Service Specification for Optometry Services

Service Specification for Optometry Services

SCHEDULE 3

Service Specification
Title: / Red Eye Scheme in Primary Care
Scope: / Primary Care Commissioning Optometry Provider Services
Period: / March 1st 2011 to March 31st 2013
Commissioner Lead / Karen O’Brien – Associate Director of Commissioning

CONTENTS

1.0  Purpose

1.1  Aims

1.2  Evidence base

1.3  General Overview

1.4  The Pathway

1.5  Objectives

1.6  Expected Outcomes including improving prevention

2.0  Scope

2.1  Service Description

2.1.1  Accreditation

2.1.2  Equipment

2.2  Accessibility / Acceptability

2.3  Whole System Relationships

2.4  Interdependencies

2.5  Relevant networks and screening programs

3.0  Service Delivery

3.1  Service Model

3.2  Care Pathway

4.0  Referral, Access and Acceptance Criteria

4.1  Geographic coverage / Boundaries

4.2  Location(s) of Service Delivery

4.3  Days / Hours of operation

4.4  Referral criteria & sources

4.5  Referral Route

4.6  Exclusion criteria

4.7  Response time & detail and prioritisation

5.0  Discharge Criteria and Planning

6.0  Prevention, Self-Care and Patient Carer Information

7.0  Continual Service Improvement/Innovation Plan

8.0  Baseline Performance Targets

9.0  Activity

9.1  Activity

9.2  Activity Plan / Activity Management Plan Hours

9.3  Capacity Review

10.0  Financial Details

10.1  Financial Matter

11.0  Appendix 1 – Patient Pathway

PURPOSE 1.0

______

1.1  Aims

Using the skills of primary care optometrists to triage, manage and prioritise patients presenting with a “red eye” condition. Patient care will be improved by;

·  Providing a timely assessment of the needs of a patient.

·  Reducing the number of GP appointments.

·  Reducing the number of inappropriate referrals to secondary care.

·  Reducing the level of activity at secondary care.

·  Ensuring the patient pathway is as short as possible whilst offering choice of service access.

1.2  Evidence Base

The evidence base for the service is contained in:

·  World Class Commissioning and the Darzi review (2008)

·  Creating a patient-led NHS: Delivering the NHS Improvement Plan (March 2005)

·  Commissioning Framework 2007-8

·  Implement care closer to home; convenient quality care for patients (April 2007)

·  Commissioning Framework for health and well being (March 2007)

·  Trust, Assurance and Safety - The Regulation of Health Professionals (February 2007)

·  Safeguarding patients ( February 2007)

·  Revision of The NHS in England: operating framework 2010-11

·  Practice based commissioning: practical implementation (November 2006)

·  Health reform in England: update and commissioning framework (July 2006)

·  Tackling hospital waiting: the 18 week patient pathway (May 2006)

·  Standards for Better Health (April 2006)

·  White Paper: Our Health, Our Care, Our Say (January 2006)

·  NHS Plan: a plan for reform, a plan for investment (2006)

1.3  General Overview

Most acute superficial eye infections can be treated topically. Blepharitis and conjunctivitis are often caused by staphylococci; keratitis and endophthalmitis may be bacterial, viral or fungal.

Most cases of acute bacterial conjunctivitis are self limiting; where treatment is appropriate, antibacterial eye drops or an eye ointment are used. A poor response might indicate viral or allergic conjunctivitis. Gonococcal conjunctivitis is treated with systemic and topical antibacterials.

GP practice prescribing data from April 2010 to March 2011 has shown that 24,910 chloramphenicol and Fucithalmic prescription items were dispensed. This figure does not include the number of prescription items that were written but not dispensed. Currently data is not collected routinely for patients presenting at A&E that require treatment for a “red eye” condition.

Using the above figures it has been estimated that up to 250 appointments per GP practice per year would be released from this scheme across Manchester (24,910/102 practices = 250). Data is not available to calculate accurate savings for A&E attendances due to “red eye” conditions. However, a basic calculation of one patient with a “red eye” condition deflected a week per practice would equate to approximate efficiency saving of £40,800.

1.4  The Pathway

The service will provide a primary care optometry service for patients referred by General Practitioners, unaccredited (Level 0) optometrists, self referral or other health care professionals. Community pharmacists will also be expected to refer into the service.

1.5  Objectives

·  To provide a service easily accessible for a patient by an accredited optometrist of a standard and equivalent to that provided in secondary care.

·  Be patient centred and sufficiently flexible to meet the disparate needs of clients, including those with disabilities.

·  Have sufficient accredited providers to ensure city wide coverage, thereby increasing access.

·  To follow the service pathway as detailed in Appendix 1.

·  Operate using evidence based care pathways and protocols.

