Schedule 2 the Services s1

NHS ENGLAND 2014/15 NHS STANDARD CONTRACT PARTICULARS

SCHEDULE 2 – THE SERVICES A. Service Specifications

Service Specification No. ST Optom Cat 1415 Service Cataract Referral Service Commissioner Lead NHS South Tees CCG Provider Lead Period 1st April 2014 – 31st March 2017 Date of Review 31st March 2015

1. Population Needs

1.1 National/local context and evidence base 1.1 The demand for eye care is set to increase significantly as the population ages. Currently 2 million people across the UK live with sight loss. By 2020 this number will have increased by 22 percent. (Access Economics (2009), Future Sight Loss UK 1: Economic Impact of Partial Sight and Blindness in the UK adult population. RNIB)

1.2 In 2012/13, 340,809 cataract operations were performed, representing an increase of over 50 per cent since 1998/99. This reflects both better access to the intervention and increased demand due to the ageing population. (HESonline, 2013. Main procedures and interventions. Available at: www.hscic.gov.uk/hes).

1.3 During 2012/13 there were 4,126 Cataract operations performed across the Teesside area.

2. Outcomes

2.1 NHS Outcomes Framework Domains & Indicators Domain 1 Preventing people from dying prematurely Domain 2 Enhancing quality of life for people with long-term conditions Domain 3 Helping people to recover from episodes of ill-health or following injury Domain 4 Ensuring people have a positive experience of care X Domain 5 Treating and caring for people in safe environment and X protecting them from avoidable harm

2.2 Local defined outcomes 2.2.1 Patients are assessed by optometrists and promptly referred to specialists for further investigation and/or treatment if required.

2.2.2 Reduction in unnecessary outpatient appointments.

3. Scope

3.1 Aims and objectives of service 3.1.1 The service aims to improve eye health and reduce inequalities by providing increased access to eye care in the community. The service utilises the knowledge and skills of primary care optometrists to manage and prioritise the care of the patient.

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3.1.2 The service is expected to reduce the number of visits for the patient and will be supported by the provision of more accurate referral information if a referral is made.

3.1.3 Optometrists, having performed an eye examination and identified a cataract that is causing visual problems to a patient will provide the following service:

 Explain what cataract treatment involves and discuss options with the patient.  Obtain patient’s consent to proceed with referral for surgery.  Check fundii under mydriasis and record results on referral form.  Complete cataract referral form up to and including “disabilities” section.  Provide the patient with the Choice Booklet and telephone number of the Choice Team, in order for the patient to discuss choice of provider and arrange booking of their hospital appointment.  To provide the patient with the RNIB Cataract Booklet or College of Optometrist leaflet.  Provide the lid hygiene/blepharitis advice leaflet and discuss the importance of good hygiene (appendix 1)  Where the patient has difficulty using the telephone to make an appointment the Optometrist will contact the Choice team on behalf of the patient during the consultation.  Fax referral form to CHOICE/MARS team within 24 hours (appendix 2)

Co-morbidity (as listed in 2.4.2) precludes patients from referral via Direct Cataract referral and must be referred in the normal manner using a GOS18.

3.1.4 The objectives of the service are:  To diagnose those patients who require cataract treatment and check for other conditions  To discuss the patients condition(s) with them and options available  Provide the patient with relevant information  Refer patient directly following Choose and Book procedures

3.2 Service description/care pathway 3.2.1 Patients will attend for a cataract assessment with accredited ophthalmic practitioners via self- referral, GP-referral or Optometrist referral.

3.2.2 A GOS or private sight test will reveal the presence of cataract and the examining ophthalmic practitioner will discuss with the patient options for further assessment and or treatment to the patient and make a referral in line with Choose and Book as necessary. If the cataract is not presenting any significant visual or lifestyle difficulties, then they will continue to be reviewed by the ophthalmic practitioner in the normal way.

