Sheffield Local Optometric Committee

Sheffield Loc meeting 10th July 2012

Sheffield Local Optical Committee

SLOC Minutes of the meeting

Held: Tuesday 10th July 2012

Present: Shirley Blundell (SB), Gerry Cowley (GC), Rob Hughes (RH), Deb Mullens (DM), Azad Nawaz (AN),

Guest: Alastair Mew (AM), Richard Oliver (RO),

Attendees: Louise Lambert (LL) (Minutes)

Apologies: James Allen (JA), Helen Bailey (HB), Tan Hussain (TH), Habib Shah (HS), Sue Stentiford (SS), Helen Wilkinson (HW),

Minutes of the last meeting
RH commented post AGM that gonioscopy was not included in the training for OHT pathways. The AGM minutes to be approved next year, the minutes from the short meeting after the AGM on 28th May 2012 were accepted as a correct record. Proposed by DM and seconded by AN

Matters Arising

1. PEARS

RH informed the group that 25 codes had been obtained for extra online PEARS training, with an estimated 3 to 4 hours to complete. He enquired whether the committee should initially do the training prior rolling it out to the wider community. Follow on from discussion with Richard Sheard; there is no LOCSU training pathway. Refresher training for accreditation is every 3-5years, the committee agreed on a 3 year approach.

RH confirmed to SB that the online training was only for PEARS not GRR.

AN asked whether the training carried any cost, RH confirmed that part 2 did. After further explanation regarding the contents of the various parts, part 2 being more “hands on”. RO suggested that the second part could be funded by the PEC budget. The committee concluded to roll out part one training to the wider optometrist community. AN also asked if there was a deadline for completing the training, 3-4 months was considered to be adequate.

The group discussed the process of certificating the training as certificates where not generated automatically.
Action: RH to contact the wopec/univeristy to query certificate.

RO recommended that SLOC put a package together for training, including certificates.
Action: Compose package

The group considered other areas that would benefit from training, including Ocular hypertension, for optometrist with the relevant equipment and GOS

2. OHT/GRR

The group discussed record keeping at SPA (Single point of Access) particularly about Ocular hypertensive training.

The clinical pathway has been agreed by Simon Longstaff. Negotiations are still happening regarding patients discharge. Optometrists who are accredited by OHT will follow up with discharged patients. It was clarified that the onus was on the patients to approach community optometrist and register. If the patient failed to attend the optimists should inform/contact GP’s. The group discussed the yearly frequency suggesting that it would be possible to do combined both the OHT and GOS checks.

The group spoke about the transfer of OHT funds from STH to SLOC. The follow up fee has yet to be clarified with finance. Re-tests should be inclusive in follow up fee. There where discussion around failed field tests and ratio – nearly 50% of fields retested pass second time around. Nearly £250K is proposed to be released, £15-20K for re-referrals, £160K for new patients and £60K for follow-ups. The group further discussed accounts and revenue. The group agreed that patients treated within the community are more likely to stay within the community setting. The fee still required further discussions prior to clarification, however RO estimated £30.

To allow patients discharge to be more manageable, RO imagined them being discharged in batches (monthly) rather then all at once and only patients that are stable. It was envisage/hoped that feedback would be received similar to Glaucoma referrals

The group continued to discuss the details, timeframe and pathways. RO wanted to obtain a feel for how many optometrists would be interested in contributing to the service, it was thought that the service will be well received by community optometrists. Some optometrist may not have the equipment although it was considered not to be a large investment.
Action: DM to draft and dispatch letter to practices obtaining interest

Roughly 4000 patients where fit for OHT type of monitoring. The fee will include having eye tests and GOS. Patients have the right to choose who they go for the GOS testing

3. Levy

With HB absence – RH gave the group a brief outline of discussion, raising the levy to 1.25 or 1.5, as previously mentioned at the AGM 24th May 2012. The item will be carried forward to the next meeting, Monday 20th August 2012. RH further went on to state that guest who attended the AGM appeared happy with the increase. The further funds would allow LOC to become more involved. Heather Marsh (HM) was going to look at a virtual network for the LPN, but nothing has happened
Action: RO to raise with HM.
Action: Place Levy on next agenda

4. Cataract.

Further to consultant ophthalmologist, Richard Sheard discussion, all optometrists should be referring directly. The group discussed the process, thresholds and scoring systems. The group was informed that there were debates going on with STH that could lead to the cataract scoring disappearing. There was a general lack of understanding coming through triaging.

Queries regarding the processes where raised; • A reasonable presence of Cataracts needs to be defined further. • Score sheets are possibly being sent to GPs who then be forward onto HES – If patient score less then 10, they do not get seen. • Duplicate copies of the score sheet – 1 to Brincliffe House the other to GP – 10 pound walk have instructed assessment sheets to be sent directly to the GP.

