VISION 2020 UK PRIMARY CARE GROUP
MEETING 14TH DECEMBER 2011 at St. Dunstan’s 11.00 am
CHAIR Wendy Franks
MINUTES Richard Wormald
Minutes
1. WELCOME AND APOLOGIES
WAF welcomed Heather Waterman, Mike Brace, Roger Buckley, Anita Lightstone, Richard Wormald, Jane Bell and Lesley-Anne Baxter (replacing Rosie Auld from the British Orthoptic Association). Apologies were received from Nick Astbury and John Lawrenson. Andrew Partner (GP) has stood down from the Eye Care Services Steering Group and is no longer an option to represent general practice. MB agreed to write to Clare Gerada at the Royal College of GP’s to seek an alternative member of the group. Waqaar Shah or Thien Win were suggested as possible nominees. Robert Harper from Manchester has agreed to join but we have still neglected to include him on the circulation list for this meeting. We will be sure to invite him to the next. (Action MB)
2. APPROVAL OF MINUTES
Minutes of the meeting in June were approved as accurate.
3. MATTERS ARISING
a. CMG’s
WAF confirmed the 61 existing CMG’s had now been endorsed by the Professional Standards Committee of the RCOphth.
The current task of updating continues those for the most common conditions. The new versions use the simpler most recent version of the Oxford Evidence Grading System and 44 have been reformatted, proof read and checked.
The remaining 15 titles mainly on posterior segment conditions are not likely to be completed without additional funding from the College of Optometrists. It was suggested that as a first step RB and JL approach the College of Optoms (CO) to ask if further funding might be forthcoming. If this is the case, advice from the RCOphth’s professional standards committee chaired by Graham Kirkby could be sought for suitable expertise to deal the predominantly posterior segment issues. The simple template used for the CMG’s should help reduce the apparent burden of the task. (action RB/JL).
NHS evidence accreditation is now under the authority of NICE and is no mean task. RB commented that he did not want to initiate the process without confidence it would succeed since failure would be major set back. Declaration of conflicts of interest would be required and would include where the funding had come from.
b. Map of Medicine
The five pathways remain on the web and may require updating. There had been no contact from MoM until very recently when the RCOphth had been approached. A meeting has been arranged in the near future and an update of this activity will be provided at the next meeting. It was noted that MoM is connected to the “Right care” Initiative led by Sir Muir Gray. MoM had been approached about producing a low vision pathway but they had indicated this would have to be paid for. Ths may change since Muir Gray has indicated a low vision pathway may be needed.
c. Primary Care Document for the RCO
The document written by Richard Smith and published on the RCOphth’s website in 2005 was circulated as requested prior to the meeting. It was agreed an update was needed but the idea of commissioning a document as suggested at the previous meeting had not progressed. Instead we agreed to modify the existing table of the proposed organization of eye care which had been appended to Richard Smith’s original document. Each member of the PCG agreed to produce an annotation to this table indicating where their respective professional groups contribute. (Actions – RW to modify table, JB/JL to indicate LOCSU role and College of optoms, L-AB – Orthoptics, HW – Nursing, RJB/RW Ophthalmology etc – GPs and OMP’s to follow). We agreed to change the title of the overall description of to Primary and Community Eye Care. The first three tiers are
i. Primary Eye Care – first contact with eye care services
ii. Enhanced Primary Eye Care
iii. Community based ophthalmology and Low vision services – interface between primary and secondary care
then
iv. Secondary care
v. Tertiary care
vi. National or regional centers
Critical to all these tiers is where the margins fall for funding sources – eg the GOS budget is negotiated nationally but everything else locally.
One thrust of Richard Smith’s document was to propose that Primary Care Ophthalmology should become an accredited sub-specialty in Ophthalmology but all agreed that this idea had not taken off. RW commented that all subspecialties in eye care had a primary care oriented front end. In practice, this is being implemented at Moorfields with Consultants from specialist services having an A and E and primary care role – for glaucoma detection and management of acute disease, for Medical Retina, DR screening etc etc.