3.2.3 Discuss and document presence of the following risk factors:  age - cataracts present in approximately 70% of people age 85 years or older  female gender - slightly increased risk  family history - heritability could be 48-59%  presence of co-morbidities, eg : o chronic uveitis o prior intra-ocular surgery, eg glaucoma filtration surgery or vitrectomy  diabetes mellitus (DM)  long-term use of systemic or inhaled steroids  smoking  excessive alcohol use  previous eye trauma or surgery  UV-B exposure  dehydration or diarrhoeal crises  irradiation  extreme shortsightedness  taking statins

Obtain a detailed visual history:  near and distance vision  past history of eye disease  binocular function  amblyopia

Ask patient (suggested questions to ask):  how cataract has affected their quality of life (QoL)  whether the decline in visual acuity has precluded them from some occupations, eg ask what they are no longer able to do or enjoy  to describe their own near and distant vision under varied lighting conditions  whether they drive or not  whether they take any medication that may increase the risk of surgery: o tamsulosin o other alpha-antagonists o anticoagulants

Perform a thorough ocular examination to include: o at distance o at near o Contrast sensitivity  check for refractive errors by assessing acuity with and without refractive correction  assessment of pupil function  measurement of intraocular pressure (IOP)  slit lamp biomicroscopy of the anterior segment  examine fundus for signs of retinal disorders  evaluation of glare disability and reduced contrast sensitivity  assess ocular motility and binocularity  assess and catergorise lens opacity NB: Exclude other causes of visual impairment. It is important that optometrists do not assess and refer patients already under the care of an ophthalmologist (eg for another active ocular condition). In such cases, the optometrist should refer the patient back to the ophthalmologist with a letter explaining the patient's current visual difficulties. 3.2.4 The service shall be provided during normal practice hours.

3.2.5 Staff Competencies - Qualified optometrist that have undertaken an accredited training programme approved by Hartlepool & Stockton CCG and South Tees CCG and must be registered with the General Optical Council. The nationally approved WOPEC distance learning module is to be completed (LOC will re-launch training and invite providers).

3.3 Population covered 3.3.1 The geographical areas of Middlesbrough and Redcar and Cleveland.

3.3.2 The provider shall ensure that the patient is an eligible person by verifying the patient’s GP before providing the enhanced service.

3.3.3 In order to qualify for a domiciliary GOS sight test, the patient must fall into one of the NHS eligibility categories and be unable to leave home unaccompanied. To be eligible for a domiciliary cataract assessment under the service, the patient must be able to travel to the treatment centre for treatment if suitable transport can be provided, and be able to co-operate with the procedure.

3.4 Any acceptance and exclusion criteria and thresholds 3.4.1 Clients should be able to access the service irrespective of the degree of sight loss or reduction in vision, as early as possible to minimise negative impact on quality of life.

3.4.2 Patients are not suitable if they fulfil any one of the following criteria:

 Patients who do not have significant difficulty with their vision  Patients who do not wish to be referred for cataract surgery  Where the patient’s GP is not within the geographical boundaries of Hartlepool & Stockton CCG and south Tees CCG.

3.5 Interdependence with other services/providers 3.5.1 Interdependencies would be with:-  Consultant Ophthalmologists  GP Practices  Local Optometrists who are not accredited to perform pre cataract assessment service.  LOC

4. Applicable Service Standards 4.1 Applicable national standards (eg NICE) 4.1.1 Treatment and care should take into account patients’ needs and preferences. Patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If patients do not have the capacity to make decisions, healthcare professionals should follow the Department of Health guidelines – ‘Reference guide to consent for examination or treatment, second edition 2009’ (2009) (available from www.dh.gov.uk). Healthcare professionals should also follow the code of practice that accompanies the Mental Capacity Act (summary available from www.publicguardian.gov.uk). If the patient agrees, families and carers should have the opportunity to be involved in decisions about treatment and care. Families and carers should also be given the information and support they need.

