What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

Current Pathway

• Patient presents to local high street optometrist.
• Following consultation and eye imagery, the optom suspects Wet Age Related Macular Degeneration (Wet AMD).
• Optom refers patient  to the local Acute Trust – usually Portsmouth Hospitals University Trust (PHU) for urgent (within 2 weeks) review.
• Patient attends PHU for review.
• Wet AMD is ruled in or out and treatment plan agreed.

The Trust receives around 2200 referrals for suspected Wet AMD per year. Around 500 of these go on to receive a diagnosis of Wet AMD requiring treatment in an acute setting.

If images could be sent with the referral, the patients could be clinically triaged using this image to support decision making.  This could result in approximately 1,700 patients who are currently being booked into urgent clinic slots being treated in an alternative more appropriate setting.

This project will pilot the use of image sharing to support virtual clinical triage.

What does your project aim to achieve?

This project will streamline the patient pathway by enabling eye image sharing and two way communication between the referrer (optom) and the specialist (PHU)  to support decision making around the most appropriate treatment plan for the patient according to their clinical urgency.

Further benefits include:

• Standardisation of the referral approach across our local delivery system
• Avoidance of unnecessary hospital  visits for patients
• Supports demand management by ensuring urgent clinic capacity is  used by those who need it
• Upskilling of local Optometrists via the two way communication feature with specialist advice from local hospital clinicians.
• Secure network for sharing images and referrals which directly feeds into patient e-records.
• Supports understanding of the business change effort needed for any further wider rollout of eRS in Optometry

How will the project be delivered?

NHS Digital are running 3-4 pilots across the country to test to use of eRS. The Portsmouth and South East Hampshire Local Delivery System is one of the pilot sites.

We will use a variety of optom settings from small independents to national optom chains. Volunteers from the optom community to take in the pilot have already been identified and the local acute Trust are engaged.

NHS Digital will provide a Subject Matter Expert alongside support for the technical implementation.

The project group will be made up of:

• ICB Transformation Manager
• ICB GP Clinical Lead
• Local optometrists
• PHU Ophthalmology Consultant
• PHU Business Manager

The initial work will focus on assessing/documenting:

• Technical (IT environment) readiness
• As-Is processes, business change and training requirements
• Engaging with receiving providers

How is your project going to share learning?

As the project leaders, NHS Digital will be able to share the project learning nationally amongst ophthalmology networks.

Sharing will also take place across ICB communications team, online  Q events and potentially poster presentation at conference

Locally, we will use the Eye Care Alliance Board and outpatient transformation platforms to share  the outcomes and lessons learned with stakeholders as they will be crucial in developing the next steps.