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Intermediate Care Ophthalmology Service
Debbie Raven, COODr Lyn Jenkins, Clinical Director
West Hertfordshire 1st October 2008
The Practice - company overview• Founded in 2005 by two NHS clinicians , headquartered in
Gt. Missenden, Bucks and employs 100+
• Delivers innovative community based healthcare for the NHS straddling primary and secondary care
• Pioneered provision of Intermediate care ophthalmology services and now the UK’s leading provider.
• Provides ophthalmology services for Bucks, E & W Berks, W Herts, Kingston, Wiltshire and shortly Harrow
• Also other specialist clinical services for GPs, the MOD and PCTs - Dermatology, Sexual Health, Urgent Care and Admission avoidance, and Secure Health
• Operates a network of GP surgeries
Ophthalmic Intermediate Care
• Why refer
• How to refer
• What to refer
Service background
• Set up by Dr Lyn Jenkins −GP−30yrs in ophthalmic primary care−23yrs providing retinopathy treatment
• Commissioned in Bucks for 8+ yrs
• Became part of The Practice in 2006
• Now covers 4 counties & 2 London boroughs
• Employ 12 ophthalmologists, 4 optometrists, 1 GPwSi, 1 orthoptist, 10 ‘back office’
• Experience shows 60-70% cases managed in primary care, 10% referred to HES
Assured service delivery
• All clinicians specifically trained in the delivery of Ophthalmic Primary Care
• Triaged same day• Waiting times max 4 weeks• Integrated IT system• Comprehensive data reporting meets 18 wk
pathway
Patient benefits
• Waiting times less than four weeks
• Accessible, community based clinics
• Choice of local clinics
• Excellent patient feedback
• All patients seen by experienced staff
• Service sensitive to patient needs
Aug 2008• 99% patients reported no problems with making
an appointment
• 90% patients were seen on time
• 96% patients felt they had enough time with a clinician and their case was discussed adequately with them
• 72% rated the clinic environment as excellent; 24% as good
Patient satisfaction results
West Herts appointments
0
20
40
60
80
100
120
140
160
180
200
Jan Feb Mar April May June July August
1st
1st Glaucoma
Follow up
Follow up VF
Follow up Glaucoma
Minor Op
Retinal Bio
W Herts referrals May-Aug 08
HES referrals Jan – Aug 2008
0
50
100
150
200
250
Jan Feb Mar Apr May Jun Jul Aug
Retained
Triaged to HES
Referral time
Time between referral and first appointment
1-5 days
5-10 days
10-15 days
15-20 days
Where?
Hertsmere PBCPotters Bar Community Hospital
Elstree & Bushey Heath
Schopwick Surgery
Borehamwood The Grove
Radlett Red House
StahComSt Albans Midway Surgery Highfield Surgery Parkbury Surgery Hertfordshire Clinic
London Colney 45 Kings Road Harpenden Memorial Hospital
DacComTring Rothschild House
Surgery
WatComWatford tbc
How to refer?
• GPs/Optoms refer directly to:
The Practice Ophthalmology Service
−Fax 01494 473169
−Post to The Practice Ophthalmology Service, Lynton House, 43 London Road, High Wycombe, Bucks HP11 1BP
−email to: [email protected]
• Triage same day
• Appointment
Or
• Onward referred to HES via Choose and Book
• Letter to GP within 10 working days
NOTE WATCOM: No direct referrals from Optoms but via GP
Presenting complaint – what we see• Flashing lights/floaters 25%
• Glaucoma 20%
• Blurred vision 17%
• Red eye 10%
• Dry eye/pain 7%
• Lid lesion 5%
• CL 3%
• Other – mac/conj/cat 13%
What to refer? (glaucoma type)
What to refer? (refer to full list in leaflet)
• Red eye
• Discomfort
• Visual disturbance
• Watering
What not to refer?
• Minor red eye conditions manage by GP in primary care
What not to refer?
• Emergencies (<48 hrs)Send to A&E
• In patient surgery or laser
• Cataract surgery• Under 16sRefer to HES
What not to refer?
• Diabetic retinopathy
• Retinal detachment
• Macular degeneration (with recent visual symptoms)
• Contact lens keratitis
Information from referrer
• Presenting complaint
• Past ocular history (squint, eye operations, trauma, contact lenses etc)
• Past medical history including drugs
• Abnormal findings
• GOS 18 when available, fully completed
Thank you on behalf of
The Practice
