for routine assessment.
*If you don’t have an appointment you must find them one elsewhere

24. Optomanager demonstration
This service would not be possible without Webstar Health Gian will run through how Optomanager works

25. Part 2

26. Quality Issues and Auditing
A full Audit trail will be established so that detailed analysis of outcomes etc. can be monitored. Outliers will be asked to explain. Patient Satisfaction Questionnaire must be completed

27. Therapeutics Topical Eye Formulary
We must bear in mind that GPs are rightly, very concerned about costs of their drug budget. if you know a patient is going to request a prescription from their GP, Please initially choose first line ocular lubricant.
For patients using a dry eye preparation long –term, and where allergic response may be a problem, then recommend a suitable preservative free lubricant. Preservative free products using a bottle with a microbial filter or a “wine bag” type design generally work out cheaper to supply and use than do single dose preparations. Hycosan is generally available on prescription.

28. Communications Will provide Leaflets & Posters to GP Surgeries
Pharmacies
NHS111
Yourselves
Anything else we can afford
Birmingham LOC website
Sandwell LOC website
Solihull LOC website
The Company website

29. To do List Nhs.net MECS email Testing MECS MECS software tweaks
oh! and the contracts

30. Launch Date
1st March 2016

31. How to Start…
1. Register with Webstar 2. Book the OSCE quick! (dates to be confirmed) 3. Certificates ready to upload onto Webstar 4. NHS.net s? (To be confirmed)

32. OSCES Most have already completed these
Thankyou for your support and patience
More sessions in the process of being organised.
BUT
If you haven’t completed or even started your MCQs get signed up more details in your pack

33. LOCSU training provided by WOPEC
Request your unique WOPEC authorisation code from Ian Hadfield, You will receive an with full instructions which include Go to the WOPEC website and choose to either ‘Register’ or ‘Login’. In the green ‘Code’ box on the website’s homepage enter your code. This will be made of two parts, a prefix (example: LOCSU) and a code (example: ).

34. Next steps
Once you have passed the MCQs you will then be required to sit the OSCE exams for MECS To find out when the next OSCEs are, please contact The OSCES are comprised of five 5 minute stations which are designed to assess whether a practitioner is able to reasonably and safely perform a MECS clinical examination.

35. Getting signed up with Webstar
Once fully accredited, please with the following information:
Name of accredited optometrist
Practice where you will be working
If the practice does not already hold a subcontract with PEC [HoWM] Ltd
the owner will need to apply [certain conditions are mandatory]
Both the practice and each of the optometrists will need to register to use Optomanager

36. Clinical Governance Requirements on Practices
QiO GOS contract [Level 1] –at start of scheme
QiO NHS Contracts– all 3 sections and audits
Accreditation Requirements through WOPEC
Safeguarding Certificates
(adult and children) needs completion by 1st March 2016
Public Liability Certificate
if you have not received instructions on what to do

37. Performance KPI’s The system records the time
Reports are done quarterly
Activity levels for each service by month
Activity levels by each practice per month
Number of referrals by practice
N.B Patients to be seen within 30 minutes of appointment time

38. Non compliance what does it mean for you
Must complete the sub contractor requirements
Must complete the patient record on line
You won’t be paid if it is not completed
The CCG needs to spend its money wisely so we have to check
and take action if you are an outlier.
Common outliers in other services are
Doing too many
referring more than the average or not enough
Not having available appointments

39. In your packs… Contract & Protocol Key Points Pathways
Service Specifications
Managing Performance
Complaints policy
Complaints about MECS must follow PEC (HoWM) Ltd policy
Must be reported via IT
Information leaflets
Prescribing policy
Patient Questionnaires
Much more on line

40. Fees and Finances Subcontractors Receive MECS £50.00 Cataract £30.00
IOPRR 1st Reading £20.00
IOPRR 2nd Reading £25.00

41. The Directors and Staff In particular: The awesome PETER ROCKETT
Thanks to
LOCSU
WEBSTAR
THE LOCs
HAYLEY ROWBOTHAM
The Directors and Staff
In particular:
The awesome PETER ROCKETT
You, the sub-contractors

42. Also a big thankyou to those who supported us on the night Charles Barlow and Peter Bainbridge for meeting and greeting and their assistants …you know who you are
Paul Sidhu for the website
Thank You
Katrina Venerus managing director LOCSU for all the behind the scenes stuff……and for coming to the second city to join us for the launch.
And most important you
Together we will be AWESOME