This case study was developed prior to the NHS Listening Exercise. The outcomes of this exercise have led to some changes to the policy, and this case study may not reflect the current policy position. More information can be found in our detailed response to the NHS Future Forum.
Ophthalmology referral refinement
An ophthalmology referral refinement service has been set up in Berkshire to reduce the number of unnecessary referrals into secondary care.
Ophthalmology services across the county were often receiving patients who could have been treated in a community setting. About 85% of patients referred for tests in hospital because of a high eye pressure (Intra Ocular Pressure measurements) were actually being discharged, because the testing is not always accurate.
The South Reading GP consortium recognised that there were a large number of glaucoma related referrals and wanted to do something to reduce the number. The consortium sought the advice of the Berkshire West PCT optometric advisor who advised that referral refinement was the best initial action.
The scheme enables optometrists to refine their own referrals for ocular hypertension. If, after visiting an opticians in the community, the optometrist diagnoses a high eye pressure reading from the standard test, then the test is repeated using state of the art equipment which provides a more accurate pressure reading. If the reading is still high then the patient will be referred to hospital. However some patients may be treated in the community.
NHS Berkshire East and NHS Berkshire West pay local optometrist practices £21 to conduct the test. Some opticians don’t have the equipment, while some have purchased it so they can be part of the scheme.
The consortium is aiming to get 50% of all local opticians across Berkshire involved in the scheme by May 2011.
The scheme enables optometrists to refine their own referrals for ocular hypertension.
Benefits for patients and clinicians
The scheme has significantly reduced the number of unnecessary referrals into secondary care. To date 66% of patients tested have not required an onward referral, saving valuable time for patients and clinicians.
If the consortium can’t get any more optometrists involved in the scheme, they may ask community ophthalmology providers to provide the test if the local optician does not have the equipment. Although preferable to a patient being referred to hospital, it is hoped that testing can be done in local opticians as it’s much more convenient for the patient.