Sheffield Local Optometric Committee

Sheffield Loc meeting 20th August 2012

Sheffield Local Optical Committee

SLOC Minutes of the meeting

Held: Monday 20th August 2012

Present: James Allen (JA), Shirley Blundell (SB), Rob Hughes (RH) (Chair), David Inman (DI), Helen Wilkinson (HW),

Guest: Richard Oliver (RO)

Attendees: Louise Lambert (LL) (Minutes)

Apologies: Helen Bailey (HB), Gerry Cowley (GC), Tan Hussain (TH), Alastair Mew (AM), Deb Mullens (DM), Azad Nawaz (AN), Habib Shah (HS),

Minutes of the last meeting
After four minor amendments the minutes of the last meeting were accepted as a correct record. Proposed by SB and seconded by RH

Prior to the meeting started there was a discussion regarding RO attending and speaking at the National Optical Conference (NOC) 2012 in October 2012. The group gave a brief overview of the event.

Meeting started at 7.40pm

Matters Arising

1. PEARS Training

RH commented that everyone should now have the codes, to enable them to complete extra online training. RH clarified to JA that the codes general take a few days to arrive. Clarification on the codes delivery could be obtained from the Wales Optometry Postgraduate Education Centre (WOPEC) website.

Online training is a update/refresher for already accredited PEARS optometrist. RH enquired how many had undertaken training. RH responded that a couple of weeks prior to the deadline a clearer number, of those who had taken the additional training would be obtain.

It was confirmed that no GRR codes had not yet been obtain for online training and it was considered to complete PEARS online training before expanding to GRR, it was noted that Glaucoma was not included within the PEARS training.

It was explained to RO that the online training was only for accredited optometrists. Non-pears optometrist would only benefit from Face to Face training (Part 2) as offered by WOPEC. RO confirmed to the group that the funds, as previously mentioned were in the region of £1,000 – £1,500. The group discussed in further detail the official WOPEC training.
Action: RH to inform RO numbers and when a cohort would be ready for training.

The group went onto to discuss the 48 hour routine policy, that was historically put in place to ensure that patients where safeguarded and attending a location/practice within the 48 hours. RO assumed the time period through SPA was more than 48 hours and queried why the two timed frames where not consistent. It was suggest that two weeks would be an agreeable consistent timeframe. The logistics of PEARS holiday cover was mentioned. RH confirmed that optometrist upon informing with SPA when annual leave arrangements would receive no referrals during that period. The group discussed further details about referrals, discussing various conditions and concluding that referrals should be handled within the timeframe of the triaging optometrist, not the referring optometrist. JA
Action: RO to investigate the 48 hour timeframe with Lynda Lidddament (LyL)
Action: RH to enquire with Mike Daybell (MD) the 48 hour timeframe.

DI wanted to highlight to the group; that the PEARS optometrist in Wales had implemented and new “iphone app”, which was currently not available on other “smart phones”. He went to enquire if anyone had either heard about it or downloaded it. Unfortunately the group had not heard about the application before. This was considered to be another layer in support offered in taking PEARS forward
Action: RH to investigate
2. OHT monitoring

RH reported that the meeting with Simon Longstaff (SL) – STH consultant, Glaucoma and Cataract didn’t go as expected. He didn’t appear to be over enthusiastic and held some reservations about financial benefits and the pathways – enquiring if anything had been actioned similarly elsewhere.

RH shared Stewart Mitchell (LOCSU) vision of the pathway that had been implemented within Leeds and Bradford. He further explained the reservations the hospital had about “Shared Care” working. RO described how patients would be discharge from the hospital and have to register with community optometrists, seen on an annual cycle. New referrals will be seen within the hospital setting. It was thought that 1 in 6 will back within the hospital system. The group discussed the convince to patients of been seen within the community.

