“Being recognised by the AOP for our work to improve care for other patients is incredibly rewarding”
Recognising excellence in community-led care: Cardiff and Vale University Health Board Primary Care Optometry and Secondary Care Glaucoma Teams
27 February 2023
Cardiff and Vale University Health Board Primary Care Optometry and Secondary Care Glaucoma Teams were recognised for excellence in community-led care at the AOP Excellence in eye care reception on 26 February.
The award category recognises a team or individual who successfully delivered a community-led eye care service that enabled patients access to assessment, management and monitoring close to home, demonstrating the benefits of building eye care into the wider health model, and has a people-centred approach.
The Cardiff team were recognised for efforts taken to improve eye care for patients across Wales by collaborating with primary and secondary health care and maximising the use of digital advancements. This included the development of a new electronic patient record (EPR) and electronic referral system for eye care in Wales, the first national system of its kind and funded via the Welsh Government’s Digital Priorities Investment Fund.
The OpenEyes platform allows patient data and images to be shared securely with hospital consultants and also enables inter-practice referrals.
Shared careA vision for shared care is at the heart of these developments.
The digitisation of eye care was a key priority in the Welsh Government’s Together for Health: Eye Health Care Delivery Plan for Wales 2013–2020 and detailed further in the document NHS Wales eye health care: future approach for optometry services. Seeing the pressures of increasing demand for eye care, amidst capacity issues within the hospital sector that meant patients were not being seen within target timelines, in 2018 Cardiff and Vale UHB announced a five-year plan to transform eye care with digitisation playing a key role in the delivery of shared care.
Gareth Bulpin, national architect eye care digitisation NHS Wales, spearheaded the initiative, bringing both professional and personal experience to the role.
Following a retinal artery occlusion, Bulpin lost sight in his left eye, an experience that led him to return from his planned retirement to support the project, and motivated his determination to “improve experiences for other critical eye care patients.”
Bulpin explained that, when he experienced losing sight in one eye, he quickly realised the pressure in the services.
When Beatty joined Cardiff and Vale UHB as the optometric advisor, the two worked together on a local shared care model that would utilise the skills of prescribing optometrists on the High Street.
“The programme needed a major culture change in how we run our local ophthalmic services to improve patient waiting times and outcomes,” Beatty said. “Joint working between hospital and primary care teams has been crucial to success,” she explained, along with investing in training for higher qualifications and utilising digital solutions.
The programme needed a major culture change in how we run our local ophthalmic services to improve patient waiting times and outcomes
Accelerated implementationWhen the lockdowns of the COVID-19 pandemic saw a 40% reduction in the capacity available for patients to attend hospital, the project was accelerated in response.
Of 64 practices in the region, 16 were asked to remain open as emergency hubs, with four practices with independent prescribing optometrists available on a rota to take referrals that might otherwise be sent into the hospital for treatment.
Due to their preparation and planning, they were ready and able to, over one “busy” weekend, establish and open the Independent Prescribing Optometry Service.
The OpenEyes electronic system was used to enable images and patient data to be shared digitally with consultants for virtual review and confirmation of complex treatments. This also allowed consultants who were isolating to assess patients virtually.
“This meant that the majority of eye conditions were able to be managed and treated by independent prescribing optometrists in the local community,” Beatty said, helping to release capacity for consultants, and for complex patients to seen more quickly.
A further five optometry practice were also connected to OpenEyes to manage glaucoma patients in the community during the lockdown, sending images to consultants at the University Hospital of Wales to be reviewed via virtual clinics.
Following the introduction of the initiatives in 2020, by June 2022 the percentage of R1 patients – those with the most serious eye conditions and most at risk of irreversible harm or sight loss – seen on time had improved. Seeing an opportunity to support optometrists upskilling to obtain higher qualifications in glaucoma, medical retina, and independent prescribing, the team worked to increase hospital placement opportunities.
With demand high for placements, the pair discussed solutions.
“The decision took the time for Sharon to get a second cup of coffee. Before it reached the table we knew we needed a Teach and Learn centre,” Bulpin shared.
To create more training placements for higher qualifications, the team collaborated with Cardiff University to establish the first NHS Wales University Eye Care Centre, enabling clinical placements for optometrists across Wales to treat local patients with glaucoma and medical retina eye conditions.
The glaucoma clinic has consultant oversight and is supervised by optometrists with a Diploma in glaucoma and independent prescribing qualifications. Practitioners in the clinic assess the patient, and provide management and advice. Cardiff University tutors provide guidance, so that optometrists are managing the patients under supervision, and learning the skills needed to take into primary care practice. The medical retina clinic has the same support and is supervised by Cardiff University tutors specialised in medical retina.
Beatty told OT: “It’s really rewarding to know that we are improving treatment times for patients, preventing those with more complex cases from developing avoidable, more serious conditions or even sight loss.”
“We have proved that there is a way to address patient waiting times and improve outcomes by increasing placements for optometrist higher qualification training and enabling primary care and secondary care teams to work together. We could not have done this without the tireless work and enthusiasm from optometry practices, Cardiff University and hospital teams,” she continued.
Considering how the wider profession might benefit from a service of this kind, Bulpin said: “This type of joined-up working is essential to make sure that patients are being treated in the right place, by the right experts and that we make the best use of the technology.”
“We need to release capacity within hospital services to enable consultants to treat the more complex patients in urgent need and support the upskilling of optometrists to assess and treat patients in primary care to an agreed treatment plan.”
This type of joined-up working is essential to make sure that patients are being treated in the right place, by the right experts and that we make the best use of the technology
Being recognised by the AOP through the Excellence in community-led eye care award is “humbling,” Beatty said.
Bulpin described being “very proud and extremely surprised” when he learnt of the AOP recognition, adding: “It is wonderful to be able to showcase the initiative and collaborative working between teams that has supported the eye care of the residents in Cardiff and the Vale of Glamorgan.”
“As a patient of the eye service myself, it is particularly rewarding to be recognised by the AOP for the work in addressing the ‘perfect storm’ in our local ophthalmic services today,” he said.
“Being recognised by the AOP for our work to improve care for other patients is incredibly rewarding,” he said.
Being a team player means…
Sharon Beatty: A team consisting of both secondary care and primary care is the essential platform to build upon delivering ‘shared care’
For me, great patient care requires…
Sharon Beatty: The patient to be seen in the right place at the right time by the right person
My most memorable moment from the project was…
Gareth Bulpin: During COVID-19 when we limited our Hospital Emergency Eye Care Clinic and four days later mobilised the local independent prescribing optometrists to treat those local patients in primary care taking referrals from the other primary care practices following initial assessment. We then digitally connected five optometry practices to assess local glaucoma patients within a month of Welsh government lockdown.
Cardiff and Value University Health Board Primary Care Optometry and Secondary Care Glaucoma Teams received the AOP’s Recognising excellence in community-led care award at the AOP Excellence in eye care reception, headline sponsored by CooperVision and hosted on the Sunborn Yacht, London on 26 February. The award was sponsored by Specsavers.