CUES: “It's about delivering care in the safest way we can”
Zoe Richmond, interim clinical director of the Local Optical Committee Support Unit (LOCSU), tells OT about setting up the COVID-19 Urgent Eyecare Service.
1. When routine sight testing stopped there was a need to understand the impact on the public, and on our patients.We worked very closely with sector bodies and quickly identified a need for some essential services that would now not be possible in optical practices. That included the essential sight testing, particularly important for key workers, but also urgent and emergency eye care that would typically be presenting to optical practices - but with our closed-door policy would no longer be able to be managed in primary care. The COVID-19 Urgent Eyecare Service (CUES) was the solution to that.
2. Whilst we were in the process of designing CUES we found that video calls to patients were already happening in optical practices.So there was a natural transition; there wasn't much work for us to do around it.
LOCSU and NHS England are supporting optical practices to get NHSmail to every practice that gets involved with CUES. With that you get a video call function, so that will be available to every optical practice that delivers this service.
The other technology is the remote consultation, and the virtual review of data it might capture. CUES invites other clinicians into that consultation, so you might get an ophthalmologist coming in to offer advice and guidance. That might be in the consultation, or it might be that you provide them with data to perform a virtual review.
CUES builds on the technology available to us - stuff that just a few months ago we were dreaming about. Now, within a matter of weeks, we're delivering it in optical practices, and it's available across England. I don't think we'll be looking backwards following the implementation of CUES. What it delivers to the system is huge. It goes far beyond just delivering for the immediate crisis in urgent eyecare.
The functionality it delivers, and the close working relationships across primary and secondary care, are developments fit for the future
3. CUES breaks down barriers between primary and secondary care.When we're looking at the consultation with the patient there's an opportunity to invite in ophthalmology advice, so teams and individuals from the hospital can support your decision-making.
When CUES is implemented at its best, it goes beyond that. It's around decision-making in primary care, so you can fully manage a greater number of patients. You can imagine the ideal patient journey: the patient is sat at home, they have a video consultation with their primary care clinician, who invites secondary care into that, and issues a remote prescription that’s delivered by a pharmacy to the patient's home.
We're tailoring care around that individual. That's going to be essential, not just for the immediate, but for the longer term. We're going to have a cohort of people that are going to be shielding for a long time. It's about delivering care in the safest way that we can.
4. The idea of extended primary care services isn't new.We've got lots of practitioners in practice delivering this already. CUES introduces it in a more standardised way, at pace and scale across the whole of England, and with a standardised service specification.
CUES also introduces the concept of referral between optical practices. If you're providing remote consultation to your own patient and you feel that you aren’t best placed to deliver the face-to-face appointment, should it be necessary, you have the opportunity to book that patient in with a neighbouring practice that perhaps has a practitioner with a higher skill set or a different piece of equipment. It allows you to work in a more networked way with within primary care, but also a partnership approach with the hospital service.
5. Recovery means two years as a minimum.We're going to be in this for a long time. So, I think CUES is here for at least the next couple of years. We're inviting local systems to evolve CUES, to work within it but to broaden it, and do everything they can to improve it to develop greater, more integrated care for their patients.
The CCGs that are implementing it now are talking in terms of their reset, and how they're going to have to deliver routine care in a very different way. I think they see CUES as an enabler to allow them to do that, because it pulls the entire web together. It’s a whole system approach, and there is going to be value in that.
• As told to Lucy Miller.