Sheffield shows foresight with new eyecare model

The NHS is facing an unprecedented squeeze with healthcare budgets under increasing strain. At the same time, the ageing population’s needs are becoming ever more expensive. The demand on the health service is such that it must deliver more care with fewer resources.

‘Our patients can now be seen at times and places that are more convenient for them. We estimate we are saving Sheffield CCG around £400,000 a year’

In Sheffield, one way we have addressed this is with the introduction of a new approach to eyecare, which saves money, improves patients’ experiences and provides a model other areas can follow − as well as demonstrating how leadership can make the introduction of new services more effective.

Good eye health brings a range of benefits to individuals and to the NHS. Not only are healthy eyes an important element of wellbeing, but problems with eye health can be a factor in hospital visits, including for older people where low vision can increase the risk of falls and injury. This is becoming increasingly pressing for the NHS as the population ages and eye health problems grow more common.

Better use of skills

Services to identify and treat eye health problems require specialist skills and equipment; traditionally these have been provided in hospital outpatient facilities. But to most people, getting to a hospital is inconvenient, sometimes expensive and frequently frustrating: most patients prefer to be seen closer in their homes. It is also usually more expensive for the NHS than treating patients in community based services. So in Sheffield we approached local optometrists to discuss how we could make better use of their skills, and whether we could fill any gaps with additional training and support.

Through this approach we have now got half of the optometry sites in the city providing a primary eyecare assessment and referral service (PEARS), which can assess and treat problems such as flashes and floaters, dry eyes and eyelid irritation. We also use PEARS optometrists to triage referrals from GPs and other optometrists and offer suitable patients the opportunity for an assessment at a local site. We have also established additional pathways to reduce possible glaucoma referrals, to manage paediatric eye screening services and to offer assessments after cataract operations.

‘Participants in the programme have included optometrists and pharmacists. We see it as a long term investment in the delivery and transformation of health services in the city’

All of these changes mean our patients can now be seen at times and places more convenient for them and we can prevent patients from having to attend hospital, so reducing the demand on consultant led services. We estimate that through these services we are saving Sheffield Clinical Commissioning Group around £400,000 a year.

Cooperative approach

The secret to this successful transition has been the close relationship between our commissioners and the local optical committee, which brings together opticians and optometrists in the city. Over the past five years, I have been able to attend committee meetings. This has helped to develop relationships and trust between the optometry community and the CCG.

This cooperative approach has supported the committee in negotiations with the local foundation trusts and has been the basis for the changes we have made. Given the structure of the CCG, having a GP champion for eye health related issues has been particularly valuable.

Another key element in the building of these services has been the development of clinical leaders. Over several years we have been identifying future healthcare leaders in Sheffield and enabling them to develop the skills to take on leadership roles.

Participants in the programme have included not only GPs, but also optometrists and pharmacists. We see it as a long term investment in the delivery and transformation of health services in the city: the results are becoming visible in the way services such as eye healthcare are adapting to financial pressures and changing needs.

Overcoming challenges

Of course, the introduction of these new services has faced challenges along the way. One hurdle has been how to facilitate referrals between competitive optometry practices. For each practice, there is an incentive to retain patients, not to refer them to others. The solution for us was to introduce a central triaging service, which manages all referrals and ensures a fair and transparent system that optometrists want to be part of.

‘Most of the services we have introduced make use of the skills optometrists learn during their primary degree’

A further lesson, relevant to other areas introducing similar community based services, has been the amount of work we needed to do to make sure the new services could be delivered effectively. There was nothing that could be introduced off the shelf.

We had to ensure the appropriate training was available, and that optometrists received the right level of funding to make it affordable for them to see patients in the new pathways. While it took time, the benefits have made it worthwhile.

Most of the services we have introduced make use of the skills optometrists learn during their primary degree. Putting these in to practice again has improved general job satisfaction for the participating optometrists

In Sheffield we want to go further and commission services for other areas of eyecare that are not already covered. Low vision services, ocular hypertension and shared care of glaucoma patients are all on our radar for future change.

Dr Richard Oliver is joint clinical director at Sheffield CCG