·  Be outcome based, the Commissioner will work with the Provider to agree a list of clinical outcome measures.

·  Achieve patient referral in a timely manner.

·  Be integrated and have developed interfaces with existing Primary Care Services, such as GPs, Community Optometrists, Secondary Care, Community Pharmacists, Clinical Assessment and Treatment Service (CATS).

·  Promote eye health within the pathway.

1.6  Expected outcomes including improving prevention

The benefits from the programme include:

·  Provision of care closer to home in the most appropriate setting.

·  Reduce the number of GP appointments.

·  Increased identification of need.

·  Appropriate and timely referrals to secondary care.

·  Reduced waiting times.

·  Reducing the burden on secondary care.

·  Improved patient experience, knowledge and concordance.

SCOPE 2.0

______

2.1  Service Description

The service will provide a timely assessment of the needs of a patient presenting with a “red eye” condition. This will be undertaken by an accredited optometrist who will manage the patient appropriately and safely; within suitably equipped premises.

Management will be maintained within the primary care setting for as many patients as possible, thus avoiding unnecessary referrals to hospital services. Where referral to secondary care is required it will be to a suitable specialist with appropriate urgency.

2.1.1 Accreditation

All optometrists providing this service must be accredited by NHS Manchester for the OHT scheme and in accordance with requirements for the Red Eye Scheme and includes;

1)  Attendance at a lecture session by a consultant ophthalmologist on the topic of Red Eye; and Completion of Multiple Choice Questions.

2)  Attendance at a lecture session for the medico-legal aspects of a Patient Group Direction (PGD) by NHS Manchester.

3)  Re-attendance at a training session for the PGD and an update clinical session. This will be repeated every two years.

4)  The Optometry practice having completed as a minimum, Level One clinical governance framework ‘Optomeyes’ and working towards Level Two.

5)  Holding a GOS contract with NHS Manchester.

6)  Optometrists providing the service are registered on a PCT Performers list.

7)  Optometrists providing the service are registered with the GOC.

2.1.2  Equipment

All practices must have the following equipment available; this will be verified by the PCT optometric adviser during the routine practice inspection.

·  Access to the internet

·  Slit lamp

·  Slit lamp indirect ophthalmoscopy

·  Contact Applanation Tonometer.

·  Distance test chart (Snellen/logmar)

·  Near test type

·  Appropriate ophthalmic drugs:

Staining agents

Chloramphenicol drops/ointment (PGD)

Fucithalmic (PGD)

Topical anaesthetics

In order to minimise the risk of cross-infection a new preparation should be used for each patient episode. Any excess fluid remaining after the procedure should be disposed of appropriately as clinical waste in line with the Infection Control policy.

The optometrist providing the service should ensure that ‘College of Optometrists’ guidelines regarding the eye examination are adhered to at each clinical episode of a patient’s care.

2.2 Accessibility/acceptability

There are currently 51 optometry practices that hold a GOS contract with NHS Manchester of which XX have been accredited to provide this service.

2.3 Whole System Relationships

The Provider will interface and network with other primary care optometrists i.e. non accredited (Level 0), accredited optometrists (Level 1 service), secondary care ophthalmologists and optometrists and the Clinical Assessment Treatment Service (CATS) and Manchester GPs.

2.4 Interdependencies

As detailed in clause 2 & 3 above.

2.5 Relevant networks and screening programmes

Not applicable see 2.3 above.

SERVICE DELIVERY 3.0

______

3.1 Service Model

A Red Eye examination will provide a timely assessment of the needs of a patient presenting with a red eye condition. This will be undertaken by an accredited optometrist within suitably equipped premises who will manage the patient appropriately and safely. Management will be maintained within the primary care setting for as many patients as possible, thus avoiding unnecessary referrals to hospital services. Where referral to secondary care is required it will be to a suitable specialist with appropriate urgency.

Patients can self refer or be referred by GPs, Pharmacists or other optometrists.

3.2 Care Pathway(s)

As detailed in Appendix 1.

REFERRAL, ACCESS AND ACCEPTANCE CRITERIA 4.0

______

4.1  Geographic coverage/boundaries

The patient should be registered with a GP practice within NHS Manchester.

4.2  Location(s) of Service Delivery

Primary Care accredited optometrist, holding a GOS contract with NHS Manchester working in a practice commissioned to provide this service.

4.3  Days/Hours of operation

This service is to be provided at all times when an accredited optometrist is available. When an accredited optometrist is not available to provide this service for a patient who presents with a “red eye” condition, the patient must be given information and directed to the nearest optometrist(s) accredited in the scheme.