4.2 Applicable standards set out in Guidance and/or issued by a competent body (eg Royal Colleges) 4.2.1 The provider will ensure that all service staff have the appropriate registrations, qualifications, experience, skills and competencies to perform the duties required of them and that they are appropriately supervised, managerially and professionally. The provider must be able to evidence training, competency and maintenance of competency which may be requested by the commissioners at any time.

4.2.2 It is the providers responsibility to ensure all service staff will undergo enhanced checks through the Disclosure and Barring Service (formally known as Criminal Records Bureau (CRB)) prior to appointment. Each member of staff has a duty to disclose any convictions for criminal offences to their employer as soon as they arise.

4.3 Applicable local standards The provider will: 4.3.1 Ensure patients are fully informed regarding their condition and are fully involved in the planning of their individual treatment programme where clinically appropriate.

4.3.2 Ensure patients and carers receive information on what they can expect from the provider, details of appointments, chaperone facilities, confidentiality issues and contact details for the clinicians. Patients and their parents and carers will be informed of the options available, the implications of these and the possible benefits and risks involved. Patients, and parents and carers if appropriate, will be informed of the rationale for all onward referrals ensuring patients maintain their right to make choices.

4.3.3 Fully complete the required dataset for every patient accessing the service as detailed in Schedule 6 Part C. Reporting Requirements (B14.2, 14.3).

4.3.4 Facilitate a survey of patient experience which will be completed by the patient without influence from service staff as detailed in Schedule 6 Part G. Surveys (B12).

4.3.5 Produce and maintain a valid up-to-date register of patients being treated as part of the service, number of patients who did not attend an appointment, and the number of referrals received that

did not fit the referral criteria and where they originated from, which may be audited as part of the service evaluation.

4.3.6 Maintain records of the service provided, incorporating all known information relating to any significant events e.g. adverse reactions, hospital admissions, and relevant deaths of which the practice has been notified. These must be reported to the Clinical Commissioning Group in accordance with CCG CO18 Serious Incidents (SIs) Management Policy.

4.3.7 Participate in all quality and clinical governance initiatives and work in partnership with the commissioner of this service. Additional quality indicators may be put in place in discussion with the provider.

4.3.8 Ensure that all information be transmitted safely and securely.

4.3.9 Demonstrate contingency plans and business continuity plans for: a) The management of services during expected and unexpected leave. It is the responsibility of the service provider to arrange and ensure cover for staff sickness and absence. b) Capacity and capability to manage peaks in demand. c) Failure of electronic systems, telephony or other infrastructures.

4.3.10 Ensure arrangements are made for non-English speakers and those with sensory impairments at no additional cost to the commissioner of this service. People from black and minority ethnic groups may have different cultural and communication needs and these should be considered. The need for interpretation should be considered alongside other means of ensuring that an individual’s needs are appropriately met. An interpreter should have both cultural and medical knowledge. Interpreters from the family are generally not suitable because of issues such as confidentiality, privacy, and personal dignity

4.3.11 Ensure all patient information is available in a variety of communication formats to ensure that those with visual or hearing difficulties or whose first language is not English will not be disadvantaged. Professional interpreters will be used as appropriate. This will include contact information for on-going support, for example from DSNs, and also for how to access emergency care both in and out of normal working hours.

4.3.12 Contribute (via the LOC) to developing and maintaining a communications plan to ensure that all agencies/practitioners who are relevant to the service are:  Aware of the service and understand its purpose and goals.  Understand how patients access the service.  Are contacted with the above information at least every six months during the service period and again every time there is a change to any of the above information.

4.3.13 Ensure no research activities are undertaken in relation to this service without the prior, written agreement of the commissioner.

4.3.14 Attend contract review meetings with the commissioner of the service for the duration of the service at frequency which will be defined on commencement of this contract and will provide any additional information reasonably requested by the commissioner for the purpose of contract monitoring at no additional cost to the commissioner.

4.3.15 Manage all referrals, assess patient referral suitability whilst ensuring effective systems and business continuity.

