Dudley Eye Care Services

From 3rd September 2018

Speakers

Charles Barlow (Director PEHWM)

Rosie Birhah & Paul Sidhu (Dudley LOC)

Webstar Health

There will be a lot of information tonight ……its all in your info pack

Key Points

Service Specifications & pathways

Patients Questionnaires

Policies & Guidance

Sign Up Forms & Guidance

Stationery

Before you go fill in our Delegate attendance & Training Form

Introduction

Tonight's Running Order

Part 1 - Overview

Part 2 - The Services

Part 3 – Training & Governance

Part 4 - Software

Part 1

Cataract

IOP Repeat Reading (IOPRR)

Minor Eye Conditions (MECS)

These are to be provided by GOS practices in Dudley

Launching on 3rd September 2018

Dudley CCG are launching 3 new eye-care services :

CCG

Practice Practice Practice Practice Practice Practice Practice

PEHWM Ltd LOC

The LOC communicates with

PEC (HWM) Ltd both giving

and receiving feedback.

PEHWM are responsible

for all practices contract

compliance. Monitored by

a network of CG&PL

This makes us

pretty tough on

Practices who

don’t perform.

Directors

Charles Barlow

Ian Hadfield

Peter Rockett

Peter Bainbridge

Dan Sanders

Aisha Jeewa

NHS Contract awarded

to PEHWM who

subcontract to all

practices.

Webstar

Webstar provide and

support the software

that underpins the

servcie

Your commitment

Information Governance

Accreditation

Infection control

Safeguarding

Patient care

Provide the right care at the right time [follow the protocols]

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.

When we say everything, we mean everything

All clinical records - you enter the data into dropdown boxes or text boxes

All referrals – referral are sent automatically to ophthalmology with copies to GP

All patient satisfaction questionnaires are provided by the system

All patient information leaflets are downloaded from the software

Governance – all documentation is uploaded to the software

Invoices and payment – all managed by the software – no paper returns

Who is entitled to these services?

The services are commissioned for patients registered with a Dudley CCG

GP

You will only be paid for appropriately registered service users.

We will not pay for people who just live in Dudley, or have a Dudley

Postcode, - it all depends on their GP

If their GP is from another West Midlands CCG, they may still be entitled to a

service – check whether a service is available on Webstar and then check

the service specifications as they can all differ slightly.

Part 1 Summary

• Dudley CCG have commissioned a Cataract, IOPRR & MECS service from

3rd September 2018

• Your LOC Company PEHWM are contracting with the CCG for the service

• All practices will need a contract with PEHWM

• Any practice can provide the service as long as they comply with the

governance requirements

• The service is managed by an Webstar software online

• The service is just for patients of Dudley CCG GPs.

Don’t forget to fill in our Delegate attendance & Training Form before you leave

Part 2. Cataract Referral Pathway

To provide assessment and management of patients presenting with signs and/or

symptoms of cataract in either eye

It includes:

▪ Pupil dilation and examination by indirect ophthalmoscopy in order to establish

whether there are any co-existing ocular disorders as well as cataract.

▪ Discussion of the health questionnaire and any outstanding issues dealt with.

▪ Communicating the potential advantages and disadvantages of cataract

extraction

▪ Ascertaining the patient’s willingness for surgery including a patient self-

assessment questionnaire

Cataract Referral

Patient meets eligibility

Offer Choice of provider

Complete Optomanager record and Optomanager

will send referral to chosen provider and copy to

GP for information

You can print off the record and referral for your

records

IOP Repeat Measures Service

The IOP repeat measures service provides primary care repeat readings

to deflect unnecessary referrals to secondary care.

Patients who are identified as having IOP ≥ 24 mmHg and no other signs

of glaucoma during a GOS or private sight test will have immediate slit

lamp GAT or Perkins tonometry.

If IOP still ≥ 24mmHg patient returns within 1 month for second repeat.

Complete Optomanager record and where required Optomanager will

send referral to chosen provider and copy to GP for information

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

MECS

You will need to provide

Triage [staff training, forms available]

Same day appointments

48 hour appointments

Full recording of all contacts

Provide advice and guidance & information on self-care

Therapy via pharmacists

Report to GP or Referral if required - auto-generated

MECS - criteria for inclusion of patients

Loss of vision (inc transient loss)

Sudden onset of blurred vision

(unless a sight test reqd)

Ocular pain or discomfort

Systemic disease affecting the eye

Differential diagnosis of the red eye

Foreign body & emergency contact

lens removal (not by the fitting

practitioner)

Dry eye

Epiphora (watery eye)

Trichiasis (in growing eyelashes)

Differential diagnosis of lumps and

bumps in the vicinity of the eye

Recent onset of Diplopia

Flashes/floaters

Retinal lesions

Patient reported field defects

GP referral

MECS Triage

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

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

MECS is for All (relatively urgent) minor eye

conditions

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

Take care

MECS outcomes

GP report

Treat and discharge

Reassure and discharge [patient leaflets available]

Advise Therapy

Follow up

Refer to GP

Routine referral

Urgent referral

Emergency referral

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 Russells Hall & BMEC for out of hours

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

Part 2 Summary

• The three new services are Cataract, IOP RR & MECS

• Follow the service specifications

• Record all patient contacts on Webstar.

