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: deborah.maxwell@nhs.net

• 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