Sheffield Local Optometric Committee

Sheffield LOC Meeting Monday 4th July

Sheffield Local Optical Committee

SLOC Minutes of the meeting

Held: Monday 4th July 2011

Present: James Allen (JA) Phil Banton (PB), Helen Bailey (HB), Shirley Blundell (SB), Rob Hughes (RH – Chair), Tanveer Hussain (TH), David Inman (DI), Deb Mullens (DM), Azad Nawaz (AN), Habib Shah (HS), Susan Wilford (SW),

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

Attendees: Louise Lambert (LL) (Minutes)

Apologies: Alex Gage (AG)

JA was formally welcomed to the committee

Minutes of the last meeting
The minutes of the last meeting held on Tuesday 24th May 2011 were accepted as a correct record. Proposed by AN and seconded by HS

Matters Arising

1. Paediatric Referral Refinement (PRR)

The scheme is receiving positive feedback. When a child has been screened a letter is sent to the child’s parents. It was suggested that a list of PRR registered optometrists is supplied with this letter. This would improve the offer of “choice” to the parents whose children fail screening. The Primary Care Trust (PCT) had concerns that this may cause parents to go direct to PRR registered optometrists without waiting for contact from the Single Point Access (SPA). The group further discussed parents attending registered optometrists directly concluding that the letter states clearly at the bottom “wait to be contacted by SPA”. Should optometrists be contacted by parents directly, they should reiterate that in the first instance SPA will be contacting the parents. The group agreed that the list of registered optometrists should be up to date with practice information, not individual practitioners. SB to discuss further with Linda Liddament (LLi).
Action: AM to investigate PCT concerns and report back to group.

SB confirmed to the group that she has a meeting with LLi and the PCT’s IT dept to discuss electronic reporting in PRR, similar to that used in CATS, PEARS and GRR.

The group discussed aspects of the current form, particularly relating to level of detail and the possibility of dual reporting. The group were eager to pursue electronic reporting.
Action: SB to meet with LLi to refine form.
SW suggested looking at the format of all forms across various schemes and obtaining a consistency and a logical format throughout.

2. Cataract

RH informed the group that there has now been official approval to raise referral threshold to 10 and use combined scoring and referral form. The group spent some time discussing exceptions to the threshold and various scenarios, including patients who have had surgery on their first eye and the necessity of second eye surgery. The group suspected these exception numbers to be low.

SW suggested that periodically there should be an audit of cataracts referrals highlighting any inappropriate referrals, including when the use of the incorrect forms and inappropriate scoring. It was suggested as Ophthalmologist will have to report scoring to LLi it would be possible to collate figures quarterly, then feedback to community optometrist.

The group confirmed that referrals for patients with cataract and one or more other conditions should be submitted via the GOS18 form.

It was thought that optometrist would be informed when the raised threshold comes into effect, some contractual issue need to be clarified prior to commencement. From September there will be one route for cataracts referrals processed through Primary Eyecare Assessment and Referral Scheme (PEARS) and GP will be then be informed that they no longer process Cataract referrals. If an exceptions referral, under the 10 threshold is thought not to have an adequate reason or meet the appropriate criteria the triaging optometrists should feedback to the referring optometrist via SPA. AM to confirm with LLi how the process will work through SPA
Action AM to discuss with LLi

The group decided once the commencement date was known, a letter will be sent to all optometrists signed by RH and RO, informing them of the new 10 threshold. It was also proposed to include the cataracts leaflets, which would be given to patients.
Action: RH to distribute proposed leaflet to group

The group discussed inappropriate referrals, noting that if a patient changes their mind it is not classed as an inappropriate referral. The committee went into further discussions regarding various individual scenarios. RO suggested that rather than trying to predict various scenarios/exception to the “under 10” threshold, implementing the increased threshold and reviewing scenarios/exceptions at a later stage.

3. Primary Eyecare Assessment and Referral Scheme ( PEARS )

PB reported the outcomes from the PEARS sub-committee;

• The need to have a meeting with PEARS and Triaging optometrists, the group proposed the end of September.

• The sub-committee discussed the refractive error issued raised by JA at the last LOC meeting, Tuesday 24th May 2011. The sub-committee discussed when patient’s prescriptions are issued incorrectly the patient should be referred back to the original optometrist. The group acknowledge the sensitivity of the situation and discussed in detail different scenarios, including if the patient did not want to return to the original optometrist. SW suggested there is a need to feedback to the original optometrist the issue and question how they would like to proceed or discuss the proposed solution.

