Sheffield Local Optometric Committee

Sheffield LOC meeting 2nd December 2014

Minutes of Local Optical Committee Meeting 2 December 2014

Present: Rob Hughes (RH-Chairman), East Patel (EP), Dee Singh (DS), James Allen (JA), Rob Hobson (RO), Azad Nawaz (AN), Gerry Cowley (GC), Tanveer Hussain (TV), Shirley Blundell (SB), Lynda Liddament (LL), Habib Shah (HS), Richard Oliver (RO).
Attendees: Karen Williams (Minutes)
Apologies: Deborah Mullens, Helen Bailey Meeting started- 7:35 PM
Agenda
Glaucoma/OHT
Pear Review
Future LOC Meetings
NHS Email Addresses
Other Business

Glaucoma / OHT
RH – I spoke to Simon Longstaff about glaucoma and OHT monitoring and voiced that they need to be discussed separately.
Concerning OHT, Simon Longstaff would like to discharge a few thousand OHT patients to be monitored by Optoms and would not want see anyone unless their pressure goes over a certain level. Simon suggested that if we were concerned about a patient a useful tool would be to send someone to hospital so you would have the patients OHT readings to compare over a period.
AZ- Who would evaluate those readings?
RH- We would. Once the patient is discharged, the hospital would pass on all their data to their chosen provider and the data for that patient would be kept with that provider, so we would have an old scan to compare with a new scan if we thought it was necessary.
JA –What criteria would we follow for patients who are being referred in with high pressure? Would they still go to the hospital on their first visit then if the pressure was normal they would be discharged back to the care of their Optom, or if their pressure was still high the hospital would indicate if they were happy for them to still be discharged into the scheme?
RH– Yes; basically. A result from OCT would be a complete disc scan. Ideally they would want pressures to be tested via Goldman Tonometry and it would have to be a dilated disc examination, fundus photograph also disc photography may also be an additional requirement and full threshold fields 30’.
Problems start with glaucoma monitoring, Simon Longstaff is very keen for Optoms to take over this monitoring as this will free up a significant amount of hospital time. At the hospital it is tested by non contact tonometry, then patients are taken for OCT, then fields are done, it is all technician lead then data comparison of results. If Optoms take over this monitoring it will be contact lead monitoring.
RO- An Optom doing OHT will need a disc dilated and a Goldman which most of you have got so there is nothing there that a Pears Optom couldn’t do.
RH – All Pears Optoms also have some degree of Glaucoma accreditation but if the OHT monitoring went ahead we would probably want everyone to do at least the WOPEC distance learning course as a refresher.
RO- Some OHT patients may not be on any treatment but will require monitoring in case treatment becomes necessary.
EP- What is the difference between the 2 types of monitoring, i.e. OHT and Glaucoma?
RH- The main differences are that when it comes to Glaucoma the patient has a disease and you are monitoring for changes in visual fields.
JA- I don’t like the idea as it will be hard to interpret the results. We are not doctors so will not know exactly what to look out for.
RH- There are ways of getting around this but it means equipment levels have to be specified, this is why I sent out the email requesting what equipment each Optom has. The Humphrey field screeners can have progression analysis software on them which very accurate and so can be used for the testing. This is a very expensive machine especially with the progression analysis software and presently no Optom in this area has one with the software although some Optoms do have a Humphrey field screener, so no Optom in this area could follow the specs at the moment.
JA- I am concerned about the safety of the scheme, it is a lot of responsibility for an Optom to take on so the specifics of the scheme would have to be very clear cut.
GC- The bottom line is the money for the equipment – A Humphrey field screener costs approx £20,000 so it is a major investment.
RH- At the moment as not many Optoms have the necessary equipment to do the OHT monitoring then they will be swamped with the amount of work.
We are there to basically carry out the monitoring to check the patient is stable but if there was any change the patient would have to be referred back to the Hallamshire for further tests or medication. The OHT patients would probably be seen yearly.
AN- When you have carried out a test using the Humphreys you can export the data via PDF or email so could we send the data on to someone with the progression analysis software to study and log the results externally?
RH- That may be possible, we should research further into that suggestion.
SB- Would it seem reasonable to take on just the OHT monitoring first for a few years so we could review how it is working before we take on the more complex Glaucoma monitoring, so it would be more of a shared care situation.
RO- There are presently 4000 to 6000 patients that are being treated by the NHS for OHT/Glaucoma and about 2000 are being monitored yearly for OHT. Of these patients about 10% convert back into the system as they are unstable and may need treatment or further tests.
JA- On the patients’ discharge we would need a definitive figure for changes in pressure indicating a referral back to hospital.
