Sheffield Local Optometric Committee

Sheffield LOC Meeting Tuesday 16th August

Sheffield Local Optical Committee

SLOC Minutes of the meeting

Held: Tuesday 16th August July 2011

Present: James Allen (JA) Phil Banton (PB), Helen Bailey (HB), Shirley Blundell (SB), Gerry Cowley (GC), Mike Daybell (MD), Rob Hughes (RH – Chair), David Inman (DI), Deborah Mullens (DM), Susan Wilford (SW), Helen Wilkinson (HW)

Guest: Ian Atkinson (IAA) – Interim Chief Executive, Alastair Mew (AM), Richard Oliver (RO)

Attendees: Louise Lambert (LL) (Minutes)

Apologies: Alex Gage (AG), Azad Nawaz (AN), Tanveer Hussain (TH), Habib Shah (HS),

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 SB and seconded by SW

Ian Atkinson – Interim Chief Executive – NHS Sheffield

The meeting was opened by RH welcoming, on behalf of the committee, IAA to the meeting

IAA proposed to reflect upon the changes that have occurred since his last visit, back in April 2011.

Firstly IAA acknowledges the committees positive impact implementing various schemes for Sheffield communities. There have been significant returns. Recognising and thanking the committee for its strong working relationships.

He proposed to update the committee in three sections, nationally, regionally and locally. Politically, nationally the outline has been confirmed. The national NHS commission board was launched, David Nicholson is the designated Chief Executive. The GP Commissioning Consortia (GPCC) will be called Clinical Commissioning Group (CCG), which will include nurses and secondary care clinician representatives.

Clusters are increasing in resilience. They will be retained in their current form beyond 2013, if necessary, as outposts, to support the new NHS Commissioning Board, in overseeing the CCG commission GP services.

The revised CCG specialists will hold the local line of engagement and will manage commissioning contracting and management of a £1bn (billion pounds) budget. The national position the CCG will be supported into maturity.

The Strategic Health Authority (SHA’s) are clustering into four clusters, which will come into effect on 3 October 2011 – London, North (which Sheffield is part of), Midlands and South. The Landscape of the commissioning board is changing and all multiple boards will be dispensed by 2014 when there will be one Primary Care Trust (PCT) cluster board.

Locally providers within Sheffield will be contracted through the CCG. We are seeing a changing landscape and are starting to see the beginnings of establishing relationships with the CCG, from October 2011. There is a distinction between the PCT and the CCG.

Locally the 4 Sheffield consortia are proposing to morph into one city wide CCG. It will be one of the largest in the country, considered to hold significant advantages. No prescription has been issued from local government and CCG’s will not look alike.

The process for electing the CCG board has been approved. Predominantly it will be clinical lead, 4 will be elected from the 4 localities (consortia) and 4 from clinician representatives. The structure under the CCG looks similar and fairly clear. Under the CCG will be the executive team. IAA stressed the importance on getting the structure correct.

The timeline from October, in meetings between the Government and the Cluster Board, will be to confirm, challenge and approve. Demonstrating engagement and creditability in service plans and delegating responsibility to the CCG. The business of running the health service will fall to the CCG. There will be a period of monitoring, implementation and a fundamental shift in relationships.

IAA finished his overview by asking the committee they had any question or wanted to address any rumours.

IAA confirmed to RH, that although the deadline had faded, the CCG becomes the shadow in readiness to take authorisation.

RH enquired about how the Local Optical Committees (LOC) within the South Yorkshire & Bassetlaw (SY&B) Cluster would work together, if at all. RH emphasized the different working practices between LOC’s, expressing that Sheffield Local Optical Committee (SLOC) had invested greatly in professional standards, working practices and schemes. IAA thought that by October most PCT will have delegated some functions, although the proposed new structure and processes cannot be imposed until the CCG has taken authorisation. It was considered that there would be degree of standardisation across the cluster and that the brilliant work of Sheffield optometrists could be adopted elsewhere, effectively saving and changing the way the services are delivered. Concern was raised regarding clinical and cost efficiency as well as leading service delivery. Primary Eyecare Acute Referral Scheme (PEARS) is working so well in Sheffield, it was hoped that there would be some local support in expanding the scheme regionally. Dependant on how the CCG wants to proceed with the situation. The CCG chairs are getting together and are looking at obtaining a wider membership, possibly a part for SLOC to play.

SW enquired how standardisation would work nationally. IAA credited SLOC with successful working practices. It was thought a regional clinical threshold would be implemented and tested with an agreed common dominator. SLOC can, if they so wish improve on the threshold. Instead of inventiveness of policy, across the region, it was hoped that the NICE infrastructure would instruct how to engage locally based on analysis and evidence based.

RO, as previously expressed in meetings, felt that there was a publicised need to recognise the work being delivered by SLOC.

IAA thought the there was a temptation to feel despondent about the NHS restructure however he saw it as an opportunity to make a remarkable and meaningful difference. A lot or reorganisation was/is required, with the necessity to achieve clinical and engagement assurances.

DM enquired if SLOC should wait to approach the CCG. IAA considered that strong relationship have already been established through RO and Zak McMurray (ZM), part of the clinical reference group. Who have their first meeting next week, when there will be a better understanding of how other professional representatives will fit in.

IAA will return to a future Sheffield Local Optometrist Committee Meeting in either October or November. Dr Charles Heatley, Chair of GPCCC, will have issued further clarification and distinction.
Action: LL to inform IAA’s office of meeting dates

IAA thanked the committee for their invitation and left the meeting at 2015hrs.

