Future Events

1. Future Events 17th November �Infection Control and Waste 23rd February 2010 � Clinical Incident Reporting 18th May 2010 � Health and Safety

2. Local Referral Guidelines Dr Sarah Slade PhD Optometric Adviser

3. Background Urgent Referral Clinic 9-5 only Modernising medical careers Emergency referrals out of hours directed to Liverpool or Manchester What happens if a problem found at a weekend but not an emergency? New referral pathways for cataracts and AMD Referral guidelines produced in other areas e.g North staffs/Bradford/Leeds Number of reasons why we wanted to introduce these guidelines -Modernising medical careers and the cut in training places means that local HES not able to support 24hour ophthalmology service -aware from LOC and practice visits some difficulty in arranging out of hours care for emergency patients -needed a system for those patients who werent emergencies but need attention soon Show how integrate with other referral pathways such as the wet AMD fast track service and cataract direct referral. -Examples of guidelines appearing in other areas was helpful in determining formatNumber of reasons why we wanted to introduce these guidelines -Modernising medical careers and the cut in training places means that local HES not able to support 24hour ophthalmology service -aware from LOC and practice visits some difficulty in arranging out of hours care for emergency patients -needed a system for those patients who werent emergencies but need attention soon Show how integrate with other referral pathways such as the wet AMD fast track service and cataract direct referral. -Examples of guidelines appearing in other areas was helpful in determining format

4. Aim of Guidelines Get patients treated in the right place at the right time Hoping it will also make it easier for you to refer especially when urgent and emergency cases appear out of hours.Hoping it will also make it easier for you to refer especially when urgent and emergency cases appear out of hours.

5. Here they are. Not expecting you to be able to read this. Colour coded red emergency, urgent amber, routine green. Useful contacts. All on one sheet. Printed and laminated in A3 to make the wall in your consulting room look pretty! and for easy reference. Developed primarily by myself and Sal Natha (based on info stolen from other PCT areas) with help from the LOC. Also been reviewed by the other ophthaslmology staff in Wigan and the medical director at the PCT. We will also be making this available to the URC and A&E and an A4 copy to local GPs so that they have a better idea of what we are doing. Might also help them get it right. Incidentally we will also be encouraging them to send any GOS 18/ optom referral on with their covering letter when forwarding routine referrals to ophthalmology. Care when using them �list isnt exhaustive and you may want to upgrade priority if patient only has one ye or other co-existing eye diseases. If in doubt where possible contact the URC for advice.Here they are. Not expecting you to be able to read this. Colour coded red emergency, urgent amber, routine green. Useful contacts. All on one sheet. Printed and laminated in A3 to make the wall in your consulting room look pretty! and for easy reference. Developed primarily by myself and Sal Natha (based on info stolen from other PCT areas) with help from the LOC. Also been reviewed by the other ophthaslmology staff in Wigan and the medical director at the PCT. We will also be making this available to the URC and A&E and an A4 copy to local GPs so that they have a better idea of what we are doing. Might also help them get it right. Incidentally we will also be encouraging them to send any GOS 18/ optom referral on with their covering letter when forwarding routine referrals to ophthalmology. Care when using them �list isnt exhaustive and you may want to upgrade priority if patient only has one ye or other co-existing eye diseases. If in doubt where possible contact the URC for advice.

6. Emergencies Acute red eye (inc glaucoma) Trauma / Injuries Retinal tears/ detachments Arterial occlusions (<24 hours) Optic neuritis Arteritis Acute onset diplopia/strabismus Proliferative diabetic retinopathy Vitreous haemorrhage Emergencies are as listed Acute red eyes �including glaucoma, iritis, chemical injuries, post op inflammation Injuries �chemical burns, trauma, hyphaema etc. Recent arterial occlusions Sudden loss of vision Acute diplopia (MS case) Retinal detachments/ vitreal haemorrhages etc.Emergencies are as listed Acute red eyes �including glaucoma, iritis, chemical injuries, post op inflammation Injuries �chemical burns, trauma, hyphaema etc. Recent arterial occlusions Sudden loss of vision Acute diplopia (MS case) Retinal detachments/ vitreal haemorrhages etc.

