I would like to respond to Moneo’s comment article (8/12/17).
While I totally agree that some parts of the professional hierarchy have classically actively encouraged creep in the expectations of the content of a sight test, in this case NICE have separated the two and helped us.
“1.1 Case-finding
The recommendations on case-finding are for primary eye care professionals before referral for diagnosis of chronic open angle glaucoma (COAG) and related conditions, and are separate from a sight test.”
This section including the word separate shows that this is not to be included as an expectation of a NHS sight test.
“These recommendations are for people planning and providing eye care services before referral
1.1.8 People planning and providing eye care services should use a service model that includes Goldmann-type applanation tonometry before referral for diagnosis of COAG and related conditions. [2017]
1.1.9 People planning eye care services should consider commissioning referral filtering services (for example, repeat measures, enhanced case-finding, or referral refinement) for COAG and related conditions. [2017]”
This section tells the commissioners that they must put a primary eye care service in place to cover the expectations in section 1.1.
Using this approach all LOCs should be actively engaging with their CCGs and lining up their Primary Eyecare Companies to manage new IOP refinement services.
Moneo is right, now is the time to be militant, not in an aggressive way but to state strongly to the CCGs, STPs and LEHNs that we will refer at 25mmHG using any tonometer and without further refinement unless these services are in place. There are many areas where these services do exist and all will be going through changes as the 24 requirement is taken into account.
While flexing our muscles and talking hardball to our CCGs we need also to point out that practices can no longer absorb all the Mecs presentations by using a GOS1 or charging privately let alone giving it away; we need a primary care contracted Mecs service in every area.
It is difficult for CCGs to understand the value of Mecs when practices are absorbing the demand. All Mecs presentations need to be referred to HES in the absence of a primary care service.