It was clarified that confusion may have arisen as a result of optometrists sending a copy of the score sheet to surgeries for information. It needs to be made clearer to optometrists to only send a copy for information in patients being sent for surgery, aiding the GP during discussion with patients.
Action: Communicate clarification to optometrists.
Action: RO to investigate the Data side and meet with Richard Sheard.

When sending letters electronically AN queried whether emails where being read obtaining a “read receipt” All primary care should have emails but the frequency of accessing them was unknown.

5. PRR

SB recounted that there where a lot of cases where the optometrist had not reported on their visits, which was requiring a lot of time and resources, chasing up details. Vicky Knight (VK) is monitoring patterns and there appeared to be a recurrence of issue with some practices. VK was then having to chase and liase with the practice to identify the problems/issues or obtain the report. SB highlighted the protocol for the PRR and suggested that there should be a consequence if it was not following it correctly. VK has identified cases where some patient had either not been seen or only seen once, resulting in the 6 week check was being overlooked. The initial steps to the follow up are to firstly phone, secondly email and then followed by the issuing of the orange and red cards. Practices repeatedly not following this agreed protocol need to be dealt with. It is a safe guarding issue not knowing whether a child has been seen or not – when feedback is not received.

Further guidance may be required, it was suggested SB would arrange a meeting with VK to identify, which practice to contact and resolve any issues. SB referred to a 4 week timeframe where practices should be chasing patients if there has not been in contact. The group discussed various scenarios and solutions. Reflecting that if patients where failing to contact practices and reduce the risk of patients being overlooked it was suggested that practice should manage their referrals once a week. The group confirmed that only optometrists themselves, should be completing the report.
Action SB to liase with Vicky and practices

It was felt reasonable that if practices continue not to report back and there was a need to continually chase them, they could eventually be removed from the scheme.

The group briefly discussed a request for information from a student at Aston University. It was felt that the request would involve a lot of additional work that would not be of benefit or audit the effectiveness of the scheme. RO stated that it would also be a governance issue, passing information to a third party.
Action: SB informing the individual the information was not readily available but conveying best wishes

6. Any other business

RO raised medication and the group discussed various medications including Icaps vitamins. From a clinical perspective, that there were other suitable alternatives that could be prescribe. Recommending Icaps and other macof ular supplement be removed from prescription and NHS funded list.
Action DM to amend website to reflect

The group went onto discuss the Minor Aliment Scheme (MAS) with particular reference to hypromellose, eye drops, which can be put on prescription after an eye test using the MAS form in conjunction with the GOS. .
Action: To put the MAS form on website

The group discussed award schemes and recognising services, which have positively impacted on Primary Care. Recently an article (post meeting – http://www.pcc.nhs.uk/uploads/Commissioning%20Excellence/2012/06/commissioning_excellence_june_2012.pdf ) emphasised the results of Sheffield optometrist in reducing MSK (musculoskeletal) referrals into secondary care. The article wrote about the contributing factors of PEARS (Primary Eye care Acute Referrals Scheme).

RO is keen to promote SLOC in Hospital journals and local news obtaining recognition and potentially, if awarded monies to be invested back into optometrist training.

The group went onto consider patients within the Sheffield catchments area. Noting that SPA (Single Point of Access) is meant to screen triaging referrals.

DM left at 2035hrs

If triaging referrals are outside Sheffield catchments area they should be sent back to SPA.

PRR

Someone in Rotherham LOC contacted Linda probing about the 12 week pathway, normally 16 weeks. Initially 12 weeks was decided in conjunction with the hospital, LOC and clinics at the time it was agreed to review the pathway timeframe. The group felt it was unnecessary to lengthen the pathway as the 12 week timeframe was working really well. It was suggested to run an audit to investigate the effects of a short timeframe and ascertain if there where any issues.
Action: Vicky and Craig facilitate audit

.
PEARS

If optometrists are unaware of which GP the patient is registered with they should send records to the previously registered GP. If patients move into Rotherham, after optometrist have referred; assume they are registered to Sheffield practices.

AN is still having difficulty with correspondence. AN to email RH to ensure correct / confirm email address
Action: AN to email Rob

The group briefly discussed payment voucher and scenarios where there was a need to issue another voucher, intolerance cases. It was confirmed that you can only re-issue a voucher when authorisation has been obtained from Liz Keyworth, who assess in case individually. It was confirmed that hospital vouchers cannot be transferred into the community

7. Date of next meeting

Monday 20th August 2012

Meeting closed 20.51hrs

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