National Eyecare Recovery and Transformation Programme Team Monthly Update

7 February 2022

SRO Update

This is our second monthly newsletter from the National Eye Care Recovery and Transformation Programme (NECRTP). We know it has been a challenging time, with the high numbers of Omicron cases combined with winter pressures, which has significantly impacted capacity for transformation teams across the country, but we continue to be impressed with the efforts that so many colleagues have made to continue to deliver and transform eyecare services. Now that the numbers are starting to fall, we can see the work getting back on track and I do want to thank you for the huge efforts you continue to make to improve eye services for your local populations you serve, despite these challenges.

There are significant changes at the top of NHSE&I, with NHSX, NHS Digital and HEE coming in and the establishment of the new Transformation Directorate led by Tim Ferris as National Director of Transformation; Mark Cubbon Chief Delivery Officer is leading the work to develop the transitional and long term structures. The integration that this will deliver will provide a higher level of coordination for transformation of care, greater flexibility in how we use improvement resources and a sharper focus on key aspects of what we are trying to achieve such as improving outcomes and experience for patients, and empowering and supporting frontline staff. We are delighted that the learning from the work we have done together in eye care has helped to inform this approach.

The new planning guidance came out on the 14th of January and can be found here (Planning guidance 22/23) with a number of key requirements of importance for the recovery of eye care, including the requirement for 10% more elective activity in 2022/23 and 30% more by 2024/25 than pre-pandemic but this is supported by £1.5 billion more capital available over three years to support new surgical hubs, increased bed capacity and equipment to help elective services recover. The guidance also asks for a reduction in outpatient follow-ups by a minimum of 25% against 2019/20 activity levels by March 2023 – we recognise that this is a challenging ask but it represents a huge opportunity to help release capacity to address the significant eye care follow up backlogs. Key to this approach will be increasing the use of PIFU and advice and guidance as well as an emphasis on expanding community diagnostic services, all of which are directly relevant to NECRTP recommendations for eye services.

We are progressing well with developing a national standard specification for NHS cataract surgery provision for both NHS and independent sector (IS) providers to improve the functioning of the cataract market and ensure no adverse effects on important issues for eye service sustainability such as surgical training. Work is progressing well on an eyecare digital service blueprint that will identify and seek consensus on the key problems that need to be addressed. Further work will follow to define how those problems should be solved, using existing capabilities where possible and sensible.

Thank you for all your continued hard work, and we welcome feedback on the format of this newsletter and what you would like to see in the content.

Recovery Update

In conjunction with stakeholders, we have developed a set of six priority areas where we believe it is possible to deliver improvements in year for your populations, without large scale commissioning change.

1. Eye Care Diagnostic and Digital Services

future.nhs.uk/NationalEyeCareHub/view?objectID=29670672

We are supporting the implementation, and spreading learning, of high flow diagnostics with virtual reporting, supplemented with any associated consultations delivered remotely rather than face to face. This can be optimised within trust settings as well as in funded diagnostic hub/centre models.

Ongoing funding for new community diagnostic centres (CDCs) is available. Phase 3 of the access to National Diagnostic Funds, aligned to Sir Mike Richards Report on Diagnostics and Recovery, is now up and running. Regional and system leads are encouraged, where eye care diagnostic capacity is required, to submit bids to Regional CDC Leads at the earliest opportunity.
The NECRTP are gathering evidence to enable sharing of the approach and lessons learnt, please do share information where you have adopted diagnostic hubs & virtual clinics.

Please get in touch to share any best practice and local experience or if you need support or advice on diagnostics and digital eye services through your NECRTP Regional Operational Implementation Lead (OIL) or Andrew.Byrne@nhs.net

2. Enabling Optometry

Guidance on how to optimise existing locally commissioned extended primary care contracts is available at link. In many areas, much more could be done in primary care simply by using better what is already in place. All systems are requested to read the guidance and implement as many actions as possible at the earliest opportunity. This also offers opportunities to lay the foundations for future service delivery through utilising the skills of primary care optometrists as First Contact Care Practitioners and for monitoring patients with long term conditions such as glaucoma.

Twelve areas from across the country have raised expressions of interest in becoming early adopters of the Optometry First comprehensive optometry service initiative supported by the NECRTP. These areas are now being assessed against agreed criteria with a view to early adopters being shortlisted by the end of January. Further details will be given once the process is completed. Please contact your OILs or Andrew.Byrne@nhs.net for more information.

3. Reducing Multiple Cataract Pre-Ops

Cataract High Volume Low Complexity (HVLC) ‘How To’ – Eye Care Hub – FutureNHS Collaboration Platform

Pre-operative cataract patients seen in a one-stop surgical provider clinics can save thousands of unnecessary appointments by doing all assessments for the operation in one visit, in line with the GIRFT /NECRTP high flow cataract pathway. We have supported development of the soon-to-be-released RCOphth/GIRFT guidance on high flow cataract surgery, covering all levels of patient complexity, and outlining steps to improve one stop pre-ops and efficiency.

