Using local service user and carer experience to shape the future of eye care services

Improving Eye Care in Dorset

Improving eye care (ophthalmology) services has been identified as a priority area within Dorset to meet significant and increasing pressures on services. These pressures are evident both locally and nationally with demand rising fast as life expectancy increases, and with it the prevalence of eye disease.  Due to this NHS England also deemed ophthalmology services to be a priority for transformation. From 2019 local areas, such as Dorset, have been challenged to develop innovative solutions to deliver safe, sustainable and equitable services that can meet the increasing demand within current budgets.

Within Dorset our population of those aged 65+ is higher than the national average, leading to additional demand. In addition, the services provided currently differ by area, with service provision being less developed within the rural North and West of the county than within the more densely populated East of Dorset. These factors have led to long waiting times, inequity of access, and low patient satisfaction.

Action taken to date on resolving the issues within eye care services has seen Dorset taking part in the “100-day challenge”, which led to the creation of a successful patient decision-aid tool for cataract operations. We also had a review of our eye care services undertaken with clinical input from Moorfield’s Eye Hospital- one of the leading eye hospitals in the country – to recommend improvements we could implement across the services. The Dorset Clinical Commissioning Group approved the recommendations report in December 2019, and shortly afterwards we set up a local Eye Care Board including managers and clinicians from local providers, along with primary care optometrist representation, to drive forwards embedding the recommendations. After a pause due to Covid19, the programme of work was restarted, with new challenges and capacity issues due to the pandemic to overcome.

The Focus and Aims of the Eye Care Programme

The eye care programme has several defined functions, broken down into project areas. The focus and aims of these are:

Minor eye conditions and emergency care:

  • Improving access for patients with minor eye conditions
  • Where appropriate, empowering patients to undertake self-care
  • Promoting the correct use of resources and services to increase the capacity for emergency condition treatment in our eye emergency departments
  • Providing equitable services across the county

Glaucoma care:

  • Reducing waiting times and the backlog of patients (first and follow-up appointments)
  • Better use of resources- including lower risk patients being seen in the community to increasing capacity and decrease waiting times for higher risk patients requiring hospital care
  • Improving patient’s knowledge of their condition, and adherence to medication regimes
  • Improving parity of access across the county

Cataract care:

  • Decreasing the number of patients on the waiting lists for surgery, leading to shorter waiting times
  • Embedding patient information and decision aids across the County to ensure everyone has the same access to appropriate information
  • Embedding community post-operative appointments across the county for low-risk patients to free-up hospital time and capacity and decrease unnecessary travel time for patients.

Macula care:

  • Ensuring all urgent cases are seen within the national guidance (National Institute for Clinical Excellence – NICE) recommended time limit through a decrease in inappropriate referrals
  • Improving joint working, enabling community monitoring of patients not requiring injection to increase capacity in hospitals and improve patient experience through care closer to home

The programme of work is also a focussed on ensuring a continuation of high standard community ophthalmology services for patients when the current service contract comes to an end in 2022.

Throughout these projects we are also looking at how we can maximise our workforce, get the best value for patients and our population, improve data flows to ensure the right access to information when it is needed to support care, and improve the overall patient experience.

Patient and Carer Feedback

The aims above have been informed by both data (including service feedback) and the service review. To supplement and verify this information from a service user perspective we undertook engagement events and surveys to gather further feedback. This has highlighted the areas which are a priority for patients. The main findings are detailed below, along with different solutions that are being explored in order to address the issues raised.

Access to the same clinician- better continuity of care

What the feedback told us:

Service users would like to see the same clinician when they have an appointment. Seeing a different clinician each time increased the time they had to spend explaining their condition and experiences, and decreased the confidence they had in their care. Some service users felt that this was linked to there not being a sufficient ophthalmology workforce within hospitals.

Potential resolutions:

  • Easing pressures on hospital services through use of community care for lower risk patients
  • Improving information databases and transfer so when a patient does need to see a different clinician, they do not have to repeat their story
  • Supporting the appointment of additional clinicians

Understanding of the role of carers, enabling them to attend appointments

What the feedback told us:

There are disparities between clinicians and services in the inclusion of carers within appointments, and the sharing of information. Carer involvement is seen as a key need for the patient to understand the information given and for holistic care.

Potential resolutions:

  • Reviewing the policy for carers with each provider
  • Learning events/ information for staff
  • Ensuring that a patient’s holistic needs are still met amid social distancing measures, with a patient focussed approach

More provisions for the early detection and monitoring of eye disease

What the feedback told us:

People would like there to be more provisions for early detection of diseases where possible, and have regular and timely checks of their eyes when eye disease is present to avoid deterioration.

Potential resolutions:

  • Maximising services to make the best use of resources to free up appointment capacity
  • Risk stratification of patients to ensure that those with the most need are prioritised throughout the pandemic and beyond
  • Research indicates that early detection programmes for glaucoma carry very little additional benefit for the resources required, however there is potential to increase patient understanding of eye diseases, risk factors and what they can do to protect their sight, including regular eye tests (including information about NHS funding for eye tests)

More trained clinicians to meet the demand

What the feedback told us:

Service users are aware of the strain on services, and are experiencing it through appointment delays. Patients would like there to be an increase in trained clinicians that they trust to undertake their care.

Potential resolutions:

  • Supporting the appointment of clinicians across the county
  • Upskilling of staff through support of training programmes and joint learning
  • Appointment of staff on a cross-county basis to increase learning opportunities

Improved appointment arrangement

What the feedback told us:

Service users would like appointments to be available and arranged in line their consultant’s recommended regularity, without patients needing to contact and prompt eye units to book these. Many service users would like to receive information regarding these appointments digitally.

Potential resolutions:

  • Best use of resources to reduce the backlog of appointments
  • Consideration of digital solutions to assist with patient management, with choice of format for the patient

Patient choice

What the feedback told us:

Different people had differing views on acceptable times and locations of appointments. Patients would like more control over appointment times that work for them.

Potential resolutions:

  • Use of the independent sector to increase capacity and patient choice of locations
  • Better use of digital to enable choice of appointment times for follow-up appointments

Information sharing

What the feedback told us:

Patients are still having to repeat their story between clinicians and services, and would like information processes to be more joined up to combat this. There should be better embedding of the Dorset Care Record, with access for patients to information about their care. Patients would like more choice over how they receive information. Information on conditions and what to expect should be available outside of appointments when they are better able to view and digest this information.

Potential resolutions:

  • Consideration of digital needs for information sharing across different providers, and primary, secondary and community care
  • Input into the development of the Dorset Care Record and the patient-facing uses of this
  • Development of processes to enable patients to choose how they receive information- with the relevant information governance procedures to enable this
  • Development of patient information, accessible outside of appointments and through screen-reader technology, to help people better understand what to expect from appointments and procedures; and increase understanding of eye diseases.

In addition to the areas above, several key themes were identified during patient and carer engagement, which we commit to considering throughout the programme of work to ensure any changes made effect patients positively. These areas are:

Holistic needs and care environment

Suitability of care

Speed and efficiency of care

Access to services

Communication

Proposed Timeline, Including Next Steps

Further Information

For further information about our providers and eye conditions please click on the links below:

If you would like further information about the programme of work including information on getting involved as a patient or carer represenative, or would like a copy of the full thematic analysis undertaken of engagement, please contact sally.horton@dorsetccg.nhs.uk.