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Glaucoma – Enhanced Services

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Practices who currently provide GOS services in Leeds can also be commissioned by Leeds CCG to provide

  • IOP (GAT) Refinement; Level 1 service (previously 1a)
  • Enhanced Case Finding Service; Level 2 service (previously 1b)
  • Ocular Hypertension Monitoring (OHTMS); Level 2 service

Both the practice and practitioners need to be accredited to provide the services.

Contractors are now responsible for ensuring individual practitioners who provide the service are suitably accredited.

Patients must be registered with a Leeds GP to be eligible for these services

 

IOP (GAT) Refinement (Level 1)

The Repeat IOP service aims to reduce unnecessary referrals to secondary care for suspect ocular hypertension/glaucoma.

Patients found to have raised IOP (24mmHg – 31mmHg) and no other signs of glaucoma during their NHS or private sight test, can be offered an applanation IOP measurement at the same visit.

If the raised IOP is confirmed to be in the same range, a further repeat measurement should be offered within 4 weeks, before considering referral to ophthalmology.

Practitioners accredited to level 1 can offer the Repeat IOP service to their (the practice’s) own patients only.

For a patient seen by a non-accredited practitioner/practice who has IOPs 24 – 31mmHg  please refer to a level 2 accredited optometrist, for the enhanced case finding service, not the GP or hospital, to avoid unnecessary hospital referrals. A list of level 2 accredited practices and practitioners is available here.

Although GAT is a core competency, practitioners providing the service must become accredited to level 1, by completing the WOPEC IOP module – a free access code is available by emailing leedsloc@gmail.com, and be confident providing applanation tonometry.

If raised IOP is confirmed, patients can be referred direct to an ophthalmology service using the Repeat IOP (GAT) Referral form, with a copy being sent to the GP.

Enhanced Case Finding Service for Glaucoma

The aim of this service is to provide an enhanced case finding pathway for patients by level 2 accredited optometrists who have been identified by non-accredited (level 0) optometric practices to have suspected raised IOPs or from the DESP (Diabetic Eye Screening Programme) with signs of possible glaucoma.

By using this pathway, there should be a reduction in false positive referrals, resulting in a lower burden on ophthalmology services, whilst providing care closer to home.


Patient Inclusion criteria

  1. Referred by DESP having signs suspicious of glaucoma or
  2. Referred by non-GAT accredited optometrists having raised pressures (IOPs) of 24-31 mmHg with no other signs of glaucoma.
  3. Will be over 18 years of age.


Clinical measurements for each patient

  1. VA.
  2. Central visual field assessment using standard automated perimetry (full threshold or suprathreshold).
  3. Peripheral anterior chamber depth assessment using van Herrick test or OCT.
  4. Goldmann Applanation Tonometry (GAT)
  5. Optic nerve head assessment and fundus examination using stereoscopic slit lamp biomicroscopy (with pupil dilation if necessary), and optical coherence tomography (OCT) or optic nerve head imaging if available.


Outcomes

  1. Refer: any patient found to have optic nerve head damage and/or visual field defects consistent with glaucoma directly to a specialist glaucoma service for diagnosis and management. This includes the Leeds Community Ophthalmology providers.
  2. Repeat IOP/GAT: any patient with IOPs 24-31 mmHg using GAT should have a repeat measurement with GAT on a separate day within 2 weeks.

Outcome: a) refer any patient with 24 mmHg or more on repeat measurement directly to a specialist glaucoma service.

b) discharge any patient from pathway if IOP is less than 24 mmHg.

  1. Repeat fields: any patient with suspicious field defects with no corresponding findings suggestive of glaucoma or obvious explanation (e.g. lid or lens artefact, longstanding defects, etc.).

Outcome: a) refer any patient with a repeatable and reliable defect.

b) discharge any patient with no definitive, repeatable, reliable defect.

  1. Discharge from the pathway: any patient with no signs suggestive of glaucoma or OHT. They must continue to attend DESP and for their regular sight test.


Paperwork

Referrals from DESP will be accompanied by a copy of the GP’s letter summarising the current clinical status and DR grading.

Optometrists will complete a standard patient record form. Provide reports to GP and to Ophthalmology services when referrals are made preferably using nhs.net. No copy of report to DESP is required.

 

 

OHTMS

Leeds LOC has negotiated with NHS Leeds CCG and Leeds Teaching Hospitals to provide an Ocular Hypertension Monitoring Service (OHTMS). The service is for patients diagnosed with OHT and now includes both untreated and patients on topical IOP lowering medication.

Patients will be discharged from Leeds Teaching Hospitals and directed towards a level 2 accredited practice for continued monitoring.

Practices/contractors are now responsible for ensuring individual optometrists providing the service are accredited.
Individual practitioners become accredited by

  • completing the four on-line WOPEC glaucoma modules and previously attended a Leeds LOC OHTMS course or completing the WOPEC practical assessment
  • or College Diploma in Glaucoma part A or above
  • or College Professional Certificate or Higher Certificate
  • or above enrolment in a similar scheme elsewhere on a case by case basis
  • or evidence of experience working in a glaucoma clinic

Protocol:

  • Once the patient has made their choice of practice, the provider will be emailed on their PRACTICE NHS email address. The practice will also receive a letter enclosing the patient’s last Medisoft clinical entry which will include all clinical details, NHS number and GP details. The responsibility for that patient’s recalls then becomes the sole responsibility of their chosen practice. The nominated community optometrist/AQP Community Eye Centre will contact the patient advising them that they will be notified of their OHTMS appointment in 12 months
  • If the patient does not attend for 2 booked appointments or they fail to make an appointment despite reasonable efforts to contact them, they should be discharged to their GP. (Please use the OHTMS patient outcome/referral form).
  • The OHTMS patient outcome/referral form should be filled and sent to the GP. If repeat visual fields are required, it is recommended to wait until all exams have been completed before sending the form.
  • The submission/claim form (for OHT, GAT/IOP and cataract) has drop down menus for GPs, choice of scheme and outcomes. Please note that all boxes in red must be filled in before payment can be authorised.
  • There will be an annual audit form which will need to be filled each March to remain on the scheme. This will be provided closer to the time.

Paper copies of the referral forms are available from Victoria Ajayi at NHS Leeds West CCG (victoria.ajayi@nhs.net or 0113 843 5233)

Fees and Claims

Please see Members section.

 

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