Enhanced Eyecare Services for Optometrists in North Staffordshire
North Staffordshire Minor Eye Conditions Service (MECS) has been re-launched to provide a comprehensive managed service for treating common eye problems by local community optometrists. MECS offers a broader scope than the previous Acute Eye pathway, enabling the management of both acute and non-acute referrals, minor eye conditions, and procedures. The purpose of MECS is to reduce unnecessary secondary care referrals and ensure efficient patient care through Primary Eyecare Services.
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MECS Guidance for Participating Optometrists North Staffs Eyecare Services Re-launch, March 2019 Author: Mark McCracken
The Acute Eye Service has been re-commissioned as North Staffordshire Minor Eye Conditions Service (MECS) Each accredited practice will have a contract with Primary Eyecare (PEC) Services Introduction PEC Services will provide an end-to-end managed service
The PEATS service was first commissioned by Stafford & Surrounds (SAS) and Cannock Chase (CC) CCGs in July 2015. It was re-commissioned as a MECS service and extended to SE Staffs and Seisdon Peninsula CCG in May 2017 Most common eye problems can be assessed and treated by local community optometrists An evaluation of Stafford and Cannock MECS by SAS and CC CCGs (January 2016) has found: Why MECS? 65% of MECS patients can be managed solely by community optometrists 13% of MECS patients can be managed by community optometrists working with GPs Only 22% need referral to the HES 100% of patients were very satisfied with the service
The Acute Eye pathway service specification of April 2008 defines the GP practice protocol for referral into the scheme, and it is quite narrow in scope. The remit of MECS is much broader than this MECS enables the triaging of not only acute referrals, but non-acute referrals also GPs can choose to send referrals from non-accredited optometrists into the service for refinement MECS vs Acute Eye Service In addition, MECS enables the treatment of minor eye conditions and also some minor eye procedures No need for a separate Adnexal pathway - most of these conditions will now fall into the remit of MECS Another important way in which MECS differs from the Acute Eye pathway is that the CCGs will now be contracting for the service via PEC Services. In this way, the CCGs hope to improve outcomes and efficiencies
The prime purpose of MECS is to reduce onwards referrals to secondary care Where referral to secondary care is required, it will be to a suitable specialist with appropriate work up, initial diagnosis and urgency MECS -Purpose There is no point in seeing these patients and then referring the majority anyway The Metastorm IT system will be monitoring this, both by practice and by practitioner.
All provision of service must be recorded on Metastorm. It s the only way you ll get paid All contacts regarding MECS should be recorded in your practice records, even if they don t result in an appointment. This is for your own protection, so that there is a record A MECS Referral Form for GPs document has been uploaded to the Map of Medicine. This will list the inclusion/exclusion criteria for the service to GPs and to their staff MECS Key Points (1) All participating MECS practices must triage the referral within 48 hours (24 hours if MECS URGENT) As a minimum, the patient will be seen by the MECS service within 14 days (MECS ROUTINE). However, urgent referrals shall be seen within 24 hours (MECS URGENT)
MECS URGENT (<= 24 hours) if... Eye red, sore/irritable: And painful And photophobic And change in vision Vision loss/Disturbance/Patient reported Field Defect/Diplopia: Of sudden onset Flashes and Floaters: Onset < 6 weeks Onset 6-12 weeks, but symptoms increased MECS ROUTINE (<= 14 days) if... Eye red, sore/irritable: And no pain, no photophobia and vision unchanged Vision loss/Disturbance/Patient reported Field Defect/Diplopia: Of gradual onset, < 3 months Flashes and Floaters: Onset 6-12 weeks, but symptoms unchanged Condition affecting the ocular adnexa/minor external eye conditions: Watery eyes Eyelid lumps and bumps Ingrowing eyelashes Dry eyes SIGHT TEST if... Patient mentions minor eye symptoms (e.g. eye irritable, but not red) during the course of a sight test Vision loss/ Disturbance/Patient reported Field Defect/Diplopia of gradual onset, > 3 months Flashes and Floaters onset > 12 weeks, and symptoms unchanged Don t forget: You can claim either a MECS fee or a sight test fee (whichever is most appropriate to patient s needs) for a single consultation, but you cannot claim both.
MECS referrals will be sent directly to your practice via GPs, via PEC Services electronic referral hub, and occasionally from non-accredited optometrists and DOs, plus self-referrals from patients You must complete a triage of referrals into your practice via a MECS reception triage form, so that referrals immediately apparent as inappropriate are sent straight to the Emergency Eye Clinic with appropriate urgency without seeing them in MECS, or bounced back to the original referrer (with comments) without seeing them in MECS MECS Key Points (2) In instances where the level of urgency is unclear, the triage should then be passed on to an accredited optometrist If the practice doesn t have the availability, then it is that practice s responsibility to find the patient an appointment from another practice in the service, within the appropriate time window It is anticipated that a relatively small percentage of patients that undergo community assessments will require follow up (just 5% in South Staffs MECS). A follow up appointment will be offered, where clinically necessary, by the accredited optometrist within 2 weeks of the initial consultation
PEC Services is providing an NHS.net address as a route into MECS for electronic referrals from GPs. A triage clinician will pick up the referral and gauge the urgency, before instructing PEC s service coordinator to fax it to one of the participating practices. MECS Electronic Referral Hub The practice would then be responsible for fitting the MECS referral into its clinics with the appropriate urgency, or finding an alternative provider if it does not have the capacity.
1) Practices would be required to confirm with Alison that they have fitted the MECS referral into its clinics with the appropriate urgency, or else found an alternative provider. Electronic Referral Hub - Failsafes 2) Alison will keep a log of electronic referrals, and chase up practices if she doesn t hear back from them. 3) If patient can t be contacted by the MECS practice, or DNA s twice, then the referring GP must be informed.
