Unique, pioneering, unprecedented were just a few of the adjectives being bandied about in Newport last week. The occasion was the official opening of the Austin Friars Eye Treatment Centre (AFTC) by Welsh Cabinet Secretary for Health, Wellbeing and Sport, Vaughan Gething AM.
In what is six months since the AFTC opened, the specialist eye treatment centre has reduced waiting times for assessment, diagnosis and treatment of people with age-related eye conditions, increased the numbers of people seen and freed up hospital time.
Perhaps more importantly patients have welcomed the centre which combines optometry and NHS nursing and ophthalmology in a single Specsavers practice in the town’s shopping centre. As Craig MacKenzie, optometrist director at Specsavers in Newport explained, this has a great ‘normalising’ effect on people’s conditions. They do not have to be sent to an alien, hospital environment, a drive away, to park and wait for hours to then go through many of the same tests that saw them referred in the first place.
It has been an enduring frustration that such collaborative working is not commonplace in the NHS around the country. Despite its national name, the NHS is anything but. There are many examples of how optometrists working for, or under ophthalmologists, can save the NHS money, reduce waiting lists, increase volumes and ensure better compliance from patients, but joint working is rarely adopted. Patient need and cost savings are no match for health service politics.
Unveiling a commemorative plaque at the AFTC, Gething underlined the point that the centre is the first of its kind in the UK. ‘We are trying to do things differently here in Wales, there are some big areas of activity, eye care is one of those really big areas,’ he said. The centre was proof that optometry and ophthalmology could work together in a high street setting. He said it was not always easy to find resources to make such things happen but it had to be done. ‘Nothing could, or should, stand still. This is a really good example of working with the high street, where we could and should do more with our services. I think we will see results here that others will see and copy,’ he added.
In the six months the centre has been open, Specsavers’ optometrists have provided an initial screening service for those with suspected wet AMD, the results of which are reviewed virtually by a hospital-based ophthalmologist to speed up the process of diagnosis and referral for treatment. Treatment is then provided by NHS staff in the centre, for 120 patients a week. The number of follow-up assessments for people in Gwent has increased by approximately 20% per week as a result, while the average referral time for treatment of the condition has reduced by more than 40% with an average reduction of 15 days - from 34 days to 19.
The catalyst for the venture was funding from the Welsh Government under its Pathfinder scheme but collaborative working between local optical practices and the health board goes back much further. MacKenzie, who is also an optometric committee member on the health board, first got the practice involved with a glaucoma screening pilot scheme as far back as December 2014. He said local ophthalmologists wanted to explore how they could work more closely with optometry. Eye units did not feel they were getting the right data to back up referrals. That pilot saw 3D imaging and OCT installed in three practices, including Specsavers, for monitoring stable glaucoma. The data gathered was beamed securely to the hospital eye services where ophthalmologists reviewed it. Two local independent practices were also involved in the scheme.
The work to create the Austin Friars Eye Treatment Centre, also known as the Ophthalmic Diagnostic Treatment Centre, was developed through collaboration between Aneurin Bevan University Health Board and Specsavers in Newport. Under the wet AMD pathway patients are now referred into Austin Friars and the OCT scans taken are saved direct onto servers at the hospital eye unit, there is no need for GP referral or an initial hospital visit.
The health board continues to have wet AMD clinics at Neville Hall and Ysbyty Ystrad Fawr hospitals, but patients who would have been previously referred to the Royal Gwent Hospital are now seen at the purpose built centre in Newport.
The benefits are evident, said MacKenzie, fewer false positives and time to treatment reduced by 40%. ‘We’ve already seen a reduction in waiting time for treatment in the six months since the centre opened and have been able to increase the number of available follow-up appointments, helping those with the potentially sight-threatening condition to access healthcare services in an accessible community setting. The centre has also helped to reduce the time that people have to wait to find out their results following initial screening for wet AMD.’
He said the everyday effect on patients was massive in ‘normalising’ their condition. The centre had eye care liaison officers, referral chase up systems, undertook low vision assessments and had nurse injectors working under an on-site ophthalmologist. For patients finding they have AMD or glaucoma it is a big shock. ‘They don’t have to spend hours in hospital, their condition can be normalised. It’s all done from within here,’ said MacKenzie. He added that Moorfields staff had already visited AFTC to see what it could emulate as part of the NHS five-year plan.
Paul Morris, director of optometry advancement at Specsavers, said the AFTC was made possible in Wales because the health board had the will to host the services within an optical practice, something the Clinical Commissioning Groups in England should take note of. ‘The English commissioners need to appreciate the value of a centre like this and look for providers to assist them. That’s good for the whole sector because it allows opticians and hospitals to work together.’ He said a long term view was needed rather than allowing shortages in some areas to emerge, such as in cataract, which led to a boom in suppliers brought in to reduce waiting times.
Chris Blyth, clinical director and consultant ophthalmologist at the Aneurin Bevan University Health Board, credited as the driving force behind the centre by both Morris and MacKenzie, thanked the Welsh Government and the multidisciplinary team that worked together on the project. He said capacity had been increased by 20% as space to expand in the previous hospital setting was simply not there, adding: ‘I don’t want to give the impression that AMD has been sorted out in Gwent but we are in a much better position.’
Specsavers co-founder and optometrist Doug Perkins thanked the ‘top man’ Gething for his time to open the ‘top facility’. He said the centre was a clear demonstration of the benefits of ophthalmologists and optometrists working closely together to deliver the best patient outcomes in a community-based facility. ‘I would like to praise the health board for their pioneering approach and the Welsh Government for their support for this venture, and indeed for the whole spectrum of eye care in Wales which is as progressive as anywhere else, if not more so,’ Perkins said.
Wales was described as at the leading edge of optometry and ophthalmology working together. ‘Wales has shown a fantastic ability to lead,’ he added. The centre shows disciplines working together and demonstrating fantastic customer satisfaction and service. The range of conditions the centre could treat covered a range of sight-threatening conditions. He said he had thought about the many things you cannot do without eyesight. ‘We are so dependent upon it. This [AFTC] will make a big impact in the community.’ He said the centre was a flagship for UK eye care and had been visited by people from around the UK. ‘Specsavers is privileged to be part of it. We owe a great debt to the Aneurin Bevan Health Board. The secret of Wales health is that unlike England they work together across skills and bring projects together,’ Perkins said.
Speaking after the event, Perkins said replicating the centre elsewhere in the UK would be difficult but it stood as an aspiration for clinical teams across the UK. ‘But who knows? If enough people come to see this facility, whether it’s Specsavers or somebody else.’
He said the skills in optometry existed but called on the GOC to push forward on undergraduate clinical skills to enable more optometrists to perform enhanced optical services earlier. Optometry had a big part to play in working more closely with ophthalmology and the Newport centre showed it could be done.
‘We must just get on with it,’ added Perkins.
