the nhs eyecare pathway pilots andrew kent anita lightstone nhs eyecare services team
TRANSCRIPT
The NHS Eyecare Pathway Pilots
Andrew Kent
Anita Lightstone
NHS Eyecare Services Team
The NHS Eyecare Pathway Pilots
Plan:– Programme outline– Pathway principles– Where are we now?– Roles and responsibilities– What next?
The NHS Eyecare Pathway Pilots
Set up by the Department of Health in 2002, with representatives of:– ophthalmologists– optometrists and dispensing opticians– orthoptists– ophthalmic nurses– patient organisations– health,social care & policy organisations
The National Eye Care Steering Group
The NHS Eyecare Pathway Pilots The National Eye Care Steering Group
Group’s initial remit: To develop proposals for the modernisation of
NHS eye care services first priority to develop model pathways for:
– cataract– glaucoma– low vision– age related macular degeneration
The NHS Eyecare Pathway Pilots The National Eye Care Steering Group
Pathway principles: To develop innovative approaches, for example
partnerships with the voluntary sector To remove barriers to and streamline services To provide services where and when they can be
easily accessed To increase awareness of the importance of eye
health To make better use of professionals
The NHS Eyecare Pathway Pilots Pathway principles
social carethird sector
GPs
opticiansoptometristsnursesDept of Health
NHS
orthoptists
ophthalmologists
patient
The NHS Eyecare Pathway Pilots
Proposed Glaucoma Pathway
1. Patient attends community optometrist (CO)•Sight test, IOP over 21 (applanation tonometry) and/or
visual fie ld de fect and/or excavated discs•Patient/optometrist makes appointment with optometrist
with special intere st in glaucoma (OSI) or OMP
2. Patient attends OSI or OMP•Full history and assessment carried out according
to protocol•Dec ision taken as to whe ther patie nt ha s ocular
hypertension (OSI/OMP re views) or ca n bedisc harged (return to CO) or has glaucoma (trea t
or refer to H ES)•Patient advised, give n informa tion etc and further
appropriate a ppointments ma de if needed
3. OSI/OMP relays data to HES•HES revie ws data, advises OSI/OMP
re garding manage ment and sets upre view at HES i f nee ded
4. OSI/OMPmanages patient incommunity setting•Regular reviews se t in
place•OSI/OMP rela y da ta to
hospital if significantprogression for H ES
re view if needed
Start
The NHS Eyecare Pathway Pilots
Proposed AMD Pathway
1. Patient attends optometrist with specialinterest (OSI)
•Differential diagnostic assessment, including fullhistory, clinical examination, biomicroscopy and
macular function•Patient has non-neovascular AMD
•Patient has neovascular AMD -OSI refers directly toHES
2. Patient attends HES•Outpatient appointment with
ophthalmologist*•AMD untreatable
•AMD treatable(* flourescien angiography and further
investigation )
3. Patient attends HES•Access to treatment
•Advice and information etc for patient
4. Fast access tointegrated lowvision services•optical low vision
services•advice and information
•counselling•social service support
•rehabilitation•possible certification
(CVI)
Start
The NHS Eyecare Pathway Pilots
Service enables re-access
Proposed Low Vision Pathway
1. Patient referred to Low Vision Service(LVS)
•Referral may be from secondary care, GP, socialworker, rehabilitation officer, community nurse, OT etc
or may be self referral•Patient may have an LVI, RVI or CVI
•All patients are contacted by LVS within 10 workingdays
2. Patient attends LVS•Service is seamless across health, social care and the voluntary sector
•A full sight test forms part of assessment•Patient is given information on eye condition, entitlements etc as well as local services
• Emotional support and advice on employment or education etc is available•Spectacles, LV aids, advice (esp. lighting, contrast and size), equipment and home adaptations
are discussed and made available as appropriate•Referral to other areas of health and social care as needed, including certification
3. Patient has follow upvisits as needed
•Visits may take place in thepatient’s home or elsewhere•Visit will be by appropriate
member of the LV team
Start
The NHS Eyecare Pathway Pilots
Sites
Glaucoma: Peterborough, North Birmingham and East Devon,
Waltham Forest
Age Related Macular Degeneration: Brighton and Hove, Waltham Forest
Low Vision: Gateshead, Sutton, Merton and Wandsworth, Barking
and Dagenham and Havering, Waltham Forest
The NHS Eyecare Pathway Pilots
Associate low vision sites: Brighton and Hove South Lincolnshire Mid and East Devon Hartlepool Northumberland South Worcestershire Morecambe Bay New Forest
The NHS Eyecare Pathway Pilots
Pilot update: Several pilots now in the process of becoming
“mainstream” services External evaluation underway and will be
completed by the end of the year Sharing of outcomes at “Delivering the Vision,
January 2007 and looking to the future
The NHS Eyecare Pathway Pilots
Mainstreaming:
Local review of service to assess local value/success/need
Need for inclusion by PCTs of the service into Local Delivery Plans
Review of contractual arrangements and agreement of new contract/handover
The NHS Eyecare Pathway Pilots
Evaluation: Both internal (at pilot level) and external evaluation
being undertaken
External evaluation will cover: Pilot outcomes – did they achieve what they set
out to do? How effective was this? Patient and staff views
The NHS Eyecare Pathway Pilots
Evaluation External evaluation will cover:
Associated issues – e.g. training, governance, sustainability and roll-out
Costs Availability of robust data
Comparison between pilots, where appropriate
The NHS Eyecare Pathway Pilots
Anecdotal findings
The NHS Eyecare Pathway Pilots
So where and how do the professionals fit in?
The NHS Eyecare Pathway Pilotswhat next?
Sharing of learning - Delivering the Vision, January 2007
Revision of the pathway and guidelines
GOS review On-going promotion of
community based services
The NHS Eyecare Pathway PilotsClosing thoughts
Be objective about new ways of working
Be aware of your patients’ fears and concerns
Provide clear and concise information
Work for better eye care services
The NHS Eyecare Pathway Pilots
Thank you for your attention
Any questions?
www.eyecare.nhs.uk