JA raised the difficulty in chasing referrals to the hospital. The group raised again the possibility of receipt faxing and discussed the possibility to broaden the receipt faxing process from PRR to other schemes.
Action: LLi to investigate the possibility further.

NHS mail was considered the best solution to avoid misplacement or loss of referrals. The group wanted to obtain confirmation that all optometrist had IT facilities in order to pursue the possibility of utilising NHS mail. RH confirmed that all practices offering enhance optometrist services have NHS mail accounts. The group went on further to discuss the processes and benefits of using NHS mail with the possibility of organising a workshop to assist optometrist.
Action: AM to raise with STH and investigate
Action: SW to investigate if it is possible for multiples (franchised practices) to access NHS mail

AM confirmed that the form formats has been addressed and suggested this could possibly reduce optometrist paperwork. IT confirmed that only the appropriate department would be able to see/retrieve the differing data from the form. The group acknowledge that PEARS optometrists still had to duplicate paperwork. It was suggested that online processing would be extremely beneficial to various optometrist schemes. It was proposed to introduce and cascade, online processing, systematically with each scheme individually to allow clinches to be identified.
Action: AM to investigate and liaise with IT about processing online.
Action: SW to enquire with the college if the proposed online processing was feasible.
Action: RO and AM to investigate from the hospital perspective.

JW enquired if LOC or the college had any referral guidance, regarding “watery eyes”. The group agreed in theory that the patient should be triaged into PEARS however, if in the optometrist professional opinion, no treatment will be offered for the condition it was questioned if there is any benefit in referring them. The group went onto further discuss consultation time and fees.

4. Contact Applanation Tonometry Service (CATS)

Currently 29 practices are taking part in the CAT Scheme, since its implementation 6 months ago. The figures are very positive, 432 patients have been seen on the scheme. 49 have been referred further into secondary care, which equates to 11%. This is a cost saving of approx £39,000 if all of these patients had been referred to secondary care. Or a cost saving of £7,000 (seven thousand) if all had been referred to PEARS. If the LOC were to encourage more practices to participate in CATS scheme there would be a greater saving.

SB left the meeting 20.50hrs

SLOC agreed to write to non-CATS optometrists introducing the scheme and inviting them to participate.
Action: PB to write letter to optometrist.

5. Correspondence
All correspondence is dealt with via email

Any other business

SW expressed the benefits of practice visits suggesting that DI is very keen for them to commence. Practice visit would be the ideal opportunity for enquires, including IT proficiency. AM informed the group that LLi would be interested in attending practices with DI.

SW wanted to highlight the meeting Alex Gage recently attended, Map of Medicine, the management of clinical pathways currently under development. The college are trying to submit an optometry pathway.

RH recently attended area meeting, to which he reported back that other LOC’s had issues with the LOCSU levy and the other groups are reducing their payment or gave smaller contributions. It was also suggested that the area meeting become a regular meeting between regions, to be paid out of LOC contributions, which SLOC disagreed with. The group went onto discuss services that have been or could be received from LOCSU and after further discussion confirmed that they would be dropping contributions from ½ to ¼, which currently incurs no further consequence. The group decided when requested by LOCSU to pay the ¼ contribution

Low Vision

As HS and TH have in passed meeting expressed interest in low vision RB suggested that they initially investigate the feasibility in progressing with a low vision scheme. In the past there has been numerous attempts to progress low vision and HB and PB offered supporting paperwork/communication to HS and TH to support them. Suggested approaches would be too meet with the PCT. One of the concerns across the city is people/patients who are unable to access services offered by Hallamshire. PB stated that low vision have been established for years and have good transportation elements.

RB went on to explain that whilst there are no funds available from the PCT there is the possibility of redistributing funds for the services offered by Hallamshire as long as it is a greater service for less expense. The group suggested areas for HS and TH investigate
• Funding (including the details) redistribution
• Rural access, looking into services provided by Wales and Scotland
• Time frame for services.
• Number of patients to benefit.
• Service currently being offered
• Improvements to the service
• What other areas are doing
Action: HS and TH to ascertain what is and is not feasible.

The group spoke about which practices who have expressed an interest in facilitating low vision. It was also confirmed that a diploma would not be required to support the low vision service.

Venue
The group examined the rates for the meeting room and refreshments being charged by Beauchief concluding to potentially look for a new venue.
Action: JA to investigate with contact

Date of next meeting
Tuesday 16th August 2011 – Ian Atkinson (Chief Operating Officer) attending

Meeting closed at 21:25hrs

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