Brighton & Hove: AMD Pilot
Aim of the project
To develop an integrated patient-centred eye care service model for age related macula degeneration (ARMD) which will significantly enhance the role of community based optometrists and OMPs. We aim to do this through building on current development of direct optometrist referral cataract pathway to secondary care, greater co-ordination of services across health, social services and the voluntary sector, and through research which will inform where our interventions have the most impact.
In developing a patient focused approach our pilot will create stronger links and communication with local voluntary groups who provide rehabilitation support and information for people with recent sight loss, and the vulnerable visually impaired in Brighton and Hove.
What organisations will be involved in and supporting this application and why you believe they are crucial to your proposal
- Local PCTs Brighton & Hove City PCT, and Mid Sussex PCT as their support will be necessary to agree funding for additional services from optometrists.
- The Brighton & Sussex University Trust – the acute Trust which delivers ophthalmic routine and specialised services through the Sussex Eye Hospital for the local mid Sussex and Brighton & Hove population.
- Local Optical Committee (LOC) – to inform, encourage and advise on optometrist support, training and development.
- Social Services - Sensory Impairment Team to create inter-agency working and understanding around rehabilitation, counselling and support services.
- RNIB to provide service led redesign, and for support in education, training, communication and emotional support.
- The Brighton Society for the Blind to provide service led redesign, and for support in education, training, communication and emotional support.
- St Dunstan’s Charitable foundation for the Blind.
Objectives of the project - why do you want to be a Pilot Scheme?
We wish to:
- Develop and improve chronic eye disease services for patients within Brighton & Hove and surrounding catchment area of the Sussex Eye Hospital.
- Include visually impaired people and their carers in all aspects of planning and service delivery.
- Develop a system of care pathways which will deliver patient focused care by the most appropriate health professionals as close to the patients home as possible.
- Minimise delays in treatment and support by utilising healthcare and voluntary sector resources in the most appropriate way.
- Set up a one stop investigation and treatment clinic where treatment programmes will be based on quality of life and efficacy of the most effective form of treatment.
- Develop clinical and support networks across professional and health, statutory and voluntary sector organisational boundaries to ensure a streamlined patient focused service.
- Use research to inform how we can best focus health resources to improve patient health and maintain their independence.
- Reflect the principles and aims in national frameworks and strategies e.g. the NHS Plan, the NSF for Older People, Valuing People; and local strategies in health and social care in the model for service delivery.
- To have clear strategies, communication and support networks in place with our partners in healthcare, social care, and the voluntary sector which offer services which empower vision impaired people to have the freedom to participate fully in the communit
Where do you want to be in 2 years' time? Describe your vision for delivery of Chronic Eye Disease Services.
We wish to:
- Have developed a system of care pathways which will deliver patient focused care by the most appropriate health professionals as close to the patients home as possible.
- Minimise delays in treatment and support by utilising healthcare and voluntary sector resources in the most appropriate way.
- Set up a one stop investigation and treatment clinic for macula disease where treatment programmes will be based on quality of life and efficacy of the most effective form of treatment.
- To have clear strategies, communication and support networks in place with our partners in healthcare, social care, and the voluntary sector which offer services which empower vision impaired people to have the freedom to participate fully in the communit
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?
- Develop rapid access to assessment and treatment of patients by using optometrists/OMPs for precise differential diagnosis/ triage.
- Test the use Telemedicine or image transfer on CD for triage/back–up advice to optometrists/OMPs where appropriate.
- Direct booking from optometrists to the HES for those patients that have treatable macula degeneration or who require counselling or low vision services or rehabilitation.
- Continue to develop research which identifies which patients benefit from PDT.
- Develop appropriate counselling, social service support for untreatable patients with either wet or dry ARMD.
- Test the use of volunteers and Expert Patients for additional support , training for low visual aids and information.
- Develop appropriate counselling, social service support for this group of patients which a) extends the role of the Eye Clinic Liaison Officer (ECLO); and b) utilises ROVI provision and volunteers from RNIB & the Brighton Society for the Blind for support
- Raise awareness of support services in the local community for clinic nurses and optometrists and GPs.
- Maximise the use of the voluntary sector to provide counselling, support and rehabilitation.
