1. Intermediate Care Ophthalmology Service Debbie Raven, COO Dr Lyn Jenkins, Clinical Director West Hertfordshire 1 st October 2008

2. The Practice - company overview Founded in 2005 by two NHS clinicians, headquartered in Gt. Missenden, Bucks and employs 100+ Delivers innovative community based healthcare for the NHS straddling primary and secondary care Pioneered provision of Intermediate care ophthalmology services and now the UK’s leading provider. Provides ophthalmology services for Bucks, E & W Berks, W Herts, Kingston, Wiltshire and shortly Harrow Also other specialist clinical services for GPs, the MOD and PCTs - Dermatology, Sexual Health, Urgent Care and Admission avoidance, and Secure Health Operates a network of GP surgeries

3. Ophthalmic Intermediate Care Why refer How to refer What to refer

4. Service background Set up by Dr Lyn Jenkins −GP −30yrs in ophthalmic primary care −23yrs providing retinopathy treatment Commissioned in Bucks for 8+ yrs Became part of The Practice in 2006 Now covers 4 counties & 2 London boroughs Employ 12 ophthalmologists, 4 optometrists, 1 GPwSi, 1 orthoptist, 10 ‘back office’ Experience shows 60-70% cases managed in primary care, 10% referred to HES

5. Assured service delivery All clinicians specifically trained in the delivery of Ophthalmic Primary Care Triaged same day Waiting times max 4 weeks Integrated IT system Comprehensive data reporting meets 18 wk pathway

6. Patient benefits Waiting times less than four weeks Accessible, community based clinics Choice of local clinics Excellent patient feedback All patients seen by experienced staff Service sensitive to patient needs

7. Aug 2008 99% patients reported no problems with making an appointment 90% patients were seen on time 96% patients felt they had enough time with a clinician and their case was discussed adequately with them 72% rated the clinic environment as excellent; 24% as good Patient satisfaction results

8. West Herts appointments

9. W Herts referrals May-Aug 08

10. HES referrals Jan – Aug 2008

11. Referral time

12. Where? Hertsmere PBC Potters Bar  Community Hospital Elstree & Bushey Heath  Schopwick Surgery Borehamwood  The Grove Radlett  Red House StahCom St Albans  Midway Surgery  Highfield Surgery  Parkbury Surgery  Hertfordshire Clinic London Colney  45 Kings Road Harpenden  Memorial Hospital DacCom Tring  Rothschild House Surgery WatCom Watford  tbc

13. How to refer? GPs/Optoms refer directly to: The Practice Ophthalmology Service −Fax 01494 473169 −Post to The Practice Ophthalmology Service, Lynton House, 43 London Road, High Wycombe, Bucks HP11 1BP −email to: deborah.maxwell@nhs.netdeborah.maxwell@nhs.net Triage same day Appointment Or Onward referred to HES via Choose and Book Letter to GP within 10 working days

14. NOTE WATCOM: No direct referrals from Optoms but via GP

15. Presenting complaint – what we see Flashing lights/floaters 25% Glaucoma 20% Blurred vision17% Red eye 10% Dry eye/pain 7% Lid lesion 5% CL 3% Other – mac/conj/cat 13%

16. What to refer? (glaucoma type)

17. What to refer? (refer to full list in leaflet) Red eye Discomfort Visual disturbance Watering

18. What not to refer? Minor red eye conditions manage by GP in primary care

19. What not to refer? Emergencies (<48 hrs) Send to A&E In patient surgery or laser Cataract surgery Under 16s Refer to HES

20. What not to refer? Diabetic retinopathy Retinal detachment Macular degeneration (with recent visual symptoms) Contact lens keratitis

21. Information from referrer Presenting complaint Past ocular history (squint, eye operations, trauma, contact lenses etc) Past medical history including drugs Abnormal findings GOS 18 when available, fully completed

22. Thank you on behalf of The Practice