Appendix 10.1
An example of a current shared-care scheme for direct optometry referral and postoperative follow-up used by The Queen Victoria Hospital, East Grinstead, and Sussex Eye Hospital, Brighton (May 2006)
This protocol applies to optometrists practising in the Mid Sussex area or offering optometric advice to patients registered with a general practitioner (GP) in Mid Sussex. Neighbouring primary care trusts (PCTs) have similar schemes.
Optometrists are asked to refer patients direct to hospitals via the PCT’s Primary Care Commissioning Centre (PCCC).
A Patient Care Adviser (PCA) at PCCC will then discuss choice with the patient and send the referral on to the hospital of choice. The PCA will also send a copy of the referral to the patient’s GP. The optometrist receives a fee for direct referral. Accredited optometrists, whose patient subsequently attends either the Sussex Eye Hospital, Brighton, or The Queen Victoria Hospital, East Grinstead, for surgery can also claim a fee for undertaking the patient follow-up at 4–6 weeks post surgery. The fees will be authorized by the PCT and passed to the Primary Care Support Centre, based in Worthing, for payment. This is the same team that processes NHS sight tests and vouchers.
The options for surgery for Mid Sussex patients are currently Queen Victoria Hospital, East Grinstead, and Sussex Eye Hospital, Brighton. Practices are provided with two leaflets to give to patients who are referred. The first is an RNIB leaflet to help the patients understand what a cataract is. The second leaflet is about choice and the local providers.
Optometrists and ophthalmic medical practitioners (OMPs) who wish to be involved in the scheme are required to register
Appendix 10.1
their interest in using the pathway for direct referral by signing
216the PCT Service Level Agreement (Appendix 10.2). They must then go through the following accreditation process before they start providing post-operative assessment.
To register their desire to train to become an accredited practitioner the PCT coordinator, who will record the practitioner’s name, practice and GOC number, or in the case of an OMP their GMC number and contact details. The practitioner will then be sent an accreditation card to take to the hospital to record training undertaken.
For accreditation training, each practitioner must:
●watch a pre-operative clinic session
●watch at least three cataract operations
●observe one post-operative patient soon after cataract surgery
●attend a post-operative session
●attend accreditation lectures, and
●undertake an accreditation assessment (Appendix 10.3).
OMPs are not required to watch clinics or surgery but may do so if they wish.
The accreditation card issued to a training practitioner by the PCT has to be signed by the person taking the clinic or theatre once the training has been completed. Photographic proof of identity is required. Once completed the card is returned to the PCT coordinator. Eleven DOCET (Directorate of Optometric Continuing Education and Training) points are awarded for the whole accreditation process.
A discussion with the optometrist or OMP prior to surgery about the desired spectacle refraction after surgery and the potential for post-operative anisometropia between the first eye and second eye should be had before referral. The final planned prescription is almost always plano to –1.0 D, so if this will be a problem between eyes some of the ways of solving this, for example contact lenses, should be explained, even if it will only be a short-term problem.
Optometrists are advised to complete a referral form (Appendix 10.4) only if the patient has decided that they wish to have surgery. The optometrist should complete the referral form
Appendix 10.1
and fax it to the PCA on the number on the form. The GP’s |
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name and address is required on the form so that the PCA can |
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send a copy of the referral on to the patient’s GP. The optometrist is also expected to provide the patient with leaflets from the RNIB about cataracts and also to request that the patient bring an up-to-date list of medication to the hospital at their pre-operative visit (Appendix 10.5).
Bearing in mind that the dates for pre-operative assessment and surgery may be 3–4 months from the date of referral, the optometrist is requested to state any unsuitable dates for the patient. For example, if the patient is away all winter or will be away at around that time.
As the patient’s primary eye care practitioner, often their optometrist or OMP is more aware of their likely preferred refraction following surgery. There is also often more chance to discuss this before referral, and therefore if there is a desired refraction then this needs to be stated in the comments box.
If the referral is for a second eye, the optometrist is advised to mark this clearly in the comments box so that the patient’s previous notes are found and a new set not made. Often the biometry readings will already have been taken.
On receipt of referral, the PCA faxes a copy to the patient’s GP requesting completion of the medical issues box within
72 hours.Within 3 days of receipt the PCA will contact the patient to discuss their choice and notify current waiting times.
The referral is posted first class to the chosen provider and the optometrist is notified by fax as to which provider has been chosen. In order to maintain patient confidentiality, the fax will only contain the patient’s initials.
On a quarterly basis the number of referrals per practice is collated to trigger the initial referral fee payment, which is paid by the Primary Care Support Centre.
Surgery takes place after one pre-operative clinic, and unless there are any complications the patient is referred back for a post-operative appointment and post-operative refraction with the referring optometrist or OMP (for which the usual General Ophthalmic Services (GOS) ST fee may be claimed) where the referring practitioner is accredited for post-operative shared care
Appendix 10.1
with the hospital. The patient attends with a post-operative form
218(Appendix 10.6), which would also have been faxed from the hospital. This must be completed and returned to the hospital. The final part of this form is the trigger for the practitioner to be paid for performing the post-operative appointment.