MINUTES of LOC MEETING MONDAY 19Thnovember 2012

MINUTES OF LOC MEETING MONDAY 19thNOVEMBER 2012

Attendees:David McGowan (DM), Dylan Barton (DB), Ian McGarvey (IM), Madeleine Norton (MN), Lyn Daly (LD),Viki Price (VP), Fred Howard (FH), Chris Houghton (CH),Pam Harris(PH), Shane Canning (SC).

Apologies:Ken Roberts (KR), Peter Ball (PB).

Minutes:No matters arising.

Proposed:DBSeconded:FH

Glaucoma Referral Refinement

The PCT are funding Defibrillators and Pachymeters for practices participating in Glaucoma Referral Refinement.There will be one pachymeter per practice. The pachymeter will allow us to do ST 2 of Glaucoma Refinement and will raise the standard of Optometry in Wirral. The PCT are also funding first aid courses at Wirral Met. SC suggested a 1 day course for first aid and an add-on for those willing to use the defibrillator.

Wirral NHSadvertised bids for Any Qualified Provider in Cheshire for Glaucoma Referral refinement.

There have been complaints about follow up appointments in the Glaucoma clinic at Arrowe Park – patients are becoming anxious that their condition could be deteriorating. A letter of concern has been sent into the Primary Care Trust and Local Medical Committee from FH and Gary Price (Wirral Community NHS Trust)highlighting the need to start re-directing patients to another provider (eg Wirral Vision).

Low Vision

The price list does not include postage (at least £5 per item).

FH suggested options such as the PCT/supplier could post direct to patients, we could utilise spare stock or have a bulk order delivered to a central practice to reduce postage costs.

FH reminded the LOC that there would be changes at the PCT after March.

DRSS

FH commented that Optimize has been running in other areas so it could be expected to deliver a robust system which did not seem to be the case.

LD said they had told her that issues with service were caused by network problems in Wirral.

FH had reported issues of poor performance of Optimize to Amanda Grange at the National Screening Committee. She replied that the NSC was not able to take action against Digital Healthcare as they are a private company.

SC had a serious complaint against Digital Healthcare and WHISas they had lost the patient database at Specsavers.

CH also reported that iCAP (image capture software) was lost off his computer when Digital Healthcare took the old Orion software off. He had to shout at Digital Healthcare to get sorted.

LD and DM both found that they could not get into NHS net since Digital Healthcare Been installed.

FH reiterated that practices are supposed to have a dedicated computer for DRSS; however we would all agree that we were not happy withthe service from Wirral Health Informatics Service (WHIS) or with Optimize, so would need as much information as possible in order to write a complaint.

FH informed the committee that some DRSS patients were to be reviewed more frequently in a Virtual Photographic Clinic (OPDR). Mr Kumar was adamant that he wants to see these patients in hospital and that he wants them reviewed withOCT. The CCGs were not happy and the NSC says OCT is not a necessity and it would be up to the local pathway.

Cataracts

FH asked if there were anyone had experienced problems with cataract referral. SC replied that he had noticed poor outcomes including increased incidences of macula oedema with patients treated by Spa Medica.

FH stated that the Clinical Commissioning Groups want data from April to judge efficacy of cataract referralso it would be useful to record the number of patients we triage out. Perhaps we could log this during January, February and March.

Som Prasad was out of action for the time being.

FH informed the committee that anyone qualified after 2006 does not need slit lamp accreditation as indirect ophthalmoscopy is a core competency. He added that as a committee we should be able to accredit any new participants in the cataract scheme.

SC suggested that as Peter Ball is a college examiner could we decide that he could accredit new participants. FH would ask PB to do SL accreditation as there were people waiting to do the WOPEC exams and Arrowe Park was too busy to carry out accreditation.

Community Ophthalmology

FH informed the LOC that a Consultant led clinic was to open in Heswall clinic, run by Wirral Vision.

So far about 400-500 patients werebeing seenin Field Road per month and 100 in community Optometrists.

Work needed to be done to improve pathways particularly to ensure that non-participating practices and GPs are aware of local protocols.SC asked for a protocol for flashes and floaters, at moment Specsavers would examine patients with Volk as per college guidelines, then refer onto optometrists in the community ophthalmology scheme. He advised the LOC to be aware college guidelines were about to change. VP was now doing flashes and floaters. Wirral Vision cannot see flashes and floaters, although the information leaflets erroneously say they can.

The Local Medical Committee has asked for GOS 18 referrals to be sent electronically. If this happens we should tell the GP where the referral should go to. FH added that GPs want to keep as much activity out of hospital as possible.

Data amassed from the Community Ophthalmology scheme revealed that only 30 inappropriate referrals had occurred out of 1200 referrals. The objective was less than 10%, the scheme had achieved 0.25%.

FH put forward the case for dealing direct with the Public Health and Health and Well Being Boards. FH voiced concern that the Community Trust had looked at setting up a one stop shop for diabetes to overcome the issue of poor uptake in Dr Mantgani’s surgery as this could dissolve the DRS Service.

NOC Report

FH reported that the message from the NOC was that data was very important to back up the worth of enhanced services.

There was a 20% reduction in the LOC Levy from 0.5% to 0.4%.

The NOC suggested that each LOC should form a limited company which needs to be able to respond to AQPs (Any Qualified Provider) in a hurry.

An issue facing limited companies could be compliance with the Care Quality Commission once services are being run by the CCGs. Significant costs could be incurred.

The LOC should now be making representations to the Health and Well Being Board, but should be well received as this is being chaired by Dr Mukherjee.

The current 50 health clusters were to reduce to 27 Local Area Teams (LAT). All national schemes eg. DRSS could not be commissioned by CCGs, but from the commissioning board.

LOCs should be forming links with Joint Strategic Needs.

There would be 1 LPN (Local Professional Network) per LAT which would mean far less representation in future.

The NOC suggested evaluating service, auditing own clinics, carrying out patient satisfaction surveys and conducting peer review.

LOC Cluster

FH suggested that Webstar was being put forward by the LOC cluster to make claims but this could be expensive and no better than the local claim form. He went on to say that if we can e-mail GOS 18 referrals and produce better protocols there should be no reason why other areas should not follow our schemes. He had given the other LOCs copies of our SLAs and so far no action had occurred.

DM added that at the cluster meetings the other LOCs did not seem to want to adopt the Wirral schemes even though they were working successfully.

AOB

SC promoted the College of Optometrists educational event at Haydock on 13th December. He reminded the LOC that peer review was to become part of College registration and had done both LOCSU and Specsavers Peer Review training. Peer review was pretty straightforward but worthwhile and needs the LOC to get behind and fund. FH suggested splitting the LOC into 2 groups and doing peer review within the LOC first, then rolling out to Wirral optometrists later.

SC, FH and LD would look into Joint Strategic Needs.