Enhanced Optometric Services

The demand for eye care is set to increase as the population ages. The current emphasis on targets for cataract surgery and first appointment waiting times is creating pressure on follow-up treatments for chronic sight threatening conditions like glaucoma. In addition, the new treatments for wet age related maculopathy will further increase pressure on clinical space in secondary care.

  

Optometry has the capacity and the skills to deliver quality eye care in the community which will help address the current demand for eye care services.

  

LOCSU has produced guidance to help LOCs/ROCs to deliver eye care pathways  for cataract, glaucoma and red eye i.e. non-sight threatening eye conditions. These pathways aim to provide:

  • equity
  • consistency
  • continuity of care
  • care close to the patients' and carers' homes
  • well-equipped practices
  • care delivered by a competent, efficient, professional workforce that is trained to a high standard
  • a service that is cost effective, efficient and safe

  

National targets to reduce waiting times for a first appointment to see an ophthalmologist have largely been achieved across the whole of England, as have the challenging targets around cataract surgery.

  

However, the price being paid within busy hospital departments is that chronic care of sight threatening conditions such as primary open angle glaucoma (POAG) is being compromised. Follow-up appointments are subject to cancellations and delays which in some cases results in sight loss which could have been prevented.

  

In addition to this, the introduction of new treatments for wet age related maculopathy (AMD) is putting greater pressures on already overstretched secondary care resources. The demographics of an ageing population will exacerbate these problems.

  

LOCSU has produced enhanced care pathways that are designed to address these problems by reducing demand in secondary care and retaining patients in primary care.

  

Patients will be able to access timely high quality service and advice, close to home and in familiar surroundings with professionals they know and trust from a wide geographic spread of practices.

  

Commissioners can have confidence that the residents in their area are receiving appropriate, cost-effective and timely eye care and that secondary services will be more efficient and effective as a result.

  

Participating optometrists will have the chance to use their skills appropriately and develop their role as part of a primary care team, as well helping to meet targets on the reduction of referrals to secondary care.

  

Enhanced services not only improve the delivery of high quality patient care, but they also encourage and facilitate the development of genuine partnerships between primary and secondary care. This increases access to eye care services whilst maintaining high standards.

  

LOCSU can help LOCs to develop business cases for enhanced services, working with local commissioners while the  service is established and thereafter, as required, to assist in  its successful implementation.

  

Please contact LOCSU  if you want detailed information on the care pathways and the expert, personalised  service we can offer LOCs/ROCs.

NHS Primary Care Commissioning (PCC) Model Enhanced Services Contracts

  

In response to requests from subscriber PCTs, PCC published a model eye care enhanced services contract in February 2010.

  

The contract comes in three variants for:

  • Individual practitioners
  • Partnerships
  • Corporate bodies and limited companies

  

Unlike the model mandatory and additional services (GOS) contracts published in 2008, use of the model enhanced services contract is entirely voluntary on the part of the PCT but Primary Care Contracting points out that using the model contracts may well save PCTs the cost of developing local contracts on an individual basis.

  

PCTs are free to use the contract as it stands or to modify it in any way that the PCT sees fit. PCTs are also free either to keep their existing contracts for enhanced services in their current format or to migrate them to the new model version.

  

PCC points out that some of the numbering of the clauses may seem at first sight to be a little bit eccentric but they have tried as far as possible to keep the clause numbering consistent across all three variants of the enhanced services contract and also consistent with the numbering of clauses, with similar effect, in the model mandatory and additional services contracts.  

  

PCTs will need to add to the model contract their own schedule 3 which should be locally negotiated and specific to the service type which is being commissioned.   PCC has produced a sample schedule 3 from NHS Somerset, based on their ACES (Acute Community Eyecare Service) scheme.   NHS Somerset has also used the optical bodies' document  Quality in Optometry and the Department of Health's document Standards for Better Health, for reference.

  

The model contracts are available to PCTs in the restricted area of the PCC website: http://www.pcc.nhs.uk/enhanced-services-contract but if LOCs want copies, they can contact  Katrina Venerus directly.