7. Emergencies Office Hours 9.00am � 5pm Contact URC Phone Bleep Evenings or weekends Refer to Liverpool/Manchester Written referral and cover letter/map for patient What to do If 9-5 contact URC If out of hours referral letter and cover and send patient to manchester or liverpoolWhat to do If 9-5 contact URC If out of hours referral letter and cover and send patient to manchester or liverpool

8. Urgent Referral to Ophthalmology � Dear Patient Date: / / You have been found during your eye examination to require urgent investigations by an Ophthalmologist due to suspected: ----------------------------------------------------------------------------------------------------- There is no Ophthalmology (eye department) service at Wigan Infirmary in the evening or at weekends. As the above condition, if left untreated, can lead to damage to your eye and/or vision, your Optometrist is referring you to be seen Today / Tomorrow. � Please take the attached referral letter with you to � ? Manchester Royal Eye Hospital � ? St Paul�s Primary Care Unit (Eye A&E) at the Royal Liverpool University Hospital Liverpool We have devised this cover letter for the patient the bottom half includes a basic map for patients and full postal address of HES departments Thanks to Julia Maiden who devised the wording and the initial draft of this letter. We have supplied you with a couple of copies so you may photocopy as required. We also plan to make the originals available on the internet. Let you now when this has been achieved and where to find it. We have devised this cover letter for the patient the bottom half includes a basic map for patients and full postal address of HES departments Thanks to Julia Maiden who devised the wording and the initial draft of this letter. We have supplied you with a couple of copies so you may photocopy as required. We also plan to make the originals available on the internet. Let you now when this has been achieved and where to find it.

9. Urgent Rubeosis Vessel Occlusions Central Serous Retinopathy Suspected ocular cancers New pupillary defects Suspected WET AMD Urgent referrals �not so many of theseUrgent referrals �not so many of these

10. Urgent Office Hours 9.00am � 5pm Contact URC Phone Bleep Evenings or weekends Fax URC Advise patient to attend Monday morning URC Generally 9-5 contact the URC. Out of hours fax URC and advise patient to attend URC at christopher home on Monday (Double clinic runs then) Exception though is wet AMDGenerally 9-5 contact the URC. Out of hours fax URC and advise patient to attend URC at christopher home on Monday (Double clinic runs then) Exception though is wet AMD

11. Urgent Wet AMD Use Fast Track Referral Forms Fax direct to the WET AMD Rapid Access Clinic FAO Mr Natha For wet AMD use the direct fax number and referral form provide to you in recent times by Mr Natha. The Fax number is on the front of your referral packs and is different to the URC fax numberFor wet AMD use the direct fax number and referral form provide to you in recent times by Mr Natha. The Fax number is on the front of your referral packs and is different to the URC fax number

12. Routine Everything Else! That cant be managed by you!That cant be managed by you!

13. Routine Generally Use GOS 18/Headed paper Cataract Use direct referral pathway Diabetic maculopathy/non proliferative retinopathy May refer direct to retinal clinic If unregistered inform retinal screening (please!) Generally use GOS 18 or your own headed paper except for Cataract �use direct referral pathway where possible Diabetic maculopathy/non proliferative retinopathy. These used to be dealt with by URC but all that generally happens is that URC directs them to an appointment in the retinal clinic. Mr Natha has advised then that you can instead send your referral letter directly FAO the retinal clinic rather than via URC as it will save the patient a journey. If patient is not currently registered for DRS screening if you wish you can get them included by contacting susan christy. They would appreciate your help as they are trying to assemble a comprehensive diabetic register.Generally use GOS 18 or your own headed paper except for Cataract �use direct referral pathway where possible Diabetic maculopathy/non proliferative retinopathy. These used to be dealt with by URC but all that generally happens is that URC directs them to an appointment in the retinal clinic. Mr Natha has advised then that you can instead send your referral letter directly FAO the retinal clinic rather than via URC as it will save the patient a journey. If patient is not currently registered for DRS screening if you wish you can get them included by contacting susan christy. They would appreciate your help as they are trying to assemble a comprehensive diabetic register.

14. Summary Following this should get patients in the right place with the right urgency GPs should only be receiving routine referrals and information only copies of urgent and emergency referrals Should help resolve the issue around out of hours referral of emergency and urgent cases Difficulties sarah.slade@nhs.net. So, to summarise If you have any particular difficulties please contact me on my secure email and include as much detail as possible including patient details where applicable so that we can try to resolve them.So, to summarise If you have any particular difficulties please contact me on my secure email and include as much detail as possible including patient details where applicable so that we can try to resolve them.

15. Questions?