We are working with exemplars to identify how they achieve the one-stop process, and with GIRFT anaesthetic colleagues to develop further resources for use at provider level such as SOPs and checklist proformas for pre-op assessments and on-the-day nursing admissions for cataract surgery. There are 2 pilots currently underway looking to reduce pre-ops and a new innovation of a Mobile App also being trialed. Further details will be shared in due course once the findings have been completed. We are still actively recruiting pilot sites to reduce multiple pre-ops, and looking for providers who do deliver one-stop preops, so if you are interested or have something to share, please contact your local OIL or mohammed.khan34@nhs.net

4. Efficient Injections

Data from the eye programme and discussion with high performing sites show some units are able, even with Covid restrictions, to deliver over the original GIRFT average of 16 intravitreal injections per injector session, and enhance their non-medical injector workforce and consistency of treatment approach. We are seeking to support other units to deliver more consistent and efficient injection services safely and optimise their non-medical injector workforce.

We will release soon an injection ‘How to Guide’ to share the learning mid Feb22. We are still seeking providers who deliver more than 16 injections per session to speak to, so please do get in touch if you are in, or know, a unit that does this. We are also seeking providers who would be keen to improve their productivity and workforce skill mix to offer a more efficient service by working closely with us.

We are also working closely with the NHS Commercial Medicines unit to seek to take advantage of the use of biosimilar drugs for injections which will be available this year, looking at the possibility of reinvesting savings to improve injection services, increase capacity and support wider eye care improvements. If you are interested in increasing efficiency of your intravitreal injection service or have high efficiency to share, then please contact mohammed.khan34@nhs.net

5. Recommendation to Discharge Routine Cataracts Post-Operatively

Work continues encouraging the adoption of the joint Colleges’ clinical recommendations to discharge routine cataracts post operatively to release necessary outpatient capacity. The intent is to release an additional 50,000 outpatient appointments in year across regions, especially where there are no community commissioned pathways in place. You are encouraged to continue with local discussions to adopt and implement this revised pathway and a reminder to update your regional teams and OILs of your alternative plan to contribute to elective care recovery where this has not been adopted.

There is still an opportunity to submit a Fund request form – 2021-2022 from the allocated £1.4M, supporting in year activity of discharges and this also applies for any cataract flow initiatives. The guidance on how to implement this which includes FQAs, case studies, patient communications and other useful tools can be found here. Please contact Bernard.Johnson3@nhs.net

6. Reduction of Over-Frequent or Unnecessary Follow Ups

To free up capacity for delayed patients – an additional 30,000 outpatient appointments in year – it is important that there is use of robust, consistent, risk-based follow-up timing, introduction of the use of patient initiated follow up (PIFU) and appropriate discharge decisions with consultant input. The national team are supporting systems and providers around the country with development of local PIFU criteria and have been supporting local workshops to develop and implement this into their eye services.

The national team are pulling together guidance on how to approach this for systems and providers. We are keen to hear from providers who have discharge policies with eye content or any risk-based or triage follow up guidance and please do get in touch if you have anything like this in place. We are also looking for systems or providers who would like to work more closely with the national team to get this in place, again please do contact us if you would like to explore this via Bernard.Johnson3@nhs.net

Commissioning and Data Update

We are moving the NECRTP commissioning and data workstream forward in a number of areas:

The Commissioning Forum will take place on 25/01/22 to address the need for commissioners to collaborate and be sighted on the progress of the comprehensive optometry model. On 15/02/22 there will be a focus on “Data Building Blocks” with speakers from NHSD, the Leeds Teaching Hospital Trust (LTHT) pilot to talk about sub-specialty coding and SNOMED.

National Standard Cataract Specification There is an ongoing review into the functioning of the cataract market and the development of a national standard specification for cataracts. The aim of this is to reduce some of the issues that are arising in the way that the market for cataracts is operating. Work continues apace to deliver a national standard cataract contract service specification with accompanying guidance.

Subspecialty Coding LTHT has partnered with the national programme to implement proposed sub-specialty coding agreed on with the NHSD case-mix team and lead ophthalmic clinicians. LTHT is due to provide the piloted coding output to the national team for analysis by mid to late February.

Other trusts with ophthalmic departments are being encouraged to join the sub-specialty pilot. Communications have been placed on the Eye Care Futures Hub, through the Royal College Bulletin, via the UKOA and through our regional contacts coordinated by the OILs.

Once a firm evidence base data has been gathered through LTHT and other pilot trusts to demonstrate our assumptions of having this additional data layer in place will give greater insight into service delivery, we can share with the Royal College and move to advice on mandatory use across England.