MECS TRIAGE RECORD Shropshire & Staffordshire Primary Eyecare Ltd Date Time Staff name / Referred by Where is the Patient? Practice Phone Patient Name NP / EP ID D.O.B Phone number GP Patient C/L wearer Yes / No Concern Any recent trauma Yes / No Any recent ocular surgery Yes / No Give details: CONCERN CATEGORY QUESTIONS (Please circle answer) OUTCOME Is it painful Problem with NO YES R L See within 24 hours Is there any light sensitivity? NO YES EYE (painful, red, sore, Is there a change in vision? NO YES irritated) Is the eye red? See within 14 days NO .YES Book sight test Has it come on suddenly? Problem with See within 24 hours NO YES R L VISION (Vision Loss, < 3 months See within 14 days If gradual, when did it start? Disturbance, Field of vision, Double vision) > 3 months Book sight test < 6 weeks See within 24hrs Problem with FLASHES and/or FLOATERS When did it start or when did it last change or when did it get worse 6-12 weeks See within 24hrs (symptoms increased) 6-12 weeks See within 14 days (symptoms same) Page 1
MECS TRIAGE RECORD Shropshire & Staffordshire Primary Eyecare Ltd Patient Name ID D.O.B Phone number GP Other signs & symptoms For patients with recent onset symptoms, follow the guidance on this form using the questions on the left and book an appointment appropriately. In cases of doubt speak to the Optometrist whilst the patient is still on the phone. Once you have advised the patient and booked the appointment, discuss with your MECS Optometrist at the earliest opportunity. In some individual cases the Optometrist may advise an alternative course of action, and some conditions are not suitable for MECS. If the patient is feeling generally unwell, advise them to seek medical advice or discuss with the Optometrist at the time of booking. PLEASE FORWARD THIS FORM TO THE OPTOMETRIST Notes / advice given to patient Has the patient been advised: (please circle) To remove C/Ls / Not to drive in case dilation is needed / If symptoms increase out of hours to consult A&E Outcome Confirm Appt; 24 Hrs / 14 days / Sight Test Hospital GP Other MECS Optom Pharmacy Professional advisor name & signature
Distorted vision Ocular pain Systemic disease affecting the eye Differential diagnosis of the red eye Foreign body and emergency contact lens removal (not by the fitting practitioner) Dry eye Epiphora (watery eye) Trichiasis (in growing eyelashes) Differential diagnosis of lumps and bumps in the vicinity of the eye Flashes/floaters Retinal lesions Patient reported field defects (NOT FROM SIGHT TEST) GP referrals (including referral refinement, and raised IOP/suspected raised IOP) MECS Inclusion Criteria
Sudden, persistent loss of vision <48 hours urgent to EEC (<24 hours) Sudden, persistent loss of vision >48 hours urgent to EEC (<72 hours) Sudden onset diplopia urgent to EEC (<72 hours) Injuries: chemical, penetrating or post-operative infection urgent to EEC (<24 hours) MECS Exclusion Criteria Severe ocular pain requiring immediate attention urgent to EEC (<24 hours) Suspected retinal detachment urgent to EEC (<24 hours) Suspected vascular abnormality (Don t forget Wet AMD and RVO pathways )
MECS should not normally be used in the following cases: Flashes and/or floaters if < 1 month has elapsed since the first full MECS consultation for the same issue For removing in-growing eyelashes if < 4 months have elapsed since the first full MECS consultation for the same issue For repeat dry eye / blepharitis consultations if < 4 months have elapsed since the first full MECS consultation for the same issue And in similar situations to the previous 2 points, e.g. transient loss of vision Use of MECS (1) Where the patient s reported symptoms indicate that a sight test is more appropriate than MECS Adult squints, long standing diplopia Removal of suture Repeat field tests to aid diagnosis following an eye examination (unless referred in by a non-accredited optometrist from a different practice) Age related macular degeneration (unless disciform changes of recent onset are suspected)
There are other specific exclusions to MECS: Patients identified to have severe eye conditions which need hospital attention, e.g. orbital cellulitis, temporal arteritis Eye problems relating to Herpes zoster Suspected cancers of the eye Patients cannot be treated under MECS if their signs or symptoms indicate they are more suitable for the following locally enhanced services: Use of MECS (2) North Staffordshire Direct Access Cataract (DAC) pathway North Staffordshire & Stoke-on-Trent Glaucoma Referral Refinement (GRR) service Staffordshire Diabetic Eye Screening Programme
A simple but important point to bear in mind is that a MECS examination is not an adjunct to a sight test, it is an alternative for those cases where the symptoms do not seem to be obvious sight test material. In other words, in most cases, you choose and either perform a sight test and deal with what you find, or perform or refer for, a MECS The use of MECS and Sight Tests In a small number of cases the outcome from a MECS might be the advice that a patient should visit their own practitioner for a sight test, but it should be extremely rare (if ever) for a sight test to lead to a MECS examination
There are limited circumstances in which a non MECS-accredited registered optician may refer a patient to a MECS-accredited registered optician (either within the same optical practice, or to an alternative optical practice), where it is in the best interests of the patient. The main conditions to which such referrals may apply are: a patient presenting with recent onset flashes and floaters a patient with mild-to-moderate ocular pain MECS Referral from Non MECS- accredited opticians a patient requiring differential diagnosis of the red eye For such patients, a sight test may not always provide an appropriate means of investigating and managing their conditions, and MECS often provides the best context for doing so. Before referring the patient into MECS, there are two things that the non MECS-accredited registered optician must bear in mind: One of the main purposes of MECS is to manage patients in primary care rather than secondary care, where possible. It is important that the non MECS-accredited practitioner understands that their duty of care to the patient under GOS is unaffected.
Thank you :) any questions?
