National ophthalmology workstream: hospital eye services

High Level Summary Messages from the National Ophthalmology Workstream

1. Health Intelligence

Ensure collection of robust and adequate data to develop and support services.

Action - Improve data capture and use of health intelligence as a basis for ongoing and informed decision making about how best to deliver our services. To capture data on diagnosis, outcomes and waiting times for new and return patients for transparency, local use and submission to a central data warehouse to highlight and evidence opportunities for further change.

2. Capacity and Demand

Identify mechanisms to determine that service capacity is adequate to meet clinical need.

Action - Ensure equality of access for new and review patients. Engage with the Getting Ahead Programme for local and national planning of demand, capacity and flows and modelling of future changes and capacity gaps to be confident that NHSScotland has enough well-utilised capacity in the right place to continue to provide a safe, efficient and patient centred service.

3. Booking Management

Develop an administratively robust mechanism to make clinic appointments.

Action - Provide a responsive system to deliver patient appointments which are timely and clinically safe. To uniformly introduce electronic patient record and e-booking within the clinically indicated time for review.

4. Workforce & Competencies

Embed a culture of recruiting and retaining high quality staff and optimising training, skills and professional development.

Action - Identify ways to attract medical staff. Systematically review options for extended roles and competency based workforce deployment to achieve patient care and efficiency benefits. To train and up-skill non-medical eye heath care professionals ( HCPs) and to work at the top of their competencies e.g. minor ops, intra-vitreal injections, triage, assimilating clinical findings, undertaking clinics for lower risk patients.

5. Eyecare Integration Network

Strengthen the functionality of the Eyecare Integration Network to support ease of use and to enable electronic two-way dialogue between community and acute care practitioners as the norm.

Action - Upgrade the Eyecare Integration Network to allow electronic uploading and sharing of images, dialogue regarding quality and appropriateness of referrals and advice-only feedback and treatment planning.

6. Primary /Secondary Care and community Interface

Increase collaborative working across primary/secondary care and community settings. To promote professional dialogue and joint education to support more patients being seen in the community, closer to home.

Action - Develop local policies and protocols to work together to share care or discharge patients who are at low risk of vision loss, progressive disease or systemic complications.

7. Patient Experience

Use evidence to ensure that all patients receive the optimum care for their specific needs.

Action - Support the realisation of the National Clinical Strategy and Realistic Medicine to support every patient through their care by providing standardised care that is individualised for their specific needs.

8. Managing and Reducing Variation

Review the evidence to highlight opportunities and to reduce geographical variation in services, systems and processes.

Action - Identify causes for variation in practice, productivity, procurement and outcomes, recognising differences in local requirements.

9. Long Term Conditions Management

Draw up pathways and systems to ensure that patients are seen, reviewed, monitored, treated and discharged as efficiently as possible.

Action - Develop mechanisms to use the workforce wisely to care for patients with chronic conditions with pathways and flows that improve both the patient journey and safety.

10. Technology to assist efficient care

Maximise IT developments for clinical benefit.

Action - Ensure development of appropriate IT capabilities to implement virtual clinics - undertaken by non-medical staff - especially for long term conditions such as age-related macular degeneration and glaucoma for the benefit of patients.

11. Cataract / High Volume Surgical Pathways

Identify ways to optimise surgical flows for efficiency.

Action - Focus on improving systems and processes by identifying barriers to increase the volume of cataract treatments undertaken within existing ophthalmology theatres to keep patients at their local hospitals for their treatment.

12. Sustainability of service provision

Take a long term view to plan and deliver health care.

Action: Secure adequate resources to deliver sustainable service provision - equipment, personnel and accommodation. Deliver and embed approaches and services which are inclusive, robust and fit for the future.

13. Community Eyecare Review

Identify ways for all involved in eyecare to work together with particular emphasis on primary/secondary care.

Action: Maintain ongoing communication to highlight and agree a mutually beneficial way forward to implement a solution focussed programme for the benefit of all patients requiring eyecare services.

14. National Eyecare Workstream

Recognise the need for a seamless ophthalmic patient journey backed up by funding and management support.

Action: Work collaboratively with all stakeholders to harness and embed 'what good looks like' within all areas of ophthalmic care, across HES and the primary/secondary care and community interface.