the record so far. Helen Tilley and Mike George

Wales Eye Care InitiativeThe Record So FarHelen Tilley &Mike George

Brief historyDevolution Labour + Lib Dem coalitionLib Dem manifesto pledge– “free eye care” for allWAG couldn’t change primary legislationWECI was born

Purpose of WECIdetect eye problems insusceptible individualsenable early assessment ofacute eye problemsprovide an accessible low visionservice

Four strands of WECIWEHEPEARSLow Vision SchemeDRSSW

Wales Eye HealthExaminationPatients at risk ofdeveloping eye diseasePatients who would find theconsequences of losingtheir sight particularlydifficult

SelfSelf-referringWEHE Criteria– Uniocular patients– Profoundly deaf patients– Patients at risk of eye diseasedue to race or family historyAMDAny patient referred by his/her GP

WEHE AssessmentVisual Acuity measurementBIO (dilated pupils)ContacttonometryVisual fields assessmentSlit-lamp lamp examinationAny other procedures necessaryGP informed of outcome

PEARSAssesses patientspresenting with an acuteeye problemMaintains as manypatients as possible inprimary care

PEARS CriteriaAny patient experiencing“acute eye problems”Self-referring or referred by anotherprofessionalincluding GPs, practice nurses, pharmacistsand non-accredited optometrists

PEARS AssessmentAn appointment within 24 hoursA A needs-driven driven assessmentGP informed of outcome

Possible Outcomes of WEHE& PEARSmanagement by the optometristco-management by optometrist and GPmanagement by the GPprioritised referral for management byan ophthalmologist

Wales Low VisionSchemeAccessible service– prompt access– based in thecommunity

Wales Low Vision SchemeCriteriaAny patient failing to achieve6/12 visual acuityReferred by– optometrist– GP– ophthalmologist– social worker

Purpose of Wales Low Visiona a free assessmentSchemefree low vision aids in alocal setting with minimal wait and links to other service providers,– social services– patient support groups

Outcomes Wales Low VisionSchemePatients issued with– free low vision aids and– a Vision PassportFeedback to the referring professional

Who does what? 490 optometrists providing GOS from 392 practices 342 optometrists accredited forWEHE & PEARS (70%) from 325 practices (83%) 125 optometrists accredited forWales Low Vision Scheme (26%) From 160 practices (41%)

WEHE & PEARS evaluationAuthors– NJL Sheen– JM Wild– D Fone– CJ Phillips– JM Sparrow– JS Pointer

WEHE & PEARS evaluationStandardised record cardsfaxed or emailed to a centre in Carmarthen

WEHE & PEARS evaluation6,432 record cards were analysed– from 274 optometrists76% were PEARS24% were WEHE76%24%WEHEPEARS

WEHE & PEARS evaluationmethod289 randomly selectedpatients had a telephoneinterview within one weekThe hospital notes of 392referred patients wereavailable for assessment

WEHE & PEARS evaluation –methodOptometric management and diagnosiswere evaluated by– two optometrists conducting the evaluation; and– an optometrist and an ophthalmologistpractising in EnglandIn all cases, the ophthalmologist was thefinal arbiter.

WEHE & PEARS evaluation –results66% of patients were managed inprimary care optometry or discharged18% were referredto the HES16% were referredto their GP18%16%66%OptomHESGP

WEHE & PEARS evaluation –results75% of HES referrals were appropriate72% of diagnoses in HESreferrals were appropriate99% of patients were appropriatelymanaged by their optometrist

WEHE & PEARS evaluationresults94.8% of patients were “very satisfied”with the WEHE or PEARS service5.2% “fairly satisfied”

WEHE & PEARSlocal variation51% of HES referrals deemedinappropriate were for uncomplicated PVDa a local referral protocol in South West Walesrequires referral of such cases andif these are filtered out, accuracy of referrals tothe HES is 88%

WEHE & PEARStravel87% of patients travelled less than5 miles

WEHE & PEARS evaluation –costThe ‘net cost’ of each WEHE/PEARSexamination was £12• = (cost of WEHE/PEARS examinations) minus(savings on unnecessary HES and GPconsultations)• intangibles, including costs of outpatientprocedures (e.g. drug costs), patient transportcosts, patients’/carers’ time off work & child careexpenses, savings on GOS budget for sight testsfees not claimed, could not be considered in thecalculation

WEHE & PEARS evaluationCheapest isn’t always best:Designed for Life– “...re-cast the role of all elements of healthand social care so that the citizen will beseen and treated by high quality staff athome or locally.”

WEHE & PEARSre-assessment4 4 CD-based distance learning modules5 5 OSCE stations at 3 venues in Wales– Objective Structured Clinical Examination100% successful reaccreditation after 2attempts

AuthorsLow Vision Service– B Ryan– T Margrain– S Whiteevaluation

Low Vision ServiceevaluationFactors considered pre- and post-implementation– number of appointments– travel time– referral routes and– waiting times

Low Vision Serviceevaluation52% increase in appointments– from 5692 to 8636AppointmentsPost-implementation8636Pre-implementation56920 1000 2000 3000 4000 5000 6000 7000 8000 9000

Low Vision Serviceevaluation80% had shorter travel timesIncreased referrals from non-healthcareprofessionals– from 25% to 44%Waiting times reduced– over 70% waited less than 2 weeks

Low Vision ServiceTake home messagesimproved access– less than 2 weeks wait and– shorter journeys to the nearest service

WEHE & PEARSTake home messagesmajority of patients managed in primarycarenational protocols have been developedlow cost

The futureNew contract in Walessubject to appropriate fundingLOCSUNew enhanced servicesglaucoma referral refinementstable glaucoma monitoringcataract pre- and post-op op assessmentscomprehensive children’s eye care

TherapeuticsThe futureNHS prescribing with fee incrementPost-graduate centre for optometryClinical governanceproperly funded

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