4.4  Referral criteria & sources

Patients as detailed in 4.1 with suspected red eye and completion of the relevant paperwork: including the following minimum data set:

·  Patients full name and address (including Mr, Mrs, Miss)

·  Optometrists name, address and accreditation number

·  GP name and address

·  Ethnicity (if given by patient)

·  Prescription details from current sight test, if available

·  Clinical information regarding the anterior segment status

·  Signature of patient indicating their consent for information to be shared and used for audit purposes (Claw back of monies if no evidence at PPV)

·  Red Eye referral form (stored in practice for PPV)

·  Red Eye audit form (submitted to the PCT for payment)

4.5  Referral route

Patients as detailed in 4.1 can be referred into the scheme by:

·  A Level 0 non-accredited optometrist or their staff.

·  A GP with a GMS /PMS/APMS /PCTMS contract in NHS Manchester.

·  A patient registered with a GP practice within NHS Manchester.

·  An optometrist from another PCT where the patient is registered with a GP practice within NHS Manchester.

·  The service can be accessed by patients presenting for a GOS or private sight test.

·  Self-referral by the patient

·  Community pharmacists / other healthcare providers.

See flow diagram Schedule 1: "Red Eye Integrated Pathway"

4.6  Inclusion criteria

·  Patient symptomatic with red eye

·  Patients registered with a GP practice within NHS Manchester

·  Patients over 12 years of age.

4.7  Exclusion criteria

·  Patients not registered with a GP practice within NHS Manchester

·  Children under 12 years of age

·  Routine case finding as part of a GOS or private eye sight test.

4.7 Response time & detail and prioritisation

·  From optometrist to secondary care - one working day for the referral to be submitted by the GP or non accredited optometrist, pharmacist or other health care professional.

·  One working day for referral to be submitted by level one optometrist for secondary care diagnosis.

In summary:

·  95% of patients to have completed their pathway within 1 week.

·  100% of patients to have completed their pathway within 3 weeks.

DISCHARGE CRITERIA AND PLANNING 5.0

______

A patient is discharged from this service after treatment and advice – follow up is generally not expected.

The patient pathway will continue where patient presents with a condition excluded from management by the optometrist that warrants further investigation by a consultant ophthalmologist.

See flow diagram "Red Eye Integrated Pathway" page 13

The referral form should be stored to conform to Caldicott Guidelines and where possible, separate from ophthalmic records for the purpose of record retrieval for Post Payment Verification.

A copy of the referral documentation is to be provided to the patient, the patient’s GP and to the referring optometrist.

PREVENTION, SELF-CARE AND PATIENT CARER INFORMATION 6.0

______

Prevention of infection

·  Where applicable the patient should also be advised on hygiene procedures to prevent infection of others.

·  A patient information leaflet should be given

Self Care and Patient Carer Information

·  The patient should be given full advice on how to administer the preparation.

·  Advice should be given regarding follow up if the condition does not resolve in the appropriate time course

·  Advice should be given regarding possible adverse reactions to eye drops

·  Patient information leaflet(s) should be given

·  A direction to discard the eye drops on completion of treatment and not to exceed use.

CONTINUAL SERVICE IMPROVEMENT / INNOVATION PLAN 7.0

______

Description of Scheme / Milestones / Expected Benefit / Timescales / Frequency of Monitoring
Confirmation of Red eye by Level 1 Optometrists / Annual / % reduction in referrals to secondary care / 6 months / 3 monthly
Confirmation of Red eye by Level 1 Optometrists / Annual / % increase in referrals to CATS / 6 months / 3 monthly

BASELINE PERFORMANCE TARGETS 8.0

______

Quality performance & productivity

Quality
Performance Indicator / Indicator / Threshold / Method of Measurement / Frequency of Monitoring
Compliance College of Optometrists Guidance / College of Optometrists management Guidelines / Undertake clinical audit / Clinical Audit of 5% patient records per practice / Annual
Post Payment Verification / Service Specification / 100% claims to match activity data returned / Practice visit / Annual
Service User Experience / % return of surveys
Complaints / Patient satisfaction survey
Investigation and resolution within 5 working days / Annual review within first year thereafter every 2 years
Infection Control and decontamination / Infection Control Measures / Practices to complete Infection Control Audit / Audit or Survey / Annual
Equipment Calibration / As per Manufacturer’s guidance or MREH or PCT recommendation / Practices to provide evidence of regular quality assurance / Contemporaneous records / PCT Annual review
Waste disposal / 100% collection & disposal of waste medicines / 6 monthly removal of waste / PCT Annual review
Performance & Productivity
Performance Indicator / Indicator / Threshold / Method of Measurement / Frequency of Monitoring
Access / Number of patients seen / No upper threshold.
10 minimum to maintain competency / Audit / Annual

ACTIVITY 9.0