MD expressed that the committee would like to continue the relationship and become involved with the clinical reference groups. RO sought to involve SLOC in the clinical forums. MD enquired if it would be the clinical reference group or board who would liaise with SLOC. RO thought that both the group and the board would liaise with the committee to facilitate optometry elements.

AM asked the group if they had any ideas that they would like RO or himself to raise. SW mentioned Chronic Glaucoma scheme being run in South Devon and thought worth monitoring.

SW informed the group that there is a Shared Care Glaucoma scheme running in Wales, having impressive statistics. The group discussed the difficulties of implementing Shard Care Glaucoma.
Action: SW to liaise with AM

Matters Arising

1. Paediatric Referral Refinement (PRR)

SB confirmed that she, PB and RO had attended the Review of Paediatric Child Screening meeting with Caroline Mabbott (CM). Initially CM had some concerns regarding PRR figures; however this was clarified as a coding error. Everyone was pleased with how the scheme is working and the saving received. Some concerns were raised at the meeting, that the savings from the scheme where not as high as thought.

The recently cancelled Diabetic scheme was finance driven and concern was raised that if the PRR scheme was finance driven that it could be cancelled as well. Even though preferred by parents, rather than attending Secondary Health Care (SHC). It was stressed that PRR is cost effective. RO assured the committee that public perception, as well as cost effectiveness would have to be taken into consideration.

The group considered the feasibility of a Patient Survey questionnaire.
Action: Lynda Liddament (LLi) to investigate the possibility.

The group acknowledged that the PRR scheme has raised standards. There is another meeting with Sheffield Children’s Hospital (SCH) to discuss the involvement of Single Point Access (SPA) in the scheme and governance with children and pathway.

It is hoped that by October electronic reporting will be implemented.

There will be a full audit of the PRR scheme followed by a further meeting in October 2011 October 2011.

The group enquired if there was a possibility of handing out the list of community optometrist in the hospital clinic.
Action: DM to obtain list from Vicky and then send to PB.

2. Primary Eyecare Assessment and Referral Scheme ( PEARS )

DNA pathways were discussed, specifically the process to follow when a patient either does not attend an appointment or fails to make contact with the PEARS optometrist
. Action: PEARS Sub-committee to meet to discuss.

The group revisited discussion from previous meetings regarding processing referral via NHS mail. SW confirmed that multi practices are able to access NHS Mail. The group discussed the benefits of omitting faxes and bringing PEARS into line with other schemes. There needs to be further discussions around how to manage referrals by NHS Mail.
Action: Confirm with Lli using NHS mail.

AM & SW to have a conversation to discuss practice governance and individual and practice access to NHS mail, including administrative staff. A Caldicott Guardian needs to be appointment to ensure confidentiality of patient and service-user information
Action: Creation of practice specific NHS mail account.
Action: AM & SW to have Caldicott Guardian conversation

3. Contact Applanation Tonometry Service (CATS)

PB confirmed that letters have gone to non-cats practice, encouraging participation in the scheme. Vision express has three practices wanting to start on the scheme

Informal independent training is available for practices that would like refresher training. The group had an in-depth conversation about a specific CATS referral.

An independent practice questioned if the purchase a Goldmann tonometer was mandatory for the scheme, as he was 5 years off retirement. Would he be able to practice using a Perkins. The committee confirmed that a Perkins is acceptable. SB confirmed that due to lack of purchasing optometrists there would be problems in obtaining Goldmann tonometers at a discounted rate.

Only a few cataracts referrals are being seen in triaging. The group discussed the scoring threshold and the strength of the clinical exception explanations. If the triaging optometrist thought the explanations was reasonable then the referral can be processed at a score lower then 10 thresholds, which SPA is monitoring.

RH advised the group to keep a log of issues that are arising with SPA.

The group continued to discuss referral pathways into PEARS, agreeing that there was value in obtaining a second opinion.

AM & RO left the meeting at 9.05pm

DI left the meeting at 9.15pm

Members of the group have heard that patients have been informed that diabetic eye screening is not done by optometrists as they are not qualified to do so. The committee have informed John Soady that the wording being used is inappropriate and a change has been agreed. The committee will continue to monitor the situation.

The group discussed new College of Optometrists guidelines regarding the frequency of NHS sight tests.
Action: PB to post link of College Guidance onto website.

4. Correspondence
All correspondence is dealt with via email

Any other business

SW mentioned that the College was holding an event at the Royal Armouries, Leeds in October 2011. The committee enquired if the college would hold events locally. SW responded that there was potential for SLOC to host an event for the college on October 2012.

SW also highlighted to the group that the college do have grants for scheme audits. Thought beneficial as the college, promoting good practice, also writes up an article.

The previously mentioned the Stable Glaucoma scheme being run in south Devon has 4 different levels of glaucoma training. The information is accessible on the college website. The committee discussed the training from the PCT.

The next PEARS sub committee is scheduled for Tuesday 23rd August 2011 at HB practices at 6pm.

The committee was informed that the Royal Society for the Blind is having a Masquerade Ball on Friday 14th October 2011 at a cost of £45 per head.

Sayah Mushtaq has left Specsavers in Hillsborough and will no longer providing PRR.
Action PB to update the PRR list

Date of next meeting
Monday 26th September 2011

Meeting closed at 22:00hrs

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