Transcript How to refer?

Intermediate Care
Ophthalmology Service
Debbie Raven, COO
Dr Lyn Jenkins, Clinical Director
West Hertfordshire
1st October 2008
The Practice - company overview
• Founded in 2005 by two NHS clinicians , headquartered in Gt.
Missenden, Bucks and employs 100+
• Delivers innovative community based healthcare for the NHS
straddling primary and secondary care
• Pioneered provision of Intermediate care ophthalmology
services and now the UK’s leading provider.
• Provides ophthalmology services for Bucks, E & W Berks, W
Herts, Kingston, Wiltshire and shortly Harrow
• Also other specialist clinical services for GPs, the MOD and
PCTs - Dermatology, Sexual Health, Urgent Care and
Admission avoidance, and Secure Health
• Operates a network of GP surgeries
Ophthalmic Intermediate Care
• Why refer
• How to refer
• What to refer
Service background
• Set up by Dr Lyn Jenkins
− GP
− 30yrs in ophthalmic primary care
− 23yrs providing retinopathy treatment
• Commissioned in Bucks for 8+ yrs
• Became part of The Practice in 2006
• Now covers 4 counties & 2 London boroughs
• Employ 12 ophthalmologists, 4 optometrists, 1
GPwSi, 1 orthoptist, 10 ‘back office’
• Experience shows 60-70% cases managed in
primary care, 10% referred to HES
Assured service delivery
• All clinicians specifically trained in the delivery of
Ophthalmic Primary Care
• Triaged same day
• Waiting times max 4 weeks
• Integrated IT system
• Comprehensive data reporting meets 18 wk
pathway
Patient benefits
• Waiting times less than four weeks
• Accessible, community based clinics
• Choice of local clinics
• Excellent patient feedback
• All patients seen by experienced staff
• Service sensitive to patient needs
Patient satisfaction results
Aug 2008
• 99% patients reported no problems with making an
appointment
• 90% patients were seen on time
• 96% patients felt they had enough time with a
clinician and their case was discussed adequately
with them
• 72% rated the clinic environment as excellent; 24%
as good
West Herts appointments
200
180
160
1st
140
1st Glaucoma
120
Follow up
100
Follow up VF
80
Follow up Glaucoma
60
Minor Op
40
Retinal Bio
20
0
Jan
Feb
Mar
April
May
June
July
August
W Herts referrals May-Aug 08
180
160
140
120
100
Hertsmere
80
StahCom
60
DacCom
40
20
0
May
Jun
July
Aug
HES referrals Jan – Aug 2008
250
200
150
Retained
Triaged to HES
100
50
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Referral time
Time between referral and first appointment
1-5 days
5-10 days
10-15 days
15-20 days
Where?
Hertsmere PBC
StahCom
Potters Bar
 Community Hospital
St Albans
 Midway Surgery
 Highfield Surgery
 Parkbury Surgery
 Hertfordshire Clinic
Elstree & Bushey Heath
 Schopwick Surgery
Borehamwood
 The Grove
Radlett
 Red House
London Colney
 45 Kings Road
Harpenden
 Memorial Hospital
DacCom
WatCom
Tring
 Rothschild House
Surgery
Watford
 tbc
How to refer?
• GPs/Optoms refer directly to:
The Practice Ophthalmology Service
− Fax 01494 473169
− Post to The Practice Ophthalmology Service, Lynton
House, 43 London Road, High Wycombe, Bucks HP11 1BP
− email to: [email protected]
• Triage same day
• Appointment
Or
• Onward referred to HES via Choose and Book
• Letter to GP within 10 working days
NOTE WATCOM: No direct referrals from
Optoms but via GP
Presenting complaint – what we see
• Flashing lights/floaters
25%
• Glaucoma
20%
• Blurred vision
17%
• Red eye
10%
• Dry eye/pain
7%
• Lid lesion
5%
• CL
3%
• Other – mac/conj/cat
13%
What to refer? (glaucoma type)
What to refer? (refer to full list in leaflet)
• Red eye
• Discomfort
• Visual disturbance
• Watering
What not to refer?
• Minor red eye conditions
manage by GP in primary care
What not to refer?
• Emergencies (<48 hrs)
Send to A&E
• In patient surgery or laser
• Cataract surgery
• Under 16s
Refer to HES
What not to refer?
• Diabetic retinopathy
• Retinal detachment
• Macular degeneration (with
recent visual symptoms)
• Contact lens keratitis
Information from referrer
• Presenting complaint
• Past ocular history (squint, eye operations,
trauma, contact lenses etc)
• Past medical history including drugs
• Abnormal findings
• GOS 18 when available, fully completed
Thank you on behalf of
The Practice