RH- On other issues- There are quite a few patients that come to the Glaucoma unit and have not had any referral refinement done – all patients should have this, no one should be referring directly without referral refinement and anyone who is not referring directly should do so via SPA and get triaged as Pears. Can we tighten up to make sure that patients don’t get to hospital without referral refinement?
Another issue is that the GRR system is sorely lacking because we are not doing gonioscopy. The GRR and Gonioscopy do not have anything to do with each other and they want all Pears and GRR Optoms to do the gonioscopy training and they are also willing to do this training.
RO- If the LOC Co was to approach us then we could offer some training to you.
RH – So we can get the training for anyone who is interested.
JA- Should we send an email out and find out who is interested in doing the scheme and the training.
RO- So to sum up OHT – So we can put together a simple protocol which says you are happy to register patients, check the personal details of the patient then follow a set pattern of testing and monitoring and also chase up the patient if they don’t attend their scheduled appointments then discharge the patient back to their GP if they repeatedly DNA their appointments. If their test results fell within certain criteria they would be referred back to hospital. If you accept OHT then the hospital will refer other patients to you for monitoring eventually.
AN- How many patients are we talking about? If we take this on can we can review it after a few months?
RO- You are probably looking at about 100 patients per year per Optom.
RH- Most patients will go to the same Optom for all their treatments.
JA- We do not want to search for co-pathologies at the same time.
RO- We want you to perform specific tasks but if you see something of concern then you should refer this on.
GC- Regarding buying a progressive Humphrey – are there funds to subsidise buying one?
RO- That is possible, but for now stick with OHT and we will develop the protocol as we progress. The discharge process needs to be thought through.
SB- There will be an online reporting tool kit.
LL- We are getting ready for handing this over to Optoms.
RO- It is expected that from April patients will start to be discharged from hospital.
GC- So there will be a one year lead in to the system and we would be looking at doing it for three years to get a proper view of how it is working.
RO- Regarding your shared care protocol. You will develop clinical criteria, have a description of the discharge process, a description of the monitoring frequency and when to call for help. The discharge process should be slow but planned, this will help other critical patients at the hospital. What time scale can you work to?
RH- I think April is too soon, we could aim to do the protocol and documentation by then.
RO- So we could start the process properly on the 1st September. That is when the hospital would start discharging patients to your care.
LL- We need to write a mandate to go through PMO office.
PEAR Review
AN- I contacted HOYA they have offered one Pear review for DO’s and one for Os. I would like to start with the Pear review for Dos first. I think it would be possible to fit it in between 6pm until 8pm before a LOC meeting. I was going to wait and see the dates of the LOC meetings and tie it into one of those.
RH- I have had about 5 DOs who have emailed expressing interest in Pear review.
AN- Suggested subjects to cover are: BV, Ocular disease, Communication and Professional conduct. We can ask what DOs would be interested in hearing about and get some feedback on how much interest there is.
JA- It is hard to get people to actually turn up.
RH- You could use my practice for a meeting of around 10 people if you like, that means you are not tied to LOC meetings.
Dates of the Next LOC Meeting
RH- I think we should start holding meeting every other month rather than every six weeks.
RO- There is a desire for NHS England to support local Optoms to develop local professional networks and to raise the profile of what Optoms can do. Is anyone willing to volunteer or contribute to setting this up?
RH- Mike expressed an interest in joining LPM.
SB- Has a friend who has been asked to look for a good scheme and Sheffield was flagged as an example.
Optoms and NHS Email Addresses
RH- Optoms and NHS email addresses – most have an NHS email for ease of communication, we could make it an obligation that they have an NHS email so we can communicate with each other. NHS mail is being re-vamped – fax will stay the same, any practice doing enhanced services needs an NHS mailbox.
RO- STH are moving towards electronic records so you will need an NHS email address as each patient will have a record stored online.
LL- I would like to be informed of staff changes so I can remove or add people with access to the NHS mail boxes. I set up these mailboxes – IT will set up new ones as we need them.
Other Business
DS- Tesco in Sheffield won’t do enhanced services. There are a few stores around the country doing some enhanced services but it is not possible here in Sheffield.
GC- The Christmas party – we used to do it in spring so I will look into arranging something early next year.
Meeting ended 9:15 pm

« Back to the archives

Next Meeting:

Holiday Inn hotel,
Blonk St
Sheffield
S1 2AB

at 7.30 pm Tues 1st Aug

Mailing List

Join our mailing list