Description of the goods or services required
Hywel Dda University Health board has a tender requirement for primary care optometric practices to provide glaucoma ODTC services within the health board.
Currently, in HDUHB there are around 7500 patients (new and follow ups not booked) waiting for glaucoma appointments within secondary care. Covid has resulted in increase in those on the waiting list and decreased secondary care capacity. However, there is a geographically spread primary care optometric workforce, many with required qualifications and specialist equipment required to act as ODTCs.
Clinical risk stratification is currently under way to determine whether these patients need to be seen in; consultant Hospital Eye Services (HES), general HES, primary care optometric practice based ODTC, or primary care optometric practice-based data capture.
Around 1,456 patients will be suitable for primary care optometric practice ODTC.
The aim of this tender for the primary care based ODTCs, is to increase the numbers of patients with glaucoma, OHT, or suspect disease, seen closer to home, in a timely manner within the primary care optometric setting. This will decrease secondary care waiting lists and free up capacity within the secondary care setting, allowing patients that are suitable only for secondary care to access the most appropriate HES clinic in a timely manner.
Description of Service
Criteria
The assessment and management of patients identified as requiring a new glaucoma assessment. Patients will be referred into the pathway from scheduled/planned Care.
Standard Procedures
Assessment
Each patient will receive a glaucoma assessment, performed by an EHEW accredited optometrist holding a Higher Certificate in Glaucoma, using procedures similar to the mandatory procedures for Eye Health Examination Wales Band 1, to include:
• Detailed history including current symptoms and/or complaints with details of topical medications and dose and risk factors
• A visual field examination of each eye using a Humphrey Visual Field Analyser using the SITA 24-2 SITA Fast programme or Standard programme
• Vision measurements (with current glasses or latest refraction, & pinhole).
• Pupil assessment including an RAPD check
• A slit lamp examination of the anterior segment.
• An assessment of central corneal thickness (corneal pachymetry)
• An assessment of the iridocorneal angle via OCT (Anterion 1300nm OCT if available)
• Applanation tonometry (Goldmann)
• Optic disc-Macular OCT (pupil dilation if required)
• Other procedures at the discretion of the examining optometrist or OMP.
A copy of the clinical record should be kept in the practice (either hard copy or electronically) as a contemporary record and another copy returned to the hospital for review using the ODTC reporting form (Annexe 1), together with copies of visual fields and OCT findings. A decision regarding the urgency of assessment required in the HES must also be included.
If a patient presents with an eye problem that needs urgent (within 24 hours) attention then the appointment should be rescheduled and an EHEW Band 1 acute examination should be offered at the discretion of the optometrist.
Reporting
All relevant findings and information to be reported to the appropriate individuals/organisations as per local protocols. Local protocols are determined by the Health Boards through their Eye Care Collaborative Groups.
Essential Equipment
The essential equipment required to participate in this service is:
• Slit lamp (Service provider to supply)
• Volk, or similar lens for Binocular Indirect Ophthalmoscopy (BIO) (Service provider to supply)
• Humphrey Visual Field Analyzer (740 and above) (Service provider to supply)
• Applanation Tonometry (Goldmann) (Service provider to supply)
• OCT (SPECTRALIS - Heidelberg Engineering, Spirit- Heidelberg Engineering, CIRRUS HD-OCT-Zeiss, 3D OCT-1 Maestro- Topcon, DRI OCT Triton swept source OCT- Topcon, Scan Duo OCT-Nidek, or up to date equivalent) (Service provider to supply)
Pathway & Standard Operating Procedure
Scheduled Care to send a copy of patient referral details and relevant clinical information to the ODTC provider, as per locally determined protocols.
ODTC provider to contact patient within locally agreed timeframe and make the necessary appointment arrangements either by telephone or by letter.
On completion of glaucoma assessment, the provider is to complete the relevant section in OpenEyes (Electronic Patient Record), if available in the provider’s Health Board, including a decision regarding the urgency of assessment required in the HES, and attach any images to the report. If OpenEyes is not available then a copy of the glaucoma assessment record, including any images, is to be securely sent to the Glaucoma Service Coordinator. All appointments to be completed within 4 weeks of receipt of referral.
On receipt of a completed Assessment Report or DNA notification, the management decisions regarding each patient will be made by a consultant ophthalmologist/senior clinician within the Health Board and communicated to the patient, the patient’s GP and the patient’s optometrist.
Service Requirements
Providers will be expected to:
• Have appropriate professional registration (General Optical Council). They are to be a member of an appropriate professional body and operate within their professional body’s standards, regulations and codes of conduct.
• Have medical malpractice liability insurance.
• Meet all the requirements, relevant legislation and conform to the clinical standards used in the Wales Eye Care Service.
• Implement local & national referral criteria and care model where appropriate.
• Establish a positive working relationship with the Health Board, neighboring optometrists, GPs, ophthalmology consultants and staff working in the hospital setting.
• Adopt evidence–based or best practice and implement NICE guidelines where appropriate.
• The Provider will work from premises which have appropriate health and safety standards, including COSHH (Control of Substances Hazardous to Health), RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations), and Equality Act 2010 (EA 2010), especially in terms of accessible premises.
• Comply with the Health Board and Welsh Government’s guidance on delivery of optometry services.
• Provide the Health Board with information on the service as and when required.
• Participate in Audit, service evaluation and research where appropriate.
• Engage with patients, own staff, HDUHB, Regional Optometric Committee (ROC) and referring practitioners to make service improvements.
• Ensure that all staff who are General Optical Council (GOC) registered adhere to the GOC standards.
• The service provider will have the appropriate medical malpractice insurance.
• Concerns/complaints are dealt with in accordance with HDUHB Policies and “Putting Things Right”
• Attend Health Board provided training as required
NOTE: The authority is using eTenderwales to carry out this procurement process. To obtain further information record your interest on Sell2Wales at https://www.sell2wales.gov.wales/search/search_switch.aspx?ID=121548
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