Primary Care Cataract Assessment Scheme

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Gervais Henry
5 years ago
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1 Primary Care Cataract Assessment Scheme The intention of the scheme is to avoid unnecessary visits to Secondary Care for patients with cataract and to streamline the referral pathway. Under the scheme, a higher proportion of referrals for cataract is likely to result in being listed for cataract surgery. If a patient has significant cataract, an accredited optometrist, who can refer direct to a Cataract Co-ordinator at Aintree Hospital Trust, assesses them for whether cataract surgery is appropriate. The patient may access the service via four possible routes: 1. Following a General Ophthalmic Services eye test by an accredited optometrist 2. Following a General Ophthalmic Services eye test by a non-accredited optometrist. They should refer the patient to the accredited list to obtain an assessment 3. The patient attends the GP with visual problems and the GP detects cataract. The GP should refer a patient to the accredited list 4. The Hospital Eye Service (HES) should refer the patient to the accredited list to obtain an assessment, before deciding whether to list for cataract surgery INCLUSION CRITERIA The patient must be registered with a GP in South Sefton and be willing and able to undergo the assessment. The practitioner must be accredited to the South Sefton Cataract Assessment Service. To achieve and maintain accreditation, the optometrist must: Be willing to undergo examination and audit of their skills and competency, as the PCT deems necessary. Have satisfactory indemnity Insurance, to a value of no less than 2,000,000 (AOP membership would satisfy this obligation) Be willing to sign an agreement to carry out assessments on behalf of the PCT Carry out assessments, with regards to the protocol, with due diligence The practitioner is personally accredited, not the practice they work at. They cannot delegate work on assessment to a deputy. If their work is deemed unsatisfactory, the PCT will convene a Competency Committee to consider their continued accreditation. This may lead to suspension or removal of accreditation to the scheme.

2 PROCEDURE It is advised that assessments be carried out one to two weeks after a GOS sight test. This would allow a cooling off period for the patient. The patient should be given the self-assessment questionnaire to fill in at home and bring along to the assessment. Also, encourage the patient to bring along a copy of recent medication. This, or a photocopy, can be clipped to the questionnaire and sent to the Cataract Co-ordinator, along with the assessment form, if referral is required. The assessment would include: Dilated fundoscopy with Volk Lens and SL-BIO External slit-lamp examination Slit-lamp examination of lens opacities Discussion of surgical procedure Discussion of pros and cons of surgery Compilation and discussion of patient self-assessment questionnaire Compilation of assessment form Assessment Form Please note on the assessment form: 1. Patient, practitioner and GP details 2. All relevant clinical findings 3. Symptoms related to the presence of cataract 4. Clinical indications for cataract surgery 5. An indication of the patient s desire to proceed to cataract surgery Please ensure that the form is complete with all relevant details before distribution and supply the patient with a Cataract information leaflet. When referral for cataract surgery is indicated, the parts of the cataract assessment form should be sent to the following destinations: White copy: Patient Choice Team, Room 502E, 5 th Floor, Hamilton House L3 6AL Yellow copy: to the patient s GP. The GP can copy the form and send on medical details to the provider, if considered essential When cataract surgery is not indicated: White Copy: send to the Optical Adviser at South Sefton PCT Yellow Copy: send to the patients GP The Pink copy should be retained with the patient s optometric record in all cases

3 REFERRAL CRITERIA The following criteria are intended as a guideline and are therefore not exhaustive. Please note all relevant findings concisely on the report form. Presence of significant cataract Reduction in the VA due, at least mainly, to lens opacities, by 1 or more lines Presence of related ocular symptoms e.g. Glare Monocular Diplopia Blurred Distance vision Blurred Near vision Variable vision depending on light conditions Evidence of lifestyle changes due to visual impairment, e.g. Giving up/reducing driving Work related problems Curtailing leisure activities Evidence of mobility or spatial problems, e.g. falls, difficulty in poor light The patient, or their carer, adequately understands the surgical procedure, pros, cons and potential complications of cataract surgery Desire by patient to proceed with cataract surgery The patient should not be referred for cataract surgery: Where they indicate that they have no desire to be listed for cataract surgery Where there are currently significant contraindications to cataract surgery Where in your professional judgement, they are not currently likely to benefit from cataract surgery Where they, or their carer, has difficulty in understanding the procedure, pros, cons and complications of cataract surgery In these cases, the patient may be: 1. Reassessed in 12 months time or less at the request of the patient, where there are new symptoms or increasing ocular difficulties 2. Seen again under the GOS after a suitable interval 3. Referred to the HES or GP, if appropriate, e.g. co-existing ocular conditions

4 PRIVATE REFERRALS If, following assessment, the patient chooses to be referred privately, please send the white copy of the form direct to the eye consultant of choice. The 2 other copies will still be processed in the usual way. Contact details for the private practice of the Aintree Trust consultants are: Mr D Clarke Mr Kamal Mr G Kyle Mr I Marsh Abbey Sefton, 1 Kenilworth Road, Crosby L23 2AD STATIONERY All stationery is available in electronic format and can be printed from the supplied CD. However, pre-printed Assessment forms, patient self-assessment questionnaires and information leaflets can be ordered from the Optical Adviser. Claim forms can be ordered from the stationery department at Central Operations Mersey.

5 CONTACTS Mr David Clarke, Ophthalmologist Brigid Doyle, Ophthalmic Sister Rhona Kelly, Ophthalmology Office Manager: Walton Hospital Eye Department Rice Lane L9 1AE Telephone: Fax No: Cataract Co-ordinators Annette Winstanley/Jayne Ellis: Call Centre, Ward 40 University Hospital Aintree Lower Lane L9 7AL Telephone: /2199 Bob Wilkes, Optical Adviser: Burlington House Crosby Road North Waterloo L22 0QB Tel: ex 363 Mobile: Stationery Department Central Operations Mersey Hamilton House 24 Pall Mall L3 6AL Tel: Jean Rogers, Burlington House Crosby Road North Waterloo L22 0QB Tel:

SWINDON PCT CATARACT DIRECT REFERRAL SCHEME SERVICE LEVEL AGREEMENT

SWINDON PCT CATARACT DIRECT REFERRAL SCHEME SERVICE LEVEL AGREEMENT PROTOCOL This document sets out the details of the administrative protocol for the direct referral by Optometrists/OMPs of cataract patients.