Implementing a new electronic ophthalmology referral pathway

Ophthalmology referral pathways across Coventry and Warwickshire were complex and added to the workload of GP practices. The ICB recognised the need to simplify and streamline patient pathways, using technology to support and standardise a more direct referral process.

NHS Arden & GEM’s Health and Care Transformation (HCT) team worked alongside ICB colleagues to design and develop a new patient referral pathway. By engaging a wide range of stakeholders and implementing a new electronic eye referral system, patients are now referred to secondary care providers directly by optometry practices, in a more timely and efficient manner.

The new system has already had a considerable impact upon referral patterns. It is supporting patients to receive the treatment they need in the place of their choice, as well as improving the recording of referrals in patient records.

The challenge

Across Coventry and Warwickshire ICS, there were three different ophthalmology referral pathways covering the historical CCG ‘place’ footprints. The complexity of the pathways meant it was difficult to ascertain levels of patient demand across the ICS and ensure equitable provision of services.

The ICB wanted to implement a new referral pathway and electronic system to streamline the referral process and reduce the administration burden on GP practices who often had to process referrals on behalf of optometry practices. The objectives for the new service were to:

• ensure all patients were offered choice in ophthalmology provision
• refer patients to appropriate accredited provision first time, reducing off-contract activity
• enable direct referral from optometry practices to secondary care, reducing the burden on GPs
• implement a new electronic eyecare referral system (EeRS) procured regionally by NHS England to enable all optometrists to refer to secondary care using a single digital system.

With experience of working with the ICB and other organisations within the ICS, Arden & GEM’s HCT team was tasked with delivering this project.

Our approach

Two improvement consultants with expertise in pathway redesign and managing change were selected to lead work in the following areas.

Developing a new model for ophthalmology referrals
The HCT project team worked closely with ICB colleagues to:

• evaluate lessons learned and best practice from early adopter sites to inform a new model
• engage the Local Optical Committee (LOC) and providers to construct the as-is and to-be process maps, ensuring clinical safety and business continuity protocols were in place
• interrogate data to establish likely referral volumes and workload for the new pathway
• assist in producing a costed business case for the new model for ophthalmology referrals.

The new model developed included establishing a Coventry and Warwickshire Ophthalmology Coordination Service (OCS) covering the entire ICB footprint. The OCS will ensure that all patients are offered a choice of ophthalmology providers and booked into an appropriate service using the information provided by optometrists.

Setting up the new pathway
The CSU team mapped different stakeholder groups and facilitated bringing together these groups in regular project meetings and information sessions. Stakeholders included members of the LOC, the ICB Elective Care team, the newly commissioned OCS provider, secondary care ophthalmology treatment providers, primary care providers, Cinapsis (who provided the EeRS), and the NHS England regional EeRS project team.

Arden & GEM’s role was to support the development of:

• end-to-end testing of referral flows with secondary care providers
• the OCS hub
• key documents and processes including an Equality Impact Assessment, Data Protection Impact Assessment, Clinical Safety Case Report, Business Continuity Plan and SOPs.

Rolling out the EeRS to opticians
A new EeRS was regionally commissioned to enable opticians to electronically refer patients using standardised forms, with the capability to attach scans and reports. Rollout was split into three phases to onboard each of the three ‘places’ within the ICS – South Warwickshire, Coventry and North Warwickshire. The team successfully managed the rollout of phase one at pace, embedding it into normal working practice and establishing the process, materials and lessons learned for later phases.

The team – together with LOC leads – facilitated communication and change management to onboard local optometry practices. This included a ‘cyclical rollout process’, using iterative testing and learning to increase the number of optometry practices included in each cycle.

The outcomes

The new simplified referral pathway was well received and delivered the following outcomes for optometrists:

• faster and more convenient routine and urgent referrals, with no need for email, post or fax
• confirmation that the referral had been sent to secondary care providers
• the ability to track progress of referrals with the assignment of a unique case number
• an overview of the referrals made by the optometry practice.

The pathway and system improvements have also benefitted GP practices by significantly reducing the administrative processes surrounding routine eye care referrals.

Positive project outcomes for patients have included:

• every patient being able to discuss the