ECAD (Earliest Clinically Appropriate Date) Coding Adoption Work continues to communicate via the regional teams through our OILs the need to meet the mandatory requirement to use ECAD (soon to be LCAD Latest Clinically Appropriate Date). Calderdale and Huddersfield Foundation Trust (CHFT) are currently working on the change with their PAS system to evidence their approach which can be shared wider. Currently exploring if this change can be made by communicating directly with PAS suppliers through our lead contacts in NHSD.

Data Developments Several data products have been developed. The intention is to expand the amount of information available through the PIP (pathways improvement programme) dashboard or the Model Health System (MHS). The team have been working on several pieces of analysis for cataract pathways and are now moving onto AMD. This includes: Workbook: Pathways Improvement Programme (england.nhs.uk), View Ophthalmology – Model Health System

Recently completed analysis on the number of intravitreal injections in inpatient and outpatient settings. This is the first of several pieces of analysis to support the AMD pathway.
The volume of cataract procedures by NHS and IS providers is due to go live on the MHS
The volume of pre-operative outpatient attended for cataracts by provider. This is due to go live on the MHS. We are refining the methodology for measuring post-operative outpatient attendances.
We have analysed the expected waiting lists for cataracts nationally, regionally and at system level. We are planning to launch this on the PIP dashboard over the next few weeks and it will be regularly updated.
We expect to have completed analysis on eyecare and inequality and eyecare by the end of February. This is an experimental piece of work and is likely to expand over time.

The collection of data to support the GIRFT eyecare metrics has begun. A compartment is being developed on the MHS to support the sector to monitor their performance against the GIRFT recommendations. This is expected to go live in mid-February. There will be quarterly data collections to support this initiative.

Workforce Update

An Eye Care workforce focus group is meeting for first time on the 11th February at 11:30. This will be an opportunity to share learning and to inform national guidance and tools.

A Medical Retina workshop will be held on the 24th February at 18:00 to showcase Eye Care Workforce programme initiatives underway to help deliver an optimal service.

ICS clinical and operational leads are encouraged to join these workshops and can book a space by contacting us on nhsi.eyecare-transformation@nhs.net

Digital Eye Care Transformation Update

EeRS

Additional funding has been agreed in principle to sustain the existing EeRS footprint into 2022/23 under a way of working agreement. Detail will follow in February 2022.

Digital Hubs

We have successfully brought together a number of related digital eyecare strands and have endorsed and aligned ways of working
We have a business / product SRO model, building on existing products if they can help serve an eyecare need.
We have submitted a bid to initiate and grow a digital eyecare transformation programme from 22/23 and are designing what that looks like including key roles and governance

The service blueprint work is well underway and increasingly socialised.

Eye Care Hub – New Resources

New Hydroxychloroquine Monitoring ‘How To’ Guide now on the Hub We are really pleased to announce that the Hydroxychloroquine Monitoring ‘How To’ Guide can now be accessed on the Eye Care Hub along with relevant case studies and useful resources. This is for providers wishing to set up a service for eligible patients on hydroxychloroquine to monitor them for retinal toxicity.

Signpost to the 6 priority areas documents

NECRTP Events

Upcoming Webinars

How Outpatient Efficiencies Can Help Improve Recovery of Eye Care Services
Subject: Outpatient Efficiencies. Date: 28/01/22. Link

Medical Retina (title tbc)
Subject: Medical Retina (GIRFT). Date: Jan (TBC)

Urgent Eye Care
Subject: UEC (Recovery). Date: Feb (TBC)

Past Webinars

Cataract Recovery
Subject: Cataracts. Date: 13/07/21. Link

Governance in Eye Care
Subject: Governance. Date: 13/09/21. Link

GIRFT HVLC and Glaucoma Pathway
Subject: Glaucoma (GIRFT). Date: 28/09/21. Link

Overcoming Commissioning Challenges in Eye Care
Subject: Commissioning (Enablers). Date: 19/10/21. Link

How to Build an Optometry First Service
Subject: Optometry (Recovery). Date 1/11/21. Link

High Flow Virtual Clinics and Diagnostic Hubs in Eye Care
Subject: Virtual Clinics and Digital Hubs (Recovery). Date: 02/12/21. Link

Workshops

PIFU Workshop
Subject: PIFU. Date: 19/11/21

Workforce Planning
Subject: Workforce. Date: 29/11/21

Cataract workshop for NE
Subject: Cataract NE (HVLC). Date: 06/12/21

Contact the National Eye Care Recovery and Transformation Programme Team at nhsi.eyecare-transformation@nhs.net

Join the Eye Care Hub on NHS Futures – future.nhs.uk/NationalEyeCareHub/grouphome