NHS England and Improvement (NHSEI) has detailed its recommendations to optimise existing locally commissioned extended primary care contracts in a recently released programme document intended for care commissioners.
In its recommendations, NHSEI urges health care commissioners to further utilise services such as Covid-19 urgent eyecare services (Cues) and minor eye conditions service (Mecs) to ease the pressures on care systems brought on by the pandemic.
Noting that eye care services in England have been put under significant pressure by the Covid pandemic, NHSEI said: ‘[Eye care services in England] must optimise all service provision to meet the needs of our population safely and sustainably.’
NHSEI added that there was a need for immediate action to support the recovery of services and reduce the risk of severe visual loss in patients. ‘This is especially true for long-term conditions like glaucoma, where existing hospital eye services struggle to meet follow-up needs and patients are at greater risk of avoidable sight loss,’ said the report.
‘There is also an opportunity to transform eye care and enable service providers to meet the needs of our population with a focus on improving access and addressing health equity.’
NHSEI explained that the purpose of its paper was to ask commissioners of eye care services and secondary care providers to review existing eye care contracts with primary care optometry, which could support immediate and future service recovery.
Optimising existing contracts
Part of what the NHSEI forwarded as a solution to increased pressures was optimisation of existing contracts. Detailing the benefits of this approach, NHSEI identified greater patient continuity of care and improved patient experience as advantages of improving the utilisation of primary eye care providers. It explained: ‘[This] helps manage the growing demand sustainably and mitigates the increasing strain on hospital eye services.’
NHSEI explained that while establishing new contracts for primary eye care services was time consuming, improving the utilisation of the many existing contracts would require ‘little effort’.
The document explained: ‘Most commissioning bodies in England already commission services that utilise the skills of primary care practitioners, that provide services beyond the sight testing service to support, manage and prioritise eye care patients.’
NHSEI requested that commissioners work with referrers, patients and those directing patients to services to optimise their use of first contact and referral filtering services in primary eye care.
Key areas
NHSEI identified five key areas that could take advantage of further optimisation in service provision. These were urgent care services (including Mecs and Cues), cataract pathways, glaucoma pathways, glaucoma monitoring and introducing a single point of access.
The organisation’s section on urgent care services noted that while there was comprehensive coverage of England for extended optometry services, such as Mecs and Cues, there was only limited utilisation of the full available capacity.
‘A recent local audit of 14 established services in one of the regions within NHS England indicated that approximately 50% of primary, urgent eye care services were not delivering as much appropriate activity as they could, indicating there is a significant opportunity to increase activity appropriately through care navigation, signposting and referral triage into the optometry service.’
To increase the activity of these services, NHSEI recommended that commissioners should agree on a process for care navigation and referral triage, and ensure the local NHS111 directory of services team recognised the primary care urgent eye care service and could signpost to the service. They should then, said NHSEI, carry out general promotion of optometry services and produce promotional material to support patient self-care and self-presentation to the primary eye care urgent service, where appropriate.
NHSEI added that all optometrist prescribers would need access to FP10 NHS prescription forms for collaborating with NHS England in this way.
In terms of recommendations for cataract pathways, NHSEI said: ‘All people identified with cataracts should have a sight test and assessment in primary eye care before considering referral for surgery.’
This would, it said, enable refractive and ocular medical status information to be provided to support referral and would involve eye care professionals in shared decision making.
- The full programme document can be accessed here: bit.ly/ 3h4tfQ7.