Convincing the commissioners
If optometry is the brand, then the Local Optical Committee Support Unit is the product development team, Richard Whittington tells OT
29 May 2018
In optometry, as in other professions, there can be a temptation to switch off when you clock out. Work is contained within four walls and rostered hours, while big picture thinking may not always be a priority. However, progress relies on people taking a step back from the task at hand. This creates the room to consider how systems and people can work better, not harder.
For this reason, the work of the Local Optical Committee Support Unit (LOCSU) in tackling the big questions that face the optical profession is key.
LOCSU’s chief operating officer, Richard Whittington (pictured), told OT that if optometry is thought of as a brand, then LOCSU is the product development team. “In one way, it’s an intelligence unit, spotting changes and trends in NHS commissioning and advising Local Optical Committees (LOCs) on the most effective way, both clinically and operationally, to pitch our offer,” he explained.
He emphasised that reform is an ever-present reality of working with the NHS. “Primary care must be agile in the delivery of eye care; reacting, repackaging and redefining itself, mirroring new structures and new vocabulary in commissioning,” Mr Whittington observed.
The latest seismic shift on the commissioning horizon that LOCSU have prepared for is the introduction of Integrated Care Systems.
Mr Whittington explained that this “next big wave of reform” will see a population-level approach to commissioning.
“We have already seen a slowing down of commissioning and where procurement is taking place, it is on a much larger scale,” he elaborated.
In response to this trend, LOCSU has worked to consolidate Primary Eyecare Companies (PECs).
This offers the NHS and patients a more consistent clinical service, while also streamlining the business model and lowering costs for LOCs, Mr Whittington highlighted.
He added that the appointment of Christiane Shrimpton as part-time director of ophthalmology at LOCSU will help to facilitate closer relationships between NHS Trusts and the community eye care sector.
“The real benefit to patients and the NHS is where we can have patients seen by the appropriate professional while also reducing pressure on the hospital eye service,” Mr Whittington highlighted.
An agreement between LOCSU and Newmedica offering post-cataract follow-up treatment in optical practices is the first of what Mr Whittington hopes will be a number of partnerships between PECs and ophthalmic providers.
Mr Whittington highlighted his belief that this will ultimately “cement optical practices as the first port of call for eye health.”
“PECs face strong competition in the field. But the strategic journey we are on should go a long way to securing the optometry brand with NHS commissioners and the general public,” he concluded.
Broadening LOCSU’s clinical base
LOCSU recently appointed a new part-time director of ophthalmology.
Streamlining for success
AOP councillor and chief officer of PEC North, Dharmesh Patel, explains how the consolidation of Primary Eyecare Companies helps the optical profession to gain traction
The Primary Eyecare Company (PEC) model has played a huge role in the success of the sector.
It has been widely embraced by Local Optical Committees and ensures that practices of any size can be involved in delivering a range of extended eyecare services. Originally, a PEC was established for each of the 75-plus LOCs.
But the rise of the regional PEC has led to a consolidation process.
This means that while the LOC remains responsible for commissioning discussions, the PEC is responsible for contract delivery.
The arrival of Integrated Care Organisations (ICOs) is driving the current consolidation of PECs, a process which will enable the sector to more easily standardise models of service delivery, reduce administrative costs and improve consistency.
This has been embraced nationally which will put PECs on a stable footing to deliver services in the future.
Evidence shows that the PEC approach brings credibility and efficiency to commissioners.
Collectively, the sector has established that community practices are best placed to provide local eye care services while taking pressure off the NHS. We now need to ensure that the PECs continue to be recognised as the best option for the delivery of such services.
I am the chief officer of PEC North, which covers 22 LOCs across the North West, North East & Cumbria, South Yorkshire & Bassetlaw and West Yorkshire.
In effect, we cover eight of the nine Sustainable Transformation Partnerships in the North region. We have a unified approach in terms of our contracting model, our clinical model and our cost mode.
It is the sheer scale; the geography, the coverage with both urban and rural practices of all sizes, the demographics of the patient population covered and the range of services offered that makes the consolidated PEC a model for the moment.
Ms Shrimpton brings with her hands-on experience of service redesign. She helped lead major NHS reforms which saw 6000 appointments move from hospital to optical practices in its first year as part of the Better Care Together Initiative in Morecambe Bay.
Ms Shrimpton’s experience will help LOCSU develop the offer that the community optical sector can provide to the NHS.
The reform of NHS delivery and the introduction of population-level, integrated care is a huge opportunity to reduce pressures on the hospital eye services by moving minor eye conditions and routine monitoring of stable conditions into primary care.
Helping to develop community-based pathways should assist both LOCs and PECs in building closer relationships and integrated working with ophthalmology departments.
The message to commissioners that community optical practices can help streamline eye health services for the patient and make them more cost-effective for the NHS will make our bids more credible and attractive
Ms Shrimpton explains: “Eye health is vital and has a wider role to play in the health of the population Having experience of a population-based approach to pathway redesign and working across organisational boundaries to make community eye services both cost-effective and more convenient for patients is at the heart of both health reform and improvement. I look forward to working with the community sector to ensure it is part of the solution to reducing hospital pressures.”
Delivering to the NHS and patients
Matt Jinkinson is an optometrist in his family run independent opticians in Stockport and the chair of Stockport LOC.
Having been finance director of GM Primary Eyecare, Greater Manchester's regional LOC company, Mr Jinkinson was appointed chief finance officer within one of the consolidated PECs in England.
With a turnover of around £3.5 million, Mr Jinkinson is responsible for the financial effectiveness of PEC North.
"As a yardstick, the MECS delivered by PEC North covers more than 10 million people and, in 2016–17, amounted to an annual activity of 30,000," Mr Jinkinson explained, adding: "It’s my role to ensure the money keeps flowing and to ensure fees are to the maximum benefit for practices by efficient budgeting of the company."
He Jinkinson continued: “I am very aware that the quicker the CCGs pay; the quicker practices receive their money, so we have processes in place between myself and the service co-ordinator to monitor the payment activity and chase where required.
“PEC North runs a basket of services including cataract, glaucoma, OHT, MECS, low vision, children’s cycloplegic refractions and enhanced sight tests for people with learning disabilities.
“My duties take up around a day per week in total, similar that of the chief operational officer and chief governance officer leads that make up the operational team of the company.
“PEC North has nine clinical governance and performance leads (CGPLs) who have access to the live data from the services and are responsible for monitoring the KPIs in the contract to both the CCG and the company.
“The CGPLs are normally engaged between half a day to two days per week on these duties depending on the area and services they cover. Our PEC also uses a service co-ordinator to ensure that administration functions and support is not having to be carried out by CGPLs. This ensures effective use of their time on clinical and service performance matters. Our structure means there is a separation between LOC and PEC personnel. Each LOC has a liaison officer.
“In addition to interpreting the data, CGPLs have an important role engaging with participating practices and monitoring outliers and low activity services. Another vital role is communication and publicity; connecting with signposting partners in general practice and pharmacy and helping practices communicate with patient.
“We provide quarterly and six-monthly reports to the PEC and to each LOC.”