Eye Health Network Shifting the Balance of Care

John OlsonCharlotte Ward

Morag Bobacka

David Fowler

Fiona Francey

Steve Graham

Jane Harcourt

Caroline Hind

Monica Hrabovsky

Neil Lavery

Malcolm McPherson

Stephen McPherson

Pamela Lowbridge

Siene Wai Ng

Gordon Porteous

Marka Rifat

Graeme Shand

David Taylor

Elaine Thompson

Mohan Varikkara

A sad storyNew and return planned and unplanned activity across NHS Grampian for

Ophthalmology in 2005/06 including eye casualty

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Total Moray Activity Total AberdeenshireActivity

Total ARI Activity

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Begs the question

• Where should you go if you have an eye problem?– High Street Optometrists– General Practitioner– A& E Department– Hospital Eye Casualty

6,000 walk ins a year…..

Average of 24 (max 33) patients per day

Eye Casualty AuditEye Casualty AuditAugust- September 2006 (n=922)August- September 2006 (n=922)

Average 24 episodes per dayAverage 24 episodes per day

12%

8%

9%

4%4%

31%

0%

23%

9%< 1 DAY

1 DAY

2 DAYS

3 DAYS - 1 WEEK

1 - 2 WEEKS

2 - 4 WEEKS

4 - 8 WEEKS

> 8 WEEKS

NO COMPLAINT

Duration of Symptoms

What happened?

Where did true emergenciesWhere did true emergencies come from? come from?

Who got it right?

73%

4%6%

17%

PatientOthersGeneral PractitionerOptometrist

What should have happened?

• 44% had ‘simple’ problems which could have been managed by optometrists in the community.

• An additional 37% could have been managed in the community if patient pathways involving prescription only medication had been available.

• Optometrists knew who to refer.

I have a dream…………..

Scottish Government’s Vision

• Optometry, the first port of call

They have the knowledge Give them the technology

New GOS Contract April 2006

"Anyone,

whether they have red eyes, painful eyes, flashes and floaters,

or just need new spectacles,

will be able to access the new NHS at their local Optometry practice.“

A network in waitingA network in waiting

Pyramid of Eye Care

Specialist led hospital clinic

Triage address issues, treat and/or direct

Community Optometry

General Practice

Community Pharmacy

NetworkNetwork• 58 Optometry practices58 Optometry practices

• Nurse led telephone triage Nurse led telephone triage serviceservice– 0845 number0845 number

• Urgent Referral ClinicUrgent Referral Clinic– Every afternoonEvery afternoon– 10 slots, directly booked10 slots, directly booked– Run by experienced SPRRun by experienced SPR– Directly Supervised by ConsultantDirectly Supervised by Consultant

Wide Consultation

Practical IssuesPractical Issues

• Informing the publicInforming the public– Local TV advertLocal TV advert– Posters: Posters:

• GPGP• eye clinic, eye clinic, • hospital and hospital and • A&EA&E

Professional Issues:Professional Issues:Training OptometristsTraining Optometrists

• Practical Eye Casualty SessionsPractical Eye Casualty Sessions– Consultant ledConsultant led

• Patient Pathway LecturesPatient Pathway Lectures• Foreign Body Workshops Foreign Body Workshops

– Consultant and Optometry Consultant and Optometry jointly ledjointly led

Eye Health Network Audit Eye Health Network Audit

• Access database for all helpline activity Access database for all helpline activity

• Access database for all urgent referral clinic Access database for all urgent referral clinic activityactivity

• Paper records for optometristPaper records for optometrist

Was it all a dream?

Transitional ArrangementsTransitional Arrangements(September-October 2007)(September-October 2007)

Patients Seen in Interim Service

49

2116

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Wk 1 Wk 2 Wk 3 Wk 4

No. of Patients

618

773 784

657

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2004 2005 2006 2007

Number of patients seen in September 2007

Preliminary Data

Community Optometry Activity Nov 07 to Mar 08

1907 forms• 52% self referred• 19% from GP• 7% from A&E • 4% from pharmacy

• 76% managed by optometry• 10% referred urgently to ophthalmology

Helpline Activity

• October 2007-August 2008• 13.9 calls per day

– 56% from optometry– 20% from General Practice – 6% from A&E

• 85% were given an urgent referral clinic appointment.

Urgent Referral ClinicUrgent Referral Clinic 10.4 per day (24) 10.4 per day (24)

Ophthalmology On-callOphthalmology On-call 28.4% reduction28.4% reduction

Average Number of Patients Seen at Ward 30

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Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Day Seen

Average seen Old Service Average seen New Service

Impact on A&EImpact on A&E13.3% reduction13.3% reduction

Optometry AgreementOptometry Agreement2% significantly different2% significantly different

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1 2 3 4 5 6 7 8 9 10 11 1213 1415 16 1718 19 2021 2223 24 2526 2728 29 3031 32 3334 3536 37 3839 4041 42 4344 45 4647

Seen

Disagreed

18.6% 18.6% DisagreementDisagreement

81.4% 81.4% AgreementAgreement

Value for money?

What happened after 2006?

News All Attendances

2006 2010 % 2006 2010 %

Lothian 19,836 18,757 5 66,057 62,096 6

Glasgow 30,645 27, 903 9 111,419 101,858 9

Fife 8,302 6,165 26 20,745 18,304 13

Grampian 17,431 10,232 41 45,136 33,557 26

Scotland 126,897 121,255 5 414,406 410,064 1

What’s going on?

Grampian

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2001 2002 2003 2004 2005 2006 2007 2008 2009 2010p

Series1

Series2

Tayside

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2001 2002 2003 2004 2005 2006 2007 2008 2009 2010p

1. PDT for AMD 20042. DRS 20063. Cataract redesign 2006-74. MMC 20075. Lucentis for AMD 2007

1. DRS 20022. PDT for AMD 2003

3. Glaucoma refinement scheme 20044. GOS contract, OHT discharged, Post-op cataracts discharged 2006

5. Eye Health network, AMD injection service, MMC 20076. OCT DRS 2008

Shifting the balance of care

Gold rush?

What next for the Eye Health Network?

An Electronic Eye Health Network

Where information flows,not patients

• Local access• Information belongs to all

– Patients, primary, secondary care, boards, government

• An electronic cloud– Advice only, shared care, triage, appropriate referral– Clinical governance, service planning– Reimbursement

• Specialist role– Where information is not enough– Education, training, planning, service redesign– Public health

• Quality of care not dependent on where you live

– Communication– Politics

Eye Health Network Shifting the Balance of Care

John OlsonCharlotte Ward

Morag Bobacka

David Fowler

Fiona Francey

Steve Graham

Jane Harcourt

Caroline Hind

Monica Hrabovsky

Neil Lavery

Malcolm McPherson

Stephen McPherson

Pamela Lowbridge

Siene Wai Ng

Gordon Porteous

Marka Rifat

Graeme Shand

David Taylor

Elaine Thompson

Mohan Varikkara