5. Applicable quality requirements and CQUIN goals 5.1 The ophthalmic practitioner shall fully complete, in an accurate and legible manner  An Optometric Patient Record in the format provided by for each patient managed.  The number of patients for whom an appointment was booked and the source of the referral  The number of appointments booked for patients who did not attend

6. Location of Provider Premises The Provider’s Premises are located at: Optometrists premises

SCHEDULE 3 – PAYMENT A. Permitted Variations to Tariff, Non-Tariff Prices and Other Payment Arrangements

Table 1: Tariff Prices

Service Description Currency Price

Payment per Cataract referral £30 per patient

Table 3: Other Payment Arrangements

NECSD0099: B6.1.1 The amount paid will be cost per case and based on the number of patients accessing the service and the type of treatment received.

B6.1.2 Payment will be made monthly in arrears on receipt of activity data submitted by the MARS team on behalf of the Optometrists

B6.1.3 The price paid is total and includes all administration, estates, travel and operating costs including any interpretation services required for sensory impaired patients.

B6.1.4 This service will commence on 01 April 2014. This contract covers the period 01 April 2014 to 31 March 2017 at which time a 2014/15 NHS Standard Contract will be issued to cover the 2014/15 service period. Any activity which is undertaken by the service provider prior to the commencement date and after the end date will not be paid by the commissioner.

SCHEDULE 4 – QUALITY REQUIREMENTS

C. Local Quality Requirements

Service Specification No. Service

Method of Consequence of Quality Requirement Threshold Measurement breach Domain 1: Preventing people dying prematurely

Domain 2: Enhancing the quality of life of people with long-term conditions

Domain 3: Helping people to recover from episodes of ill-health or following injury

Domain 4: Ensuring that people have a positive experience of care % of patients given the leaflets and Monthly quality and 100% advice as detailed in the specification performance report 100% of Patient experience survey to be returned Monthly quality and completed and results shared with the questionnaires performance report commissioner reported to commissioner % of patients referral sent within 24 Monthly quality and hours of decision to refer to the 100% performance report Choice/MARS team Number of incidents and complaints Review 100% of all incidents and 100% Performance report complaints

SCHEDULE 6 – CONTRACT MANAGEMENT, REPORTING AND INFORMATION REQUIREMENTS

C. Reporting Requirements Frequency Format Timing and Method for delivery Local Requirements Reported Locally Emailed no later than 15 working days following the end of the month to which the No later than 15 working days following Electronic, in the template data relates. Email to: Dataset the end of the month to which the data provided by the relates commissioner [email protected]

Emailed prior to the commencement of this contract, and within five working days of Prior to the commencement of this every amendment. Qualifications and Professional contract and when a new member of staff Electronic Registration is appointed to provide any aspect of this Emailed to: service. [email protected]

Dataset: Monthly to be sent to the commissioner

Number of patients receiving the service Number of Patient DNAs Number of patients referred to MARS Number of patient that declined a referral to MARS % of patients given the leaflets and advice as detailed in the specification Patient experience survey to be completed periodically and results shared with the commissioner - number of surveys completed % of patient’s referral sent within 24 hours of decision to refer to the Choice/MARS team Number of incidents Number of complaints

G. Surveys

Service Specification No. Service

Type of Survey Frequency Method of Reporting Method of Publication Each patient should be Service User Survey given a blank questionnaire and Paper based survey Patient Experience Upon request from the encouraged to completed and Survey (appendix 3) commissioner. complete it without returned by patient. influence from service staff.

Appendix 1: Lid Hygiene/blepharitis advice

blepharitis_lr.pdf

Appendix 2: Referral Form to be sent to the MARS team The referral form below is to be completed and faxed to the Choice Team by the Optician via the safe haven fax - 01642 737622

Patients are informed by the optician to contact the service on 0345 045 0620

Cataract Referral Form.docx

Cataract referral process flow chart for information:

Cataract Process updated 13.02.14.doc

Appendix 3: Service User questionnaire

Patient Satisfaction Questionnaire Cataracts.docx