National Eye Care Recovery and Transformation Programme February 2022 Monthly Update

3 March 2022

SRO Update

Welcome to this month’s newsletter from the National Eye Care Recovery and Transformation Programme (NECRTP). We are delighted to see how, as the pressures from the recent pandemic surge are declining, colleagues across England have refocused efforts within their eye care improvement work. It has been a pleasure to continue to support you and learn from you.

The NECRTP team are actively involved in consultation processes to help bring colleagues across NHSE& I, NHSX, NHS Digital and HEE together and use our experience, and your feedback, over the last year to help inform how the new Transformation Directorate will operate. Although it is hoped that this will result in a better ability to innovate and bring digitally enabled healthcare to the fore, there are several uncertainties to work through in this complex situation which means that we have an interim plan to inform how the eye care programme will go forward in the next financial year. We are very pleased to be able to continue for at least the next 6 months but, in line with the strategic direction, will need to streamline the specialty specific resource so that more specialties can benefit from the end-to-end pathways approach eye care has been using and the transformation work can be more responsive to need. We are currently focused on bringing some aspects of this year’s work to a position in which it can be handed over to regional colleagues for local implementation and on developing a realistic plan for next year and hope to share these plans with you soon.

We have recently released a number of new guidance documents and related resources supporting our 6 in-year eye care improvement priorities, which are detailed below, and there are several webinars and events coming up to support these and related eye care pathways. There has been increasing interest and an active and passionate debate over how best to implement improvements in the way the independent sector contributes to cataract surgery. Eye care is at the forefront of this significant change in surgical provision and the NECRTP wishes to work with all stakeholders to manage this in a way which protects against any risk to the wider comprehensive eye care service including care for long term sight threatening conditions such as glaucoma and retinal disease. Upcoming conversations with many ophthalmic professionals, with support and involvement of the Royal College of Ophthalmologists, will help to move this debate forward and we hope the learning from the experience in ophthalmology can help not only eye care but also other surgical specialties where a similar change is beginning or likely. At the same time, we will continue to send the message that ophthalmology is about much more than cataract surgery and champion at-scale transformation which will protect patients from avoidable loss of sight from delayed outpatients.

Thank you once again for all your significant efforts to improve and transform eye care and sharing the learning as you proceed. As always, 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

A workshop looking at diagnostic services has been put in place for 16 March 2022. We will be seeking clinicians’ views system-wide on what the art of the possible is for data capture in both Hubs and utilising existing resources in Primary Care.

Meanwhile, a data-gathering exercise is taking place to evidence the benefits realised from the adoption of diagnostic hubs for eye care. The NECRTP is looking to compile all the returns and produce a report evidencing the benefits of both data capture sources. The information will be distributed to all eye care stakeholders across the NHS and published on the eye care hub. The evidence will also help us target possible case studies and provide benchmarking information for those providers looking to optimise their services. In addition to this, we will use the data as evidence in future business cases seeking funding to implement diagnostic facilities.

2. Enabling Optometry

Primary eye care is well placed to provide a coordinated and comprehensive service as part of a broader eye care delivery system, reducing pressure on hospital eye services for the benefit of patients and the wider NHS. Most commissioning bodies in England already commission services that utilise the skills of primary care practitioners, that provide services beyond the sight testing service to support, manage and prioritise eye care patients. Recently published Guidance makes recommendations to optimise existing local arrangements through improved care navigation, referral triage and redirection, signposting and discharge into the locally commissioned services already in place, to deliver immediate system benefit that will deliver both in-year and future sustained recovery.

Sixteen areas from across England expressed an interest in becoming early adopters of Optometry First, a comprehensive and innovative new care model supported by the NECRTP.

Three placed based early adopters of Optometry First have now been selected, they are:

• Bassetlaw
• Sefton
• Isle of Wight

The NECRTP are at late stages of discussion with a small number of systems with view to announcing at least one system-wide early adopter in the coming weeks. We will continue to engage with all regions and systems who expressed an interest whilst working intensively with the early adopters to co-develop the service blueprint for implementation in 2023.

3. Reducing multiple cataract pre-ops

Pre-operative cataract patients can have all their assessments undertake in a one-stop surgical provider clinic, rather than multiple pre-op attendances, saving thousands of unnecessary appointments. The new RCOphth/GIRFT guidance on using high flow principles for all levels of cataract case complexity is now published and includes details how to establish and improve one stop pre-ops and efficiency. We have met with a number of exemplars to identify how they achieve the one-stop process, with case studies in development in collaboration with GIRFT to be shared on the NECRTP Eye Care Hub over the next month. We are also working with GIRFT on further resources, including a lean pre-op and day of surgery assessment proforma for cataract and a frequently asked questions guidance on how to manage key things before and on the day of local anesthetic cataract surgery including medical aspects such as blood pressure and epilepsy, MRSA and VTE assessments. We would encourage each region to push forward with plans to bring providers in line with one-stop cataract clinics as soon as possible. If you are interested in learning more about how to implement this locally or have good practice to share, please contact your local OIL or mohammed.khan34@nhs.net

4. Efficient injections

Some high performing sites 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 and we wish to support other units to deliver more efficiently. Our new “How to guide” for efficient injections Efficient Intravitreal Injections: How to guide is available on the eye care hub. We are now visiting exemplar sites to do a deep dive and undertake process mapping to understand and share exactly how they achieve their great results. We welcome trusts to get in touch where they are interested in seeking our support to improving productivity of their injection clinics, for further details 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 NECRTP operational improvement leads 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.

For more details or to explore how you can work with primary eye care to avoid unnecessary routine postop cataract visits to hospital, please contact Bernard.Johnson3@nhs.net

6. Reduction of over-frequent or unnecessary follow ups

In support of elective care recovery and to reduce harm and sight loss for delayed outpatients, we need to urgently release as much ophthalmology outpatient capacity as possible to use for the most clinically urgent patients. The NECRTP has developed new guidance to support eye care pathways to do this through:

· Increased discharges
· Reduction of the frequency of follow-ups
· Reduction of unnecessary follow-ups
· Increased utilization of patient initiated follow-up (PIFU)

The guidance is an enabler for improved performance in these areas and signposts to good practice and tools providing clarity of necessary steps to be taken. There are samples of useful templates, modelling for optimising opportunities, SOPs and an audit tool to allow consultants and senior clinicians to assess performance on decisions of the whole team around this. The national team is keen to support some systems and providers to support their improving discharge and follow up processes to release capacity. We are also finalizing a practical resource for the whole team as to which conditions are suitable for discharge, PIFU and follow up, and what the timing of these should be, which we will share soon.

If you are working on this aspect of eye care now, have good practice to share, or would like support from the national team, please do contact us via Bernard.Johnson3@nhs.net

Commissioning and data update

Log in to access new GIRFT ophthalmology metrics on Model Health System

As the NHS works to restore activity to better than pre-COVID levels, GIRFT has worked with the National Eye Care Recovery and Transformation Programme (NECRTP) to gather data via a nationwide questionnaire for a set of national ophthalmology ‘gateway’ metrics – metrics which can be used by trusts and health systems to measure performance and benchmark against top performance.

The responses have resulted in data now published at trust level on the Model Health System (17th February 2022). System-level data is also available, and both can be accessed via model.nhs.uk

Trusts and systems can now use the metrics to benchmark their performance against their peers in areas which can support their recovery process – for example, comparing the percentage of new glaucoma patients undergoing referral filtering before attending hospital.

Going forwards, the data will be collected and refreshed quarterly. This will effectively give users the insight and ability to highlight changes in clinical pathways and identify trends of improvement over time.

Lydia Chang and Alison Davis, the GIRFT clinical leads for ophthalmology, and Melanie Hingorani said: “We look forward to being able to share best practice across the country.

“By enabling greater visibility and easier identification of unwarranted clinical variation, individual providers and systems will be able to identify the opportunities to improve patient access and care and ultimately, clinical outcomes.

“We are grateful for everyone’s involvement to date.”

SNOMED/Subspecialty Coding

The most recent commissioning forum successfully explored the potential around SNOMED coding and the benefits to data collection were this dataset to become mandatory for eye care services. Leeds updated the forum on where they were making with regards to piloting subspecialty coding in their area, and the challenges they’ve faced to date. As they are at early stages with this, an update on the progress and any emerging benefits the region is seeing by adopting this approach to data collection. This work will be bought to the commissioning forum in May as a focused subject.

ECAD/LCAD

Next steps with the ECAD/LCAD workstream are to escalate PAS issue nationally, thereby identifying any keys individual that may have the leverage with PAS suppliers to implement change to CDS reporting. Work us also underway to reach out to regions to support trusts with collection and submission of relevant data. Work needs to begin with individual trusts to identify case study sites to demonstrate collection process, benefit and use of data, and a longer-term mandate submission process, in effect utilising revision to CDS.

Enablers Steering Group

The upcoming Enablers Steering group will be focused on commissioning, with an update on the Independent Sector Cataract workstream as well as next steps in implementing Optometry First.

Workforce Update

The National Eye Care Recovery & Transformation Programme would like to invite you to attend a National Medical Retina Workforce Workshop on Wednesday, 23rd March, 17:30 – 19:00

Please book your place by contacting the team: nhsi.eyecare-transformation@nhs.net

Digital Eye Care Transformation Update

Service future state work – We have completed the first phase of our service blueprint work, creating a clear picture of problems with eyecare, focusing on 3 specific pathways as examples: Amblyopia, Ocular oncology, and Wet AMD. We conducted 20 1:1 stakeholder interviews, and several workshops to validate the insights and observations we had heard. We now have

– An eyecare system map, which explores the relationships between different organisations and eyecare sectors

– Three pathway maps highlighting challenges and some improvement opportunities identified

– A set of ~45 problem statements that affect eyecare, spanning Data, Transformation, Technology, Workforce, Commissioning, Patients, and Clinical areas. We are still working on honing those down to fewer root cause problems which we can start to tackle over the next financial year.

The second phase of work is due to start at the end of February, and will look at creating a to-be service blueprint of how we believe eyecare services could be delivered in the future, to give us a common vision of what we are aiming for. This will focus on one ICS to start with, to form a starting view of what capabilities need to be delivered nationally, regionally, locally, in order to allow systems and providers to deliver genuinely transformed eyecare services. From that picture created from one ICS, we will be able to share and challenge more widely beyond April, to iterate that initial view of one ICS to encompass more views and ensure any final artefacts represent thinking across the regions.

EERS – Ways of working documents that describe and agree regional commitments for EERS in 22/23 have been agreed with the 5 regions that expressed interest in funding.

Eye Care Hub – New Resources

Documents

Efficient Intravitreal Injections: How to guide

Guidance for Optimizing Primary Care Optometry Services Care Optometry Services. Version 1.3

Guidance to Reduce Frequent and Unnecessary Follow-ups V1

Case Studies

National Eye Care Recovery Case Study_Single point of access SPoA – Final Draft

National Eye Care Recovery-Case Study-Sheffield bilateral cataract surgery.pdf (360 KB)

NECRTP Events

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

Upcoming Webinars

Urgent Eye Care
Subject: UEC (Recovery). Date: 28/02/22. Link

Cataract Contract Specification and Supporting Guidance
Subject: Cataract. Date: 02/03/22. Link

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: 11/11/21. Link

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

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

Upcoming Workshops

Monitoring & Measuring Optometry Contracts and Development of Key Outcome Measures (Part 1)
Subject: Enabling Optometry. Date: 01/03/22

Monitoring & Measuring Optometry Contracts and Development of Key Outcome Measures (Part 2)
Subject: Enabling Optometry. Date: 08/03/22

Developing Diagnostic Services & Ensuring Spread and Adoption
Subject: Diagnostic Services. Date: 16/03/22

Medical Retina Workshop
Subject: Medical Retina. Date: 23/03/22

Past 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