Sandwell and West Birmingham Solihull Eye Care Services Launch Evening

1. Sandwell and West BirminghamSolihullEye Care Services Launch Evening

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

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

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

5. 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. CCG The LOC communicates with PEC (HoWM) Ltd both giving and receiving feedback. LOC PEC(HoWM) Ltd Webstar Practice Practice Practice Practice Practice Practice Practice

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. 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 • Cataract • IOP repeat measures • Solihull • Cataract • IOP repeat measures • MECS

9. Who is entitled to these services The services are commissioned for patients registered with either a Sandwell and West Birmingham CCG GPor 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 1stMECS • 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… • Where other enhanced serviced are appropriate • Cataract referral • Cataracts post-op • Repeat IOP • Diabetic retinopathy • More not for… • Adult squints • Longstanding diplopia • Repeat field tests • AMD • Previously identified • Severe eye conditions needing HES • Herpes Zoster • Tumours

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. 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 http://www.loc-net.co.uk/birmingham • Sandwell LOC website http://sandwell-loc.co.uk • Solihull LOC website http://Solihull-loc.co.uk • The Company website www.eyecarewm.co.uk

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

30. 1st March 2016 Launch Date

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 emails? (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, Ian.hadfield@nhs.net • You will receive an email with full instructions which include • 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).

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 ian.hadfield@nhs.net • 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 email ian.hadfield@nhs.net 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 • Email deborah.graham4@nhs.net 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. 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