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60% of OPD activity should be moved to community –HSE Primary Care Eye Services Report

The first ever national review of Primary Care Eye Services, which was published today, sets out the current levels of service, models of service provision and the consultation process undertaken with patients and advocates, ophthalmic staff and representative bodies.

In order to achieve the recommendations outlined in the report, “new revenue funding” of €23,188,000 is required. This funding will cover the cost of establishing the PCETs across the Community Healthcare Organisations (CHOs) and new contractual arrangements with ophthalmologist, optometrists and dispensing opticians and the planned increased service provision, “including the shifting of a considerable volume of work from acute hospitals in relation to GMS patients”.

One PCET will be established per CHO and limited outreach services may be provided, as required. A community ophthalmic physician lead will provide overall clinical governance for eye services within a CHO (HSE and contracted services). “These lead posts will be subject to the usual processes to agree remuneration and working terms and conditions relevant to the responsibilities of the post,” states the report.

The PCET will be staffed with optometrists, orthoptists, nurses, technicians, community ophthalmic physicians and a community ophthalmic physician lead.

More surgical and treatment procedures, e.g. injections for AMD, will be provided by the PCET. According to the report, opportunities for hospital consultant ophthalmologists to attend specialist clinics in the PCETs and for community ophthalmic physicians to attend clinics in the hospital setting to promote integrated care provision “will be explored”.

The report highlights the limitations of the current model of delivery and sets out the way forward for a significant amount of eye services to be delivered in a primary care setting. A large proportion of acute hospital services and consequent waiting lists are taken up by patients who could be seen, diagnosed and treated in the community. The report estimates that 60 per cent of existing outpatient activity could be moved to the community.

It is estimated that there are currently 225,000 people with low vision and sight loss and approximately 13,000 blind people living in Ireland today. These numbers are expected to grow in the coming years as the population grows and ages, according to the HSE. A significant proportion of the older population experience sight loss which is to a large extent, preventable. Blindness and vision impairment can dramatically reduce quality of life by affecting physical, functional, emotional and social wellbeing. All of this translates into a significant economic and social impact on individuals, families, society and the State. The review report sets out the models of care that will enable the HSE to focus on improving outcomes for all patients who require eye care services.

Mr Brian Murphy, Head of Planning, Performance and Programme Management, HSE Primary Care Division, and Chairman of the Review Group, noted: “People need to avail of eye care services locally and for these to be provided in a timely and safe manner. We need to re-organise our services to be able to meet our patients’ needs and put in place new models of working. The Review Group has undertaken an in-depth analysis of the existing services in place across the country and has set out models of care and care pathways for the management of most eye conditions.”

Mr Murphy added: “This has been done in consultation with services users, clinical staff and HSE services. I would like to thank the Review Group members for all of their work and analysis and I want to thank everyone who took part in the consultation process and all stakeholders who contributed – it very much informed our work.”

The Review Chairman concluded: “We know we can deliver safe, timely, high quality services by moving low risk and diagnostic eye services out of our hospitals and into local primary care settings. We need to provide services to patients that are safe, accessible and of high quality and to deliver them in more practical ways. For example, in our current services we know highly trained hospital consultants are reviewing patients who can be more effectively seen in local eye clinics. By transferring services to the local eye clinics in the community we will be enabling our acute eye services to focus on more urgent cases.”

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