{ Background PCT Open Tender in 2011 30% Ophthalmology OP Services - - PowerPoint PPT Presentation

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 PCT Open Tender in 2011  30% Ophthalmology OP Services  Multiple Bidders  THH won the bid

Background

70% 30%

Hillingdon Ophthalmology Services

HES COS

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Required Activity

Activity Year 1 Year 2 Year 3 Year 4 Year 5 First OP 2,284 2,353 2,423 2,496 2,571 Follow up 4,276 4,404 4,536 4,672 4,812 Total 6,560 6,757 6,960 7,168 7,383

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COS Specific Conditions

 Watery eye / Dry eye / Red eye  Blepharitis / Eyelash problem  Floaters / flashing lights  Retinal lesions / Blurred vision / Field defects  Stable Glaucoma / OHT  Cataract (Triage)  Some suitable Paediatric Ophthalmology  Some urgent provision  Suitable Minor Ops

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Key Performance Standards

• Triage:
• Routine within 2 working days
• Urgent within 4‐8 hours
• Consultation:
• Suitable Urgent within 48 hours
• Suitable Routine within 4 weeks (95%)
• Referrals for surgery with PPwT form (100%)
• Suitable Minor Ops : 98% within COS

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Key Performance Standards

• Admin:
• Letters within 4 working days (100%)
• Acceptable DNA rate 9%
• Consultant involvement 70%
• Choice: 75% (year 1) to 90% (year 3)
• Patient Satisfaction:
• 90% satisfied (minimum 40% response rate)

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How did we start?

• F4P Exercise
• Process Mapping
• Key areas critical to COS

 Referral Management & Triage  Clinical Care Pathways  Clinic set-up  Clinic specific staff skill-mix  Effective use of EPR

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Cataract Pathway Glaucoma Pathway Scooby Doo Pathway Urgent Conditions Pathway External/Lid /Lacrimal/Minor Ops Pathway COS Specific Triage Protocols

COS Clinical Care Pathways

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COS Common Pathway

Community Clinics New & FU (Consultant Led) *

• Referral refinement
• Full Diagnostics
• Low risk eye care (see,

treat, discharge)

• Refer to Long Term

Glaucoma / General FU COS clinics Long term Glaucoma FU Clinics (virtually consultant delivered) *

• Full Diagnostics
• Monitoring
• Follow‐up
• Treatment

DISCHARGED

Low risk eye care as per specifications Low risk/treate d Glaucoma G Suspect OHT

High risk patients needing interventions

New and FU seen, diagnosed treated (FU where applicable) High risk & excluded as per specifications Low risk/treated glaucoma, Gl Suspect OHT and

• ther

Hospital Eye Service Sub Specialty Clinics



STAGE 1 – Referral (Choose & Book / Letter / nhs.net /Phone / Fax)



STAGE 2 – Triage of Referrals



Community Ophthalmology Clinic



Hospital Eye Service R E F E R R A L

M A N A G E M E N T

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 Ophthalmology Dedicated Citrix Server  Practice Manager EPR  Medisoft EPR  EMMA (Glaucoma FU)  Imagnet/Ibase  PAC  Sunquest ICE

IT Links & EPR

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COS Sites

Oakland Surgery Long Lane Eastbury Surgery Northwood

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Referral Process

Choose & Book ‐ DOS with GP Booking Paper referrals – COS Proforma Fax Referrals – COS Proforma Phone Referrals E‐mail Referrals (nhs.net)

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• Watery eye
• Dry eye
• Red eye
• Lid lesions excluding suspected cancer
• Blepharitis
• Eyelash problem
• Floaters / flashing lights of long

duration (more than 2 weeks)

• Field defects
• Retinal lesions
• Blurred vision
• Some urgent provision
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• GOS
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 Multidisciplinary Team

 Optoms  Nurses  HCAs

 Latest Equipment  Full IT infrastructure & live IT links  Consultant Led & Consultant Assured

Community Clinics Set‐up / Team

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New & some FUs: Seen directly by Consultants & Senior staff Stable Glaucoma patients: Tests performed by MDT 100% on‐line decisions by Consultants & Senior

Glaucoma Fellows

Paeds:

 Senior Orthoptists & Optometrists  Fast track protocols

COS Clinics & Innovation

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Key challenges ahead?

 Strict Service Specifications  COS specific KPIs & Penalties  Block Contract  Limited Numbers  Same Quality for less  Risks & Opportunities  Innovation, Integration & true Partnership

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What next?

 Motivated team  Mobilisation Plans in place  Procurements mostly completed  Some delays with data links

& premises

 Phased start / Learn & Develop

 Celebrate good practice  Identify areas for improvement

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Planned start Date: 3rd Nov Consultant Assured Service Innovation Quality Assurance Cost Effectiveness

Key Messages

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Open Discussion