Optimising the Primary/Secondary Care Interface in Eye care Services

1. Optimising the Primary/Secondary Care Interface in Eye care Services Richard Best Belfast Health and Social Care Trust

2. OphthalmologyHospital Eye Service • One of the largest outpatient specialties in NHS • Rapidly evolving • Changed from observation to intervention • High volumes of patients • Day case surgery

3. Ophthalmology • Accurate diagnosis • Technological advances • More treatments • More patients

4. Pressures on Ophthalmology • More referrals • Ageing population • Chronic disease management-diabetes COAG, ARMD • Limited resources (Staff/Equipment/Facilities) • Guidelines informing practice (NICE)

5. NHS in UKChange in last 10 years • Large increase in funding (6%GDP to 11%GDP) • Macromanagement tools (access targets) • Targets have become standards • ? Sustainable

6. Current Problems • Demand exceeds supply • 10% rise in number of referrals • Heavy use of IS to increase provision • Financial constraints

7. Solutions • Increase funding/increased provision • Waiting lists • Effective use of resources • Look at current model – is it appropriate?

8. Increased Funding/Provision • Outpatient waiting lists behave as a complex system that resists change • Appear self regulating ‘power laws’ • Obey their own laws • Similar to traffic jams/avalanches • Shorten waiting lists increase referrals Smethurst et al Nature 2001

9. Ideal ModelPatient Flow

10. Actual Modelin Ophthalmology Tertiary Care Secondary Care Primary Care Population

11. Primary Care • GPs • ‘Gatekeepers’ • Triage and assessment • Provide appropriate treatment

12. Primary Care in Ophthalmology • GPs • Undergraduate training • GPWSi s (postgraduate training) • Allied Health Professionals • Ophthalmologists

13. Primary Care in Ophthalmology • Embrace skills of those working in primary care settings • Decentralisation of heavily populated central units • Allow recruitment of flexible practitioners to practice in Primary care setting but with strong links to the centre

14. Primary Care in Ophthalmology • Refinement of referrals • Referral guidelines (Local development) • Shared Care for chronic conditions • Managed Clinical Networks

15. Primary Care in OphthalmologyReferrals • Good referral should ensure that the right patient accesses the right service or specialist at the right time

16. Interventions to Improve Quality of Referrals • Triage • Referral guidelines • Active educational input from local secondary care specialists • Structured referral sheets

17. Shared Care • Post op reviews • Chronic diseases • Telemedicine • Combined clinics (specialist and primary care team)

18. Managed Clinical Networks • Linked groups of health professionals from primary secondary and tertiary care working in a coordinated manner unconstrained by professional and organisational boundaries

19. Thank you