Financial it was considered beneficial to continuing with this line of enquiring/debate with the hospital. To begin with the monitoring of stable glaucoma was raised by and in conjunction with the Clinical Reference Group, LOCSU, NICE and initially with the support of SL. The financial impact to both the PCT and the hospital was discussed and it was estimated that the community setting would reduce 4,000 referrals and save ¼ million pounds. There is now a need to obtain supporting evidence and previous learning, from other areas who have implemented the pathway. RH commented that Shared Care schemes had been running for some years and the move out to the community had been mostly hospital led.
Action: Look into other area’s scheme

This led to a larger discussion about the various elements/degrees of Glaucoma including field test being subjective and thresholds over 30 should be referred back into hospital.

3. Non functional surgery.

RO wanted to obtain the committee’s point of view regarding non-functional surgery. The group discussed various conditions that may require a patient to undertake surgery to remove abnormalities in and around the eye. Mild degrees of squints do not effect fields, Benign lumps and Minotrophin. The viewpoint within the PCT is that these sort of conditions should not be funded within the NHS as they are aesthetical pleasing.

The evolved into a lively debate and it was questioned whether the costing where higher then that of other cities. It was felt that it was not being an easy as a yes/no decision and the optometrist felt strongly that they shoul not be involved in this. With the possibility of incorrect diagnosis, things slipping through, whereby a condition could be underlying symptom of a more significantly condition.

RO thanked the group for the input and felt that the discussion had raised some interesting points. The group felt that the ownership shouldn’t just be placed on community optometrist.

4. Levy

The item will be carried forward to the next meeting, Tuesday 2nd October 2012. HB is going to look at a virtual network for the LPN
Action: RH to raise with HB.
Action: Place item on next agenda

5. PRR

SB spent a morning at SCH to discuss areas of problems with PRR patients. Vicky Knight (VK) has been collating cases. It was in most cases straight forward to see the rational behind how they were doing things. It was agreed to put a general email together to allow other practices to learn from identified errors.

Further to service evaluation SB asked the group to consider some slight amendments to the PRR pathway. The evaluation revealed that children are being seen within 2 to 5 weeks, which is excellent. RO wanted to publish, from evidence collected, “good news” stories, within the school and star.
Action: RO to speak to Comms regarding a publishing plan.

It was proposed to give 8 weeks for the first appointment, as opposed to the original 6 weeks. The second/follow up appointment to be extended to 18 weeks given the child’s vision more time to come up to expected standards in line with national guidelines. Audit suggests that extending this period would reduce referrals to secondary care.

The group discussed the procedure of obtaining re-issued vouchers from the PCT in the event of non tolerence. On the rare occasion when the patient does need to be re-tested a voucher can be re-issued to the optometrist relatively quickly by redefining the first prescription and demonstrating the changes, allowing another voucher to be reissued. Optometrist must contact Sue Marriott at the PCT for authroisation
Action: RH to email out SM contact details.

A discussion arose round the data the recent audit had unveiled. The discussion concluded that the scheme had been very well received, including the college and by optometrist. DI suggested that this might be a scheme that RO highlighted at NOC and raise profile of successful schemes such as PRR and GRR.
Action: SB to send RO, VK contact details

SB enquired if everyone was happy that the changes, it was decided to tweak and extend the pathway prior to the commencement of the school term in September. RO stated that as funding will not be effect there was no need to obtain PCT approval.
Action: Website to be updated to reflect agreed changes

6. Any other Business

RO informed the group that in the future CATS scoring maybe removed. The group discussed the implementation of this and it was thought that Richard Sheard must make some kind of scoring system for operations. It was highlighted that criteria enabled SLOC to make an informed choice.

Although CATS has reduced the community referrals it has not reduced the number of operations in hospital.

RO will continue to support a scoring system although it was acknowledge that if the scoring system is removed it will affect the number of referrals.

The group discussed controlling measures that could be put in place in the event that the scoring was discontinued. The definition of cataracts was spoken about and the need to reassure patients that everyone may have a bit of cataracts.

RO finished the conversation by stating that a further discussion is required by commissioners.

RO left the meeting at 9pm

The group continued to discuss the frequency and the benefits of patients have surgery earlier. The discussed concluded that optometrist would need to use clinical judgement. The statistical data was obtained directly from Hallamshire hospital.

Date of next meeting;

Tuesday 2nd October 2012

Meeting finished at 9.10pm

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