Paragon Clinic

Frequently Asked Questions (FAQs)

What is the eligibility criteria for the service?

• Paragon Clinic’s service offers annual monitoring for patients aged over 12 years of age, who are registered to a Shropshire, Telford & Wrekin GP and who are taking either Hydroxychloroquine or Chloroquine. 
• Patients will be eligible for referral to Paragon Clinic for monitoring if they have been treated with Hydroxychloroquine either continuously or non-continuously for 5 years, or if they meet any of the following higher risk criteria:

• On a high dose of Hydroxychloroquine therapy (>5mg/kg)       

• On Hydroxychloroquine and tamoxifen therapy 

• On Chloroquine therapy (>2.3mg/kg)

• On HCQ therapy with reduced renal function (eGFR<60ml/min/1.73m2) or a history of renal impairment if eGFR result not known

• We would recommend still making a referral to Paragon Clinic if you are unsure whether a patient meets the abovecriteria as eligibility will be validated by Paragon with the patient via the initial telephone call.

I have a patient to refer to the service. How do I do this?

• Please use Cinapsis’ Electronic Eye Referral Service (E-ERS) to make the referral. The form is available under the “Shropshire, Telford & Wrekin Referral Service Option” and is called “HCQ/CQ Monitoring Service (aged 12 and over)”.
• GPs and Rheumatologists can also refer into the service. 

I have just referred a patient using EERS to Paragon Clinic. How long will it take for the patient to be contacted by the service?

• Patients can expect a telephone call within 3 weeks of the referral from Paragon Clinic. Paragon Clinic will go through with the patient the eligibility criteria during the initial call. 

We have a few patients attending the early NHS GOS sight test for a ‘baseline’ eye examination before they are to even begin HCQ therapy, on instruction of their Rheumatologist. Should I refer these patients to Paragon Clinic?

• Paragon’s service supports patients already on Hydroxychloroquine and/or Chloroquine, as identified in the eligibility criteria to access monitoring. The service model does not cover the undertaking of any baseline tests before the initiation of the prescribing.

• Guidance from The Royal College of Ophthalmologists (HCQ and CQ Retinopathy: Recommendations on Monitoring 2020) advises that a baseline test to detect any deterioration is no longer recommended and ‘there is no specific recommendation for patients to arrange annual community optometry assessments, or any specific form of self-assessment, before monitoring commences.  We are linking in with local Rheumatologists to ensure there is consistent messaging for patients.

 I cannot locate my patient on Cinapsis’ Electronic Eyecare Referral System to refer them. Is there anything I can do?

• We find that patients sometimes may use a name that doesnot match their GP record, which can cause issues in locating the patient on Cinapsis:

• You can undertake a search for the patients using the first 3 characters of their first and surname and adding a “*”. This will bring up any similar records

• You can search using the patient’s NHS number. We find it can be helpful to ask the patient to bring with them a letter with their NHS number. 

 I am not sure if my patient is registered to a Shropshire, Telford & Wrekin GP Practice, which is a requirement forthe service. How do I find this out?

• Cinapsis has introduced the functionality to display the registered GP Practice for the patient when accessing the individual’s record.

• A list of Shropshire, Telford & Wrekin GP Practices can be found on the ICB’s website: GP Practices in Shropshire, Telford and Wrekin – NHS Shropshire, Telford and Wrekin

Should I refer someone who meets the eligibility criteria even if they have had a recent eye test?

• We would recommend that all patients eligible for the service are referred to Paragon Clinic, even if they have attended a recent eye examination at their local optician. This will enable them to be triaged and added to Paragon Clinic’s list for annual monitoring, where appropriate. 

I am aware a patient has attended a Hospital Eye Clinic in the past for monitoring. Do I still need to refer them for a monitoring appointment at Paragon Clinic?

• We would recommend the patient is still referred to Paragon Clinic if they fulfil the service eligibility criteria. Any current access to a monitoring service can be validated by Paragon Clinic with the patient during the initial phone call.

The patient has advised they are seen for retinopathy screening in connection with their diabetes. Should they be referred to the service?

• The Diabetic eye screening and Hydroxychloroquine monitoring are two different types of check-ups, with different imaging procedures and different protocols used for interpreting early pathology. For instance, the Diabetic screening does not include Visual Field testing and may not include OCT, which are undertaken as part of the Hydroxychloroquine Monitoring Service.

• The Diabetic eye screening is a national screening programme commissioned by NHS England.  The Hydroxychloroquine monitoring service is locally commissioned and it would not be possible to combine the two appointments because they are two completely different services. 

• On this basis we would ask that the patients are still referred into the Hydroxychloroquine/Chloroquine Monitoring Service delivered by Paragon Clinic, as this is separate to the Diabetic Eye Screening and undertakes different tests.

How will I know and what happens if a referral has been rejected?

• Any referrals rejected by RAS and TRAQS will show in your Cinapsis work page. Cinapsis is implementing a flag to help easily identify any rejected referrals within your workflow. 

• Notification will be sent to the referrer by Paragon Clinic to advise on any patients that are not appropriate to access the service following the telephone triage call.

I have a query on the status of a referral. Who do I contact?

• We would advise confirming the status of the referral using Cinapsis first.

• If the referral is still showing as pending we would recommend contacting the ICB’s Referral Management Centres.

• If the referral is showing as accepted, please contact Paragon Clinic via reception@paragon-clinic.com. Please also contact Paragon Clinic if you have any queries on a patient. 

For more information via the ICB website, click below:

Hydroxychloroquine Eye Monitoring Service Patient Information