AT A GLANCE
THE CHALLENGE
Demand for ophthalmic services was outstripping capacity due to the impact of COVID-19, workforce challenges and an ageing population.
Sussex has one of the highest proportions of older people in the country and the increasing demand for glaucoma and medical retina services is expected to rise significantly over the next 20 years. More than 7,000 patients were on the glaucoma waiting list with 600 people waiting over a year for their first outpatient appointment.
To meet the increasing demand, there was a need for a more efficient process for optometrists to make direct referrals and for the service to develop new ways to optimise the workforce to support the delivery of care.
WHAT WE DID
The CLEAR team made several site visits and conducted remote interviews, clinical observations and documentation reviews. Data was collected on estates, workforce, systems, patient flow and staff perceptions. The team interviewed 40 staff members including nurses, advanced practitioners, ophthalmologists, optometrists, orthoptists, healthcare assistants, administrators and theatre staff.
CLEAR RECOMMENDATIONS
The waiting list backlog could be tackled in the short term by increased use of diagnostic hubs, opticians with diagnostic capability and a “prEYEority” month for validating waiting lists in virtual clinics.
The national CLEAR team’s key recommendation for the long-term was a co-located diagnostic hub – created as part of a phased integration of hospital and community eye services into a new Sussex integrated glaucoma service. They suggested a new outpatient referral and glaucoma pathway be developed, using the Eyecare electronic Referral System (EeRS) to support referral refinement and the digital transfer of diagnostics.
Up to six community optometrists could work in the hospital’s glaucoma clinic. Nurses, optometrists and allied health professionals could be upskilled and trust grade doctors gain specialist glaucoma training. Better use could be made of technicians and healthcare assistants in clinics and the diagnostic hub to increase capacity.
FORECAST IMPACT
Around 30% of stable and low risk glaucoma patients could be managed by community optometrists – freeing up 6,310 hospital appointments and reducing waiting times. Direct referrals from optometrists could generate annual savings of £10,203 in primary care with up to £27,000 a year saved by the digital transfer of OCT data. The cost of the proposed new workforce model could be met by savings from other parts of the service (see case study: Sussex Eye Hospital- cataracts).
Career development opportunities and a more sustainable workload could improve staff morale, recruitment and retention as well as reduce sickness rates.
