Ophthalmology is a high demand specialty, typically accounting for approximately 10 % of all outpatient appointments, regionally and nationally, each year and accounts for 7.1% of all consultant led appointments. In the Northern Ireland context, this demand is in excess of 100,000 acute care appointments annually.
Many ophthalmic conditions are age-related, and many are long-term conditions (LTC’s) where ‘cure’ may not be possible, and management to maintain useful vision the goal. Glaucoma and macular degeneration are such conditions. In addition to the long term or ‘chronic’ ophthalmic conditions, patients who have a sudden onset or ‘acute’ eye condition contribute to the demand for unscheduled or emergency eyecare. Audit and pilot service evaluation has demonstrated that many of these patients could be safely and effectively managed by primary care optometrists. Optometrists working in the community have the knowledge, skills and equipment to assess, triage, manage and treat many of these patients.
Developing Eyecare Partnerships: Improving the Commissioning and Provision of Eyecare Services in Northern Ireland (DEP) is a five year plan to reform and integrate eyecare services with twelve identified objectives. Ophthalmic Services in the Health and Social Care Board have worked collaboratively and in partnership with key stakeholders and service users to plan and implement changes in the eyecare pathways for patients with both ‘long term’ and ‘acute’ eye conditions.
The Optometry / Ophthalmology ECHO Knowledge Networks aim to democratise and de-monopolise medical knowledge, allowing primary care optometrists a safe space to improve their knowledge base, and in turn helping them to better manage patients who
- Present with suspect glaucoma or macular eye disease
- Present with an acute eye condition
By tele-mentoring and case-sharing, ECHO will enhance the knowledge and skill in primary care, helping to improve case-handling and referrals patterns. As the Optometry / Ophthalmology Knowledge Networks embed into the clinical practice of both Optometry and Ophthalmology the ECHO community of practice will be developed and strengthened. This will provide the foundations on which DEP can progress further service developments in the eyecare pathways. Supported by the educational governance and communications portals which ECHO affords, the vision of ‘shared’ care for patients with stable long term eye conditions in the primary care setting can be realised which will help to manage demand and facilitate the treatment of patients closer to home. In this way, optometry primary care can be fully utilised, ensuring that each element of the ophthalmic workforce works to the top of their licence, helping to manage demand and delivering patient-centred, local and accessible care.