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€23 million in new funding required for primary care eye plan — HSE report

The figure is contained in the report published by the HSE last week.  

According to the report, the over €23 million in funding would cover the cost of establishing Primary Care Eye Teams (PCETs) across Community Healthcare Organisations (CHOs) and new contractual arrangements with ophthalmologists, optometrists and dispensing opticians, as well as the planned increased service provision, “including the shifting of a considerable volume of work from acute hospitals in relation to GMS patients”.

The Department of Health, when contacted by the Medical Independent (MI) for comment on implementation, referred this newspaper to the Executive.

A HSE spokesperson told MI: “There has been close to €1 million provided in 2017 to commence the implementation process. This funding will see the initial steps in setting up PCETs in the Dublin region, which has the most challenges for delivering eye services in a primary care setting.

“The HSE will be making applications for funding through the annual estimates process to enable us to deliver the changes on a phased basis over the next four-to-five years.”

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

The report states that, throughout the implementation process, each CHO would establish one PCET at a primary eye care service centre of excellence. This PCET would have highly-skilled staff and “high-end medical equipment” for the provision of primary care eye services, it says.

Approximately 60 per cent of the current adult and paediatric OPD eye care work would transition to the PCETs, once they are established. The report also says more surgical and treatment procedures, eg, injections for age-related macular degeneration (AMD), will be provided by the PCET.

It will be the responsibility of each CHO Chief Officer to implement the recommendations of the report in their respective areas, the document outlines. A Project Manager and Clinical Lead will be employed from 2017 to 2019 “to support the Chief Officers with implementation, to ensure consistency of implementation across the CHOs and to oversee the implementation of national actions”.

The Irish College of Ophthalmologists (ICO) has welcomed the report’s publication and also called on Minister for Health Simon Harris to ensure that the necessary funding is made available to implement the recommendations.

Speaking to MI, College President Dr Alison Blake said the publication of the report was “very positive”.

She said: “It was launched quietly, and hopefully that is not a bad sign but rather just [an indication] that we going to get on with the work of it, rather than making a fuss before there is implementation, which is very reasonable. What is important is that the Minister supports it with funding to make sure the recommendations can be implemented, because the HSE has already said that primary care is not funded well enough in general but in terms of eye services particularly, and it has been difficult to recruit and retain medical ophthalmologists in the community, which speaks volumes. So hopefully this is a very positive step towards having care for patients where it should be. Maybe up to 80 per cent, if not more, of patient visits are medical and not surgical and the vast majority of those can be looked after in the community… ”

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Dr Alison Blake, President of the Irish College of Ophthalmologists

Dr Blake was not anticipating that implementation would be immediate, “but my understanding is that in the background, the HSE are working towards having the staff in place to drive the implementation, and I have no reason to doubt their good faith in wanting to implement this”.

In respect of implementation, the ICO President also emphasised that “it is very important that the national nature of this is front-and-centre”.

Community ophthalmic physicians (COPs) are crucial to the plan.

Dr Blake said it is important that terms and conditions attached to this role are addressed in the implementation piece.

“The reality is there are a lot of areas that haven’t been able to replace retiring community ophthalmologists, and there have been areas where ophthalmologists have started and have not continued — they have pulled out of the public sector.”

According to the HSE’s report, many COPs currently work in isolation as single practitioners, with under-resourced clinics and inadequate diagnostic equipment. Nurses work as part of a team with the COP in some, but not all, primary care clinics.

It says the COP Lead posts in the CHOs will be subject to the usual processes to agree remuneration and working terms and conditions relevant to the responsibilities of the post.

Costings in the report are based on the current salary scale of COPs.

The prevailing view within ophthalmology is that reform towards a more community-orientated service is vital to address hospital waiting lists and provide better care and working environments.

As of May 2017, there were 13,485 people on ophthalmology’s inpatient/day case waiting list, the highest for any specialty. There were also 36,341 people on ophthalmology’s outpatient waiting list, the fourth-highest of any specialty, according to latest figures from the National Treatment Purchase Fund (NTPF).

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