Eyecare Services Programme

Eyecare Services Programme The way forward: Key points from the NHS Eyecare Services Programme Pilot Sites

There are an estimated two million people in the UK currently living with sight loss, of which approximately 1.7 million are over 65. By the age of 80, one in four can expect to have some degree of sight loss. Estimates based on official population projections and epidemiological prevalence surveys predict that the number of cases of glaucoma in England and Wales will increase by a third by 2021 and will continue to rise. Similar increases could be predicted for other eye conditions and coupled to the availability of new treatments, demands on eye health services will rise rapidly. In addition for people with untreatable sight loss, services are needed to help them make the most of residual sight, which will help in avoidance of falls and enable people to maintain independence.

The NHS Eyecare pathways form a basis to help commissioners and providers to deliver services in line with wider objectives such as those found in National Service Framework for Older People, Our Health, Our Care, Our Say and Choosing Health and Opportunity Age.

This summary of key outcomes and learning from the pilots is intended to support Primary Care Trusts and Strategic Health Authorities in reviewing the provision of eye care within their area and in considering the case for new modes of service delivery that will provide services closer to people’s homes and also meet future demand.

The NHS Eyecare Services Programme was set up to test and evaluate the model pathways drawn up by the Department of Health’s Eyecare Services Steering Group and published in the First Report of this group in April 2004. Following a bidding process, eight pilot sites were selected for AMD, Glaucoma and Low Vision.

Outcomes of the programme are summarised below:

 Change to the manner and location of service delivery of eyecare services can be used to reduce pressure on secondary care services and introduce additional capacity, improve access to services and so, reduce waiting lists.

 By working with ophthalmologists, other professionals can potentially focus on providing community based services thus releasing capacity within secondary care. This will enable them to deal with more complex procedures and provide more specialised services.

 Action is required to both acknowledge the time required and process involved for improving historical working practices, particularly when introducing new clinical roles.

 During the process of improving service delivery, strong relationships will be a major influence on the success of the project. At the early stages, these will be built on a personal rather than an organisational basis.

 Services related to specific eye disease (eg glaucoma) are most effectively led from the secondary care sector. The effectiveness of the new services, even if wholly community based, will be increased through maintaining engagement with the secondary sector at all stage.

 Improving the skill mix is crucial in the process of improving and redesigning services. Therefore appropriate clinical and administrative support is necessary to facilitate good communication between all parties when developing and implementing new ways of working.

 Mapping of current service delivery, future demand, capacity issues, patient engagement and cost benefit analysis all need to be considered during the process of service re-design. In addition, a communication strategy should be put in place to ensure engagement of all potential stakeholders.

 Service configuration must reflect local circumstances and for low vision services, voluntary sector organisations are often the most appropriate to take the leading or facilitating role.

 The low vision projects have demonstrated that primary care- based partnership working can create a valued service, which in many cases did not previously exist. However, the projects demonstrated that the establishment of a one-stop combined low vision assessment service may not reduce costs in the short-term.

 The introduction of the role of a Community-based Optometrist with Special interest (COSI) is most effective when there is active engagement on the part of consultant ophthalmologists. This is more readily achieved if they have led the process.

 All COSIs will need to undertake the clinically appropriate minimum level of training and activity to maintain clinical proficiency. In addition, clinical audit should form part of the service quality standards.

 Clinical audit of the COSIs role in relation to the AMD pathway suggests that there will still be an ongoing requirement for a fast-track doctor-led clinic to confirm the diagnosis.

 The limited available data indicate that the COSI role, particularly in relation to AMD, may add to overall costs for the PCT, while the impact on HES costs would depend on whether existing resources could be reallocated. Evidence obtained from the piloting of the AMD pathway does not yet support the case for wider rollout.

 One important aspect of the COSI role would be to engage in a programme of ongoing work to promote the skills needed to trigger referral to doctor-led rapid assessment.

 Emphasis needs to be placed on the importance of raising awareness of new service pathways amongst all potential stakeholders, including commissioners, providers and patients/service users.

From these findings, commissioners of eyecare services are strongly recommended to review the service provision for their locality and to link these to supporting delivery of both national and local objectives particularly those within the NSF for Older People.

The learning achieved through the NHS Eyecare Services Programme provides new models and approaches to the delivery of eyecare services. These can then be adapted and applied locally to meet the particular needs of the local population in providing an easily accessible, community based, patient/user focussed sustainable services.

The full evaluation report can be found on the NHS Eyecare Services Programme website. (McLeod H, Dickinson H, Williams I, Robinson S and Coast J., November 2006. Evaluation of the chronic eyecare services programme: final report)

Andrew Kent, Director Anita Lightstone, Clinical Lead and Manager Richard Tolson, National Programme Manager

NHS Eyecare Services Programme www.eyecare.nhs.uk January 2007