How can being a pilot help you to achieve your vision?
- Becoming part of a national pilot which requires formal project management will help us in our desire to radically redesign these services for patients.
- Short term additional revenue will pump prime changes in current referral and treatment pathways which will lead to more cost-effective services in the future to meet the needs of these vulnerable patients, and lead to lasting sustainable improvement in t
- It would provide the opportunity to train a different skill mix of healthcare professionals targeted across primary and secondary care.
- Developing pathways of care which are inclusive of the expertise of the voluntary sector will provide targeted focused support at important transitions in the patient’s pathway of care and rehabilitation.
What are the short, medium and long term benefits for:
a) Patients
Patients will experience shorter waiting times, less steps in their pathway of care, services nearer home with a healthcare professional that they have experienced a sustained contact with. Co-ordination of education and support will improve patient outcomes not only in terms of clinical outcomes of the most appropriate treatment, but also in terms of maintaining independence and minimising social isolation. Integrated working based on clear pathways of care will reduce the incidence of falls and accidents in the home and other co-morbidities associated with social isolation and reduced mobility. Accurate early diagnosis and treatment which will maximise medium and sustained visual preservation
b) Staff
Increased job satisfaction in being part of a system of patient centred care that is well integrated with our partner organisations and other stakeholders and endorsed by the patients themselves. Healthcare professionals will be able to focus on those patients who they can help most effectively. Local Optometrist, nurse practitioners will be able to upgrade and improve their skills
c) Organisations/local health economy
Provide a more effective use of resources, while at the same time improved access to care for patients with macular degeneration. Service redesign for these patients will provide a model service improvement which can be replicated and have a positive effect on Low Vision Services in the local health economy.
Who are the key stakeholders and potential leaders in your scheme and why?
- Local PCTs Brighton & Hove City PCT, as lead commissioner for BSUH The PCT strategic direction is to commission along care pathways - Jacqui Nettleton Performance Manager acute commissioning.
- Mid Sussex PCT as commissioners for acute services of BSUH . Mike Lander Commissioning & Performance Manager.
- The Brighton & Sussex University Trust – Mr Anthony Casswell & Mr Michael Eckstein Ophthalmic Consultants – Gek Ong Research Fellow, Michelle Brawn Care Centre Manager Sussex Eye Hospital.
- LOC – Vicki Macken optometrist also optometrist representative on the Primary Executive Committee.
- Social Services - Sensory Impairment Team – Pat Grant manager & Kerry Leask eye clinic liaison officer.
- Voluntary sector RNIB & Brighton Society for the Blind to provide service user advice and support.
- St Dunstan’s Centre for the Blind- Dick Lake Manager – to use their state of the art rehab facilities to deliver group education and training around activities of daily living.
- Local Patient Forum to provide service user advice and support.
Proposed project management arrangements
- Use Collaborative programme, methodologies and toolkits (e.g short change cycles, run charts).
- Appoint Project Board & Manager.
- Develop a project plan.
- Where appropriate, use PRINCE2 methodologies.
How will the success of the project be measured?
- By the creation of a clinical and communication network across optometrists, HES consultants, health and social care professional boundaries.
- By introducing a new referral pathway which ensures that patients who do not require hospital treatment have shared care arrangements with their local optometrists.
- By measuring the appropriateness of referrals for ARMD to the Sussex Eye Hospital.
- By reducing referral and access times for HES services and treatment where appropriate
- By identifying which patient do well with PDT based on locally produced evidence, which will produce cost savings on PDT.
- By evaluating the use of telemedicine/ image transfer for optometrist/OMPs diagnosis/advice service for referral and treatment decisions.
- By measuring Patient satisfaction/experience with/of treatment management plans and the kind of support offered.
- By reducing the number of falls in those patients who have visual impairment.
- By auditing number of patients who take up the opportunities to access voluntary sector support and education.
What are the challenges and barriers to the success of the project? How will these be overcome?
- Human resources - recruitment of optometrists/OMPs when funding streams have not be formalised – identify and agree primary care funding.
- Training for optometrists/OMPs and consultant time competing with cataract Choice – by using training programme already set up for direct optometrist led cataract referral.
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