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Q&A: Tackling the eye health postcode lottery


19 May 2014

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The newly appointed president of the College of Optometrists has a bone to pick with commissioners across England. Although they are moving from strength to strength in addressing other conditions, David Parkins believes more could be done to improve eye health commissioning. 

Eye health issues account for 4.5 million GP appointments across the UK each year, and at least two million people in England have some form of sight loss, according to figures from the UK Vision Strategy. By 2020 this number is expected to have increased by 22%. 

The newly appointed president of the College of Optometrists has a bone to pick with commissioners across England. Although they are moving from strength to strength in addressing other conditions, David Parkins believes more could be done to improve eye health commissioning. 

Eye health issues account for 4.5 million GP appointments across the UK each year, and at least two million people in England have some form of sight loss, according to figures from the UK Vision Strategy. By 2020 this number is expected to have increased by 22%. 

The Commissioning Review Senior Reporter Lalah-Simone Springer caught up with David Parkins to explore the issues – and possible solutions. 

Lalah-Simone Springer: When the Health and Social Care Act was introduced, did you have concerns that this would affect the commissioning of eye health services? What has your experience been on the front line? 

David Parkins: I was a little bit concerned because where the enhanced contracts sat with primary care trusts, they moved to NHS England in the transition year, and then from last April they went back to clinical commissioning groups (CCGs). It varies throughout the country, there are differing levels of expertise in the optometry schemes and this will play out in whether schemes continue or not. 

All schemes that were transferred to CCGs have a year’s extension. Therefore any new services, or the same services, will need to be re-procured in the second year. Schemes may be under threat in certain areas just because of the lack of capacity within CCGs to take this on. 

This is one of my interest areas at the moment, to see how the changes will have an impact on services. I think the Call to Action [NHS England's document outlining why the health service needs to improve to tackle future challenges] will be one way to bring this to the attention of everybody and look at new ways to deliver these services.

LS: How do you feel that the NHS England Call to Action for Eye Health is likely to improve service inequalities?

DP: I think it will be a starting point. The main thing to consider is that there is a postcode lottery in England. Because CCGs have their own commissioning intentions, they have their own priorities – but [eye health] is not necessarily a priority. 

It’s an opportunity to look at how we can do things differently. We need to have more integrated commissioning. That’s the only way we’re going to get integrated services, and we’ll need pooled funding to do that. 

There are a lot of analogies between the different professions. Whatever the kind of service provision, we have all got the same problems. Ageing population, more advanced treatments and very flat budgets.

LS: In that case, how do the challenges affecting optometry differ from those affecting the other primary and community care services? 

DP: I wouldn’t say that those are challenges – more an opportunity. When you look at the pathways, we need to be in a position to manage patients better. At the moment, with the general ophthalmic services sight test, we currently only have one opportunity to make a decision. We don’t get paid to see that patient again or for managing that patient. 

Therefore, it would be a real plus if optometrists were allowed to see patients more frequently and monitor patients without the need for a referral.

Parkins: 'If we want to make changes, we have to align commissioning intentions'

[However], to get more integrated services, we also need more integrated IT. We need to be able to talk to hospitals and GPs much more efficiently. At the moment we either have to send a letter to the GP who refers us on, or in some places they use NHS.net. We also get very little feedback about what’s happened to that patient in hospital. Quite often they return just because we’re not kept informed of what is going on about the treatment of that patient.

LS: Would that not be a CCG’s role, as part of their remit to improve primary and community care? Should they not be the ones that step forward and say, ‘This needs to be improved’?

It is, but within the remit of CCGs, they do not have any responsibility for the National Health sight test, that sits with NHS England. The scope for CCGs is more the extra services that they may wish to commission, such as repeat measures or cataract assessments or the primary eyecare assessment and referral service (PEARS) scheme that is for minor eye conditions. It’s important that where CCGs are concerned – particularly in London, where there are 32 – that these operate across a wider area. 

Otherwise, you may have patients seeing an optometrist outside the CCG area who cannot access or deliver the services which are on offer to that particular patient.

Certainly in my particular CCG area, 20% of patients went outside our area for their eye care, as they had bypassed all of the services that we had in place.

If we want to make changes, we have to align commissioning intentions through CCGs in a particular area. It will take time to have that conversation. I think this where local eye care networks have a place.

LS: Could you explain the role of local eye health networks? 

DP: Round the table [of local professional networks] there will be commissioners, public health, a range of clinicians and patients. Out of that will come a focused look at what is happening in their area and how they can work collectively to change things. 

But also their recommendations will have to go to the CCGs in order to make those changes. That is where the responsibility for ophthalmology and funding lies. It is very important that they are not seen as something removed from CCGs. 

They need to be actively engaged in CCGs. Would it not be nice, rather than having schemes just in one CCG, to have them over a much wider population? It would remove the postal code lottery that we currently have and it would be more efficient. 

LS: David, what is your top take-home message for CCGs? 

DP: [We] recognise that they have a lot on their plate at the moment. I think to raise the importance of eye health in their commissioning intentions for the coming year. I think we get feedback that hospital departments are under great pressure and that patients are not necessarily being seen on time, particularly with regard to conditions such as age-related degeneration. 

Therefore, I feel that it should be higher in their priority list at the moment. The fragmentation has not helped them and I would hope the call for action will allow NHS England, CCGs and patients to come together to actually look at how we are doing. It could be a lot better and it could be more joined-up. We need to re-align commissioning contracts and service delivery in a much more efficient way.

 

Resources: 

College of Optometrists – PEARS

Local Optical Commitee Support Unit – Local Eye Health Networks

College of Optometrists 

UK Vision Strategy 

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