Associate Site: Brighton

Low Vision Services Pilot

Currently we are implementing a new ARMD Pathway, an essential component of which is the provision of LVA Services within a community based setting. We would like to develop this 'cinderella' service and put it in a robust and patient orientated framework.

Our vision for an LVA service is to jointly deliver a service with Social Service's ROVI input. Within our pathway a dispensing optician and ROVI will be co-located.

However we need more target resources to role this out and to strengthen this service by being able to:

The resources allocated through the ARMD project do not allow us to employ an additional ROVI or provide a more comprehensive service. The plan is to re-site the current hospital based Low Vision Clinic to a permanent, specially adapted community based setting in partnership with Social Services and the Voluntary Sector.

By having a more suitably adapted clinic we will be able to offer a more comprehensive stock of LVAs, offer a loan service and rehabilitation service which would comprise of a fully equipped kitchen and demonstration room. This would provide significant added value to the current hospital based service (which does not have the physical capacity to hold a stock of LVA’s), and the proposed ADL Centre clinic.

The re-sited Low Vision Clinic would be a one-stop service based on the model at RNIB Judd Street, where patients will not just be assessed by an optician for their LVA, but also be seen by a ROVI who will jointly assess the patient needs and be able to prioritise domiciliary assessments. The patient will have the opportunity to take away ADL aids as well as a magnifier.

This is delivered in a community based setting for ease of access and will give prompt advice and counselling which will maintain and promote independent living. The location of this facility has extremely good access with disabled parking. It would also be able to provide a loan service for more expensive aids for LVAs.

Within our current ARMD Pathway, the patient access to both hospital based treatment for Wet ARMD and for Dry ARMD (through a Low Vision Co-ordinator), to community based LVA service is via their optometrist. This augments the current hospital based LVA service which has a six week waiting list.

Within the pathway the diagnositic episode of the pathway takes place at the community based optometrists. For those patients who have a Dry ARMD and who therefore do not require a hospital based assessment, the referral route will be into a LVA assessment clinic in which a ROVI and Dispensing Optician will be co-located. Differential diagnosis by Optometrists allows a Dispensing Optician to be able to rapidly assess the low vision needs of the patient as they would already have accurate refractive performed by their community optometrist.

A successful bid will enable us to extend our work on this new pathway and offer this service to wider patients with other eye pathologies. The model for the current pathway is to offer a more immediate service so that the patient experiences no delay in the dispensing of their aid. This entails maintaining a supply of popular aids on the premises, which can be immediately demonstrated to the patients and a further assessment to ascertain the suitability of the aid given.

Patients should have the opportunity to try out more expensive aids based on a loans scheme, which within our current new ARMD pathway, would be difficult to achieve.

The patient currently experiences a patchy service in which they encounter delays in the ordering of their equipment, the suitability of which is not consistently assessed due to a lack of counselling and follow-up. In addition, patients have a limited choice where they can access the service. Within our plans, they will have the opportunity to access the "one-stop" LVA service in a community location which has a fully set-up activity of a daily living centre. The benefit of offering this in an additional location will allow us to increase access across the city.

Joint delivery of this service between Social Services and Community based practitioners places the emphasis on offering a service which addresses all the patient’s sensory impairment needs, rather than focusing on low vision aids.

This promotes collaborative whole systems working within an integrated patient centre pathway, which provides rapid access into a dedicated community based one stop clinic.

The robustness of the community based diagnosis/triage is reinforced by a rigorous clinical governance framework, which allows for re-assess into specialist optometrists services, as well as hospital based consultant clinics should the dispensing optician have any queries about patient's condition. A successful bid would enable greater patient choice in where they may choose to receive this service.

Brighton & Hove PCT would like to be able to offer patients who have macular pathologies a rapid, locally based service across a number of strategically located sites, which meets their immediate and long term low vision and social needs. The delivery of these services would be based on a multi-disciplinary approach which is based on some agreed core standards of care and delivery. The model pathway should include self-referral for follow-up and access to a loans service.

We are fortunate in that we are already planning to offer a limited Low Vision Service within one location in the community. Historically, patients have only been able to access Low Vision Services in a hospital based setting. The new pathway, however, does not allow us to test out more than one site and has not allowed an increase in ROVI provision. We plan to use current project management structures and personnel.

It will extend the transfer of work from secondary to primary care that is currently going on with a direct optometrist referral and follow-up pathway for cataracts and the above mentioned ARMD pathway. We are therefore in a fortunate position of having engaged local optometrists in these two pathways. GPs will be used for referring to optometrist and not straight into the hospital.
The experience of working with Social Services to deliver the low vision part of the pathway has already tested partnership working,

There is tremendous enthusiasm for making this project sustainable in the long term.

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