• All MECS enquiries must be Triaged and where required 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.

• You must manage DNAs

• If you don’t have an appointment you must find them one elsewhere

Don’t forget to fill in our Delegate attendance & Training Form before you leave

Part 3 - Optometrist Accreditation:

• GOC Registered

• Cataract - Completion of Wales Optometry Postgraduate Education

Centre (WOPEC) Cataract Services Online Distance Learning

• IOP RR - WOPEC Level One of the Glaucoma online distance learning

programme relating to IOP and Visual Field Refinement. Also show that

they can demonstrate the technique competently (through practical

demonstrations).

• MECS - WOPEC Distance Learning modules (Part 1), and the

associated Practical Skills Demonstration (Part 2 - OSCEs).

• Safeguarding level 2 certification (DOCET)

LOCSU training provided by WOPEC

Request your unique WOPEC authorisation code from the LOC , website

(contact us) or directly form Paul Sidhu at whitestar123@hotmail.com

Go to the WOPEC website www.wopec.co.uk 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: 1234567).

Practice Accreditation & Governance

• Submit Quality in Optometry (QIO) for GOS contracts (must be the latest

2017 version)

• Complete QIO NHS Standard contract LOC company subcontractor

short form checklist

• Comply with Safeguarding requirements (level 2 for all performers)

• Comply with Infection Control standards by completing QIO audit

• Have appropriate Insurance

Therapeutics

Dudley Formulary

Follow the Formulary Guidelines – very comprehensive for Lubricants

Recommend pharmacy medicines (P) or general sale list medicines (GSL) only

P or GSL medicines will need to be purchased over the counter as part of a self-care

approach

Refer to the Pharmacy Minor Ailments Service for Chloramphenicol & Sodium Cromoglicate

Communications

Will provide Leaflets & Posters to GP Surgeries

Pharmacies

NHS111

Yourselves

Anything else we can afford

Dudley LOC website http://dudleyloc.co.uk/

The Company website www.eyecarewm.co.uk

Quality, Performance & Audit

KPI’s

A full Audit trail enables accurate KPIs and detailed analysis of outcomes .

Reports are done quarterly and include:

• Activity levels for each service by month

• Activity levels by each practice per month

• Number of referrals by practice

• Patients not seen within 30 minutes of appointment time

• Numbers of satisfaction questionnaires completed

Outliers will be asked to explain.

Clinical Governance

Clinical Governance & Performance Leads Day to day Monitoring of all aspects of the service

• Service Provision & delivery

• Clinical governance

• Information governance

• Audit

• Performance monitoring

• Commissioner Liaison and reporting

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

Our CCG Contract requires us to monitor the service by practice and by performer.

KPI analysis will highlight statistical outliers, which are investigated and supported.

Common outliers in other services are

• Unexpectedly high activity

• Referral rates higher or lower than the average

• Not meeting appropriate timescales for appointments

• Low patient satisfaction submissions

Poor performance is managed with a five stage breach process, including remedial action plans

and terminating with service suspension.

Fees and Finances

Subcontractors Receive

MECS £50.00

Cataract £30.00

IOPRR 1st Reading £20.00

IOPRR 2nd Reading £28.00

Part 4 - Optomanager demonstration

This service would not be possible without Webstar Health

Gian will run through how Optomanager works

LAUNCH DATE

3rd September 2018

A launch event with local dignitaries and publicity will be held at a lucky

practice in Dudley.

To be selected at Random tonight

Next Steps – Info packs…

Key Points

Service Specifications & Pathways

Patient Questionnaires

Policies

Complaints, Serious Incidents, Service User Consent

Performance Management, Medicines Management

Mobilisation Check – Sign-Up requirements

Use of MECS & Sight Test

More on the LOC Website.

Next steps … summary

1. Complete the Webstar Registration form in your packs

2. Complete your QIO

3. Do your training and book the OSCE quick!

4. Look out your safeguarding certificates

5. Watch out for the contract from Webstar and ensure you sign it and

return it ASAP

Don’t forget to fill in our Delegate attendance & Training Form before you leave

Thanks to

LOCSU

WEBSTAR

THE LOCs

The Directors and Staff

You, the sub-contractors

Don’t forget to fill in our Delegate attendance & Training Form before you leave