Merton, Sutton & Wandsworth: Low Vision Pilot
Aim of your project
To develop integrated and accessible eye-care services, making the best use of the available personnel from across agencies, in order to enable independence to be maintained for vulnerable (mainly elderly) people by building on the work already undertaken locally to implement new low vision services pathways. This incorporates the development of a community based service, extending the role of community optometrists and Dispensing Opticians (DOs), providing a joined up multi disciplinary service, using IT to improve communications and enable the development of the electronic patient record, electronic booking and choice at the point of referral.
What organisations will be involved in and supporting this application? Why do you believe they are crucial to your proposal?
There are two key groups that have been involved in the development of this bid: SW London Ophthalmology Network and Merton, Sutton & Wandsworth Low Vision Services Committee.
Merton, Sutton & Wandsworth Low Vision Services Committee (MSW LVS Committee) is a multi-disciplinary group and includes representation from hospital eye departments (ophthalmologists, nurses, DOs, orthoptists, managers); community optometrists (LOC and SMPCT Optometric Advisor); social services (managers and re-hab workers); a hospital link worker; the voluntary associations; former CHC; and the PCT. Several of the past/present members of the group are blind/partially sighted.
The support of local partners in this bid is key to ensuring that each agency and profession within the service plays their part in improving services and working towards our vision for Low Vision Services. Multi agency support is necessary due to the nature of service where improving communications can provide a co-ordinated patient centred service.
We have also worked closely with the Strategic Health Authority and the SW London Ophthalmology Network. The Network comprises both clinicians and managers from hospitals and primary care across the sector. This linkage is key to ensuring both primary and secondary care are aware of and signed up to the changes proposed and will ensure that the project has the appropriate strategic links across the sector and enable a wider dissemination of good practice.
At their meeting on 11th December 2003, the SW London Ophthalmology Network confirmed that the development of Low Vision Services was one of the key areas for modernisation and that they supported the submission of this bid to help to provide this service.
Objectives of the project - why do you want to be a Pilot Scheme?
MSW LVS Committee completed a mapping exercise, identifying gaps in current service provision and from this developed patient pathways on how an integrated service should operate. Sutton & Merton already funds a pilot community low vision service and lessons have been learnt from this. Being a pilot site would enable the lessons learnt from the small scale pilot to be put into effect and test the effectiveness of the proposed patient pathways and communications links to support the delivery of the baseline standards for Low Vision Services.
Similar arrangements will be made to co-ordinate the implementation of the project in Wandsworth PCT, building on the learning achieved so far. The good practice gained from this pilot can easily be shared across the sector through the Ophthalmology Network.
Through the LVS Committee and SW London Ophthalmology Network there are good working relationships and a will to improve services. This is an ideal opportunity to harness this enthusiasm to further develop services. Introducing IT into Optometric practices will also support the delivery of other key modernisation projects including electronic booking and choice.
Where to you want to be in 2 years' time? Describe your vision for delivery of Chronic Eye Disease Services
Our vision for the delivery of chronic eye disease services is to:
- Streamline services for all those with visual impairment.
- Have swift access to services, with agreement about times within which appointments will be offered.
- Provide services in a choice of locations convenient for service users.
- Be sensitive to the views of the service users.
- Make best use of personnel in their respective roles.
- Have access to appropriate information and advice about the services and equipment available (including equipment supplied for loan, and that could be privately purchased) for both health professionals and service users.
- Have good communications between agencies and professionals across the pathway.
- Avoid duplication of appointments, and provision of similar aids by different service providers.
- Have in place a re-cycling scheme for low vision aids no longer required by service users.
- Review patients by way of an annual recall system.
- Regularly review services, and where appropriate, adapt them in line with emerging evidence of successful service delivery and changes in legislation affecting the health professions.
- Provide a clinical governance framework for service providers, and support to enable them to provide ongoing improving services.
- Share learning from this project and others to improve the delivery of other services including chronic eye conditions, both locally and nationally.
Scope and focus of the project - what aspects of Chronic Eye Care services do you want to develop? What new ideas do you want to test?
The focus of the project is on:
- Extending the role of Optometrists and DOs in the provision of Low Vision Services from community practices.
- The use of IT to improve: Communications between the agencies; Access to information about services for both health professional and service users; Enable implementation of Electronic Booking and Choice.
- The use of shared records so that each agency is aware of the patients’ main aims and problems, including visual status, LVAs supplied, and appointment schedule.
- Developing an information resource centre.
Within this, we want to test:
- Impact of introducing Community Optometrists and DOs in the provision of low vision services on improving access (both in terms of waiting times and with respect to numbers accessing the service).
- Impact of introducing IT and internet access into Optometric Practices to facilitate accurate speedy transfer of information to other agencies involved in the patient pathway care scheme.
- Use of a ‘virtual’ Low Vision Services Centre by having web based information.
This will give details about services available and information for patients and professionals on Low Vision Services and specialist equipment available (not necessarily through this scheme) linking in with Integrated Community Equipment Services (ICES).
How can being a pilot help you to achieve your vision?
Being a pilot would enable the lessons learnt from the small scale pilot to be put into effect and enable the patient pathways to be implemented across the sector.
We have been working locally to improve Low Vision Services. Being a pilot site would enable significant improvements in the delivery of Low Vision Services for the local population.
It will enable the role for Community Optometrists and DOs to be extended so that access will be improved (both in numbers accessing service and in waiting times to be seen) and enable services to be provided in more convenient locations for service users. The provision for assessment would enable us to develop services on an evidence-based fashion, with input from both service users and providers.
Being considered for a national pilot has raised the profile of Low Vision Services. If funding is made available to set up the scheme and for project management, this will enable significant elements of the vision to be achieved and help the PCTs in making a long term commitment to improving this service, as we have to compete against the wide range of priority areas requiring modernisation to improve what is currently an overstretched resource . It will also provide a framework with which to share the outcomes of the project with others.
What are the short, medium and long term benefits for:
a) Patients
Short term: Quicker, easier more convenient access to services, leading to improved quality of life.
Medium term: Improved links with other services and less duplication of tests and appointments (because of better inter-agency communication), providing increasing choice and offering a joined-up service.
Long term: Ongoing service with regular reviews should help patients with daily living skills, eg. following medication regimes, ability to manage their own nutrition requirements appropriately, and in the prevention of falls.
b) Staff
Short term: Ability for more community practitioners to expand their scope of practice and provide a service directly to those with poor vision.
Medium term: Better communication with other service providers, leading to better understanding and working relationships, and ability to provide a more appropriate service for patients.
Long term: Being part of a team providing a good, ongoing service, building a relationship, developing further skills and knowledge base, leading to greater job satisfaction
c) Organisations/local health economy
Short term: Reduced pressure on HES.
Medium term: Help with achieving NSF targets.
Long term: Ongoing service provision for an increasing number of vulnerable people, enabling them to remain independent and help to maintain their physical and mental wellbeing. Improved cross agency working
Who are the key stakeholders and potential leaders in your scheme and why?
Key stakeholders: Social Services, Voluntary sector, Hospital Eye Service, community Optometrists & DOs, PCTs, patients, user representative groups, carers and public.
These key stakeholders are essential to ensure that the integrated service can be set up and provided with all providers having ownership so that all play their part and the service is centred on the users and potential users. The key stakeholders can be accessed through the well established SW London Ophthalmology Network and MSW LVS Committee.
Potential leaders: The S&M PCT LVS Committee, Optometric Advisor and Modernisation Manager are key to drive the scheme forward because they have been heavily involved in mapping current service provision, developing patient pathways, and identifying service gaps. This dual partnership will ensure that the modernisation agenda is incorporated into the project (including e booking, EPR and Choice) and that best practice is shared throughout the organisations involved. It will also ensure that local Optometrists and DOs are fully engaged in the process with appropriate clinical governance arrangements that can be adapted to suit the needs of the particular PCT. This Committee reports to the Ophthalmology Network and so will ensure this group is also engaged in the developments.
The Strategic Health Authority have taken a keen interest in this project and in addition to the network, will be key in ensuring that there is engagement and support for the progression of the project at the highest level of both health and social care organisations.
Proposed project management arrangements
Sutton and Merton PCT, as leads for the Ophthalmology Network and for the bid, will lead the project and recruit a project manager to support its implementation. The project manager will be line managed from the PCT, but will be accountable to a small project team (made up of members of the LVS committee). Progress will be reported periodically to the Ophthalmology Network.
How will the success of the project be measured? What is current project measured on?
Proposed project:
- Who uses the services – profile of age, ethnicity, visual problems (checking whether this is in line with the local population, if not target those not accessing the service).
- Outcome of services – referred for further medical treatment or blind / partial sight registration; reading ability with normal spectacle & LVA; take up of referral to Social Services & Voluntary Sector.
- Efficiency – length of time from request for service to appointments with different agencies; use of web site; ability to re-cycle LVAs.
- Costs – to different agencies.
- User satisfaction survey.
- Service provider survey.
- Discussion with key local GPs/ Ophthalmologists/ Patient Forum.
Current project:
- Age profile.
- Types of LVAs dispensed.
- Reading magnification given.
- Cost per patient of LVAs.
What are the challenges and barriers to the success of the project? How will these be overcome?
Challenges / Barriers
Working across different boroughs, PCTs, and agencies
Solutions
Project manager to set up a small project team with suitable representation. Good communication with all involved so that potential problems can be discussed early and solutions found.
Challenges / Barriers
Pressures on Social Services, (work load for re-hab workers) and the challenge of implications for the new arrangements for access to services in addition to BD8 registration ( this is an unknown quantity but could significantly increase the number of referrals.)
Solutions
Support from the group as a whole should help Social Services, and the proposed IT will enable them to better access vital information about the problems the service user has, and what help and LVAs have been provided.
It will be necessary to keep up to date with developments and consider the impact once the new arrangements have been in place for a while
Challenges / Barriers
Lack of funding for the Voluntary Associations for link workers in hospitals.
Solutions
Help from the group by giving information about possible sources of funding, and with putting together and supporting bids.
Challenges / Barriers
Involvement of DOs.
Solutions
A register of local DOs can be developed from the GOC register, their interest evaluated and training arranged.
Challenges / Barriers
Lack of understanding of the scheme by both potential service users and potential referrers (e.g. GPs, Carers).
Solutions
Sensitive, targeted publicity and face to face discussions.
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