A point made strongly by L-AB and others was that eye care needs to remain integrated with other medical specialties eg in stroke care and in integrated care of the diabetic.
d. Outstanding Actions
The action on the need to collect and collate information about successful models of care around the country remains. HW, JB and L-AB agreed on the need to do this and now audits on quality and outcomes are usually being included in new model. There is still no clear repository for this information and RW had been in contact with Carol Hawley from Warwick University and it did not appear that any summary or systematic review of different models is yet published. (Action HW, L-AB and JB)
RW mentioned Gokuloraj Ratnarajan, a HIACE fellow in North London who is writing an MD thesis on co-management and referral refinement models for glaucoma in North London which includes a systematic review of the literature. His MD is registered with UCL and is being co-supervised by Prof Rupert Bourne of Anglia Ruskin University and RW. RW suggested inviting him to join the PCG and there was general agreement this should be so. (action RW)
The status of JL’s review work was unclear and will be brought up again at the next meeting. Carol Hawley is also considering the possibility of a Cochrane systematic review on the topic. (Action RW/JL)
Another Action carried over from the previous meeting but not discussed at this meeting was on equity. The RNIB has commissioned research on inequity in 4 inner city areas – Bradford, Cardiff, Belfast and Hackney – which is ongoing. We agreed to invite the RNIB to present the findings of this research to our next meeting. (ACTION AL)
4. NATIONAL EYE CARE STEERING COMMITTEE UPDATE - WAF
WAF had recently attended a meeting of this group chaired for the first time by Elizabeth Lyneham. A presentation planned for the meeting was changed apparently at short notice but there was still a lengthy presentation from John Barlow from the National Commissioning Board giving a broad view on how commissioning was going to work after the implementation of the NHS reforms in April. (A copy of this presentation is attached for interest to the minutes.) However there was little detail relevant to our interests and concerns and Elizabeth Lyneham was concentrating on the GOS contract which seemed to be the total extent of the thinking on eye care commissioning. The next meeting is planned for May when Graham Kirkby of the Prof Standards committee of the RCOphth will take over WAF’s role. Graham K will also presumably be invited to take over her role on the England implementation group.
5. CO-CHAIR OF THE GROUP
WAF announced her intention to stand down from the co-chairmanship of the group and RW invited a volunteer to succeed her. L-AB kindly did so to the approval of all other members present. The question of who will “feedback” to the Colleges of Ophthalmology and Optometry was left uncertain but suggestions that Gok R for the RCO and Robert H for the CO might work if both could be in a position to do so. WAF will suggest this to Graham K at the RCO and we will enquire whether Robert H will be able to to this for the CO at the next meeting. The group warmly thanked WAF for her role as co-chair and wished her a very contented retirement.
6. FUTURE OF THE GROUP – RESPONSE TO BOSANQUET
RW asked the group about their views on the continuing role of the group and all asserted the strong view that we should continue with our efforts. In the light of previous discussions on the structure of Eye Care, a new title for the group was explored. The CAPEC group was suggested – for Community and primary eye care group.
RW stated that he remained concerned about one of the primary roles of the group as he understood it to be – the issue of equity –inequalities that persist in access to and uptake of eye care and prevention of avoidable blindness in the modern NHS. This was why he felt there was still a need for a public response to both Bosanquet reports especially the most recent which claims current arrangements provide cost effectiveness and equity. WAF pointed out that Richard Smith on behalf of the RCOphth had written a coherent and comprehensive response and members of the group felt this had done the job. This document is publicly accessible on the RCO website . RW stated he did not consider this response to be sufficiently assertive in dealing with issue of equity and proposed to write another piece and seek publication in a political journal such as the New Statesman or Spectator.
7. AOB
RB asked the group to congratulate MB on his appointment as Honorary Fellow to the RCO and also Fellow in Business Administration at Anglia Ruskin University. MB announced he too will be retiring in June and Matt Broom will be taking his place. The group warmly thanked MB for all his work for VISION2020UK and the PCG.
8. NEXT MEETING
13th June 2012 RNIB or AOP new offices in Woodbridge Street – venue to be confirmed.