Optometrists are responsible for the majority of referrals of patients for glaucoma in the UK and have the necessary skills to monitor the clinical needs of these patients once they have been diagnosed and stabilised. Working to locally agreed protocols optometrists can decide if patients can continue to be managed in the community or if they need to be seen again by the HES before the routine review. The latter is a part of most schemes. The whole approach to streamlining the care pathway should be considered from the point of view of the patients, so needs to allow this care to be delivered at a time and place convenient to them, where this does not prejudice clinical safety. In redesigning this process there should be involvement of the whole care team, which will include ophthalmologists, GPs, optometrists, management from both the primary and secondary sector, hospital clerical staff and patients. It is important for there to be common ownership of the scheme.
More than any other scheme, there will be HES determined levels of required equipment (such as Goldmann tonometry instead of NCT) and standardised methods of visual field analysis. Any new scheme should be financially viable for all parties, and it must be recognised that moving care away from the secondary sector will not necessarily in itself produce cost savings. It will allow patients to be seen in the secondary sector who are more appropriate to that service, with shorter waiting times. There is also little point in "reinventing the wheel" and so the protocols, forms etc. from existing schemes can be used, but in line with the policy of ensuring local ownership, these may need to be modified to suit local needs, circumstances and opinions.
Please click on the pdf files on the bottom of this page for an overview of glaucoma enhanced services and some examples of current schemes.
Glaucoma Services in Wales
The business plan for developing glaucoma services in Wales, which you can viewed as a pdf document at the bottom of the page is a good example of how a business plan should be prepared. It was created with the help of the AOP's Primary Care Toolkit.
The Do Once and Share Programme (DOAS)
The Do Once and Share Programme (DOAS) is a national programme designed to provide clinical input into the design, development and implementation of the Connecting for Health Programme (CfH) for IT in the NHS. It is composed of about 50 clinical topics that include glaucoma, cataract and diabetic eye disease.
The Glaucoma DOAS Project
This project started on 14th November 2005. This phase of the project has a duration of 6 months. It is a distinctly multi-disciplinary venture ensuring that all healthcare professionals involved in eye health care are represented, and that the views of patients are reflected within it.
Its objectives are to :
• Define and develop a national glaucoma care pathway template that has been approved by relevant professional bodies
• Define a core national dataset for glaucoma supporting the national glaucoma care pathway template
• To engage and consult with the wider community of practice of professionals and patients involved in glaucoma care
This clinical care pathway and core dataset will inform the development of the NHS Care Record, its presentation to the user through the Common User Interface and ultimately, its use in practice.
This is an important opportunity for healthcare professionals to engage in, and inform the Connecting for Health Programme, and taking full advantage of IT and emerging technology to improve patient care and health services. Ophthalmology has done well in getting 3 out of 50 of these projects and this is a real opportunity to keep it in the mainstream of future IT developments for the NHS. The Association of Optometrists is represented on this project’s National Steering Committee. Please take a look at the DOAS Glaucoma web-site on www.doasglaucoma.org and get involved.
Optometric Glaucoma Society
The Optometric Glaucoma Society have launced an electronic journal called OGS E-Journal. If you click on the their website, http://www.optometricglaucomasociety.org/ you will be able to find a wealth of information on glaucoma and also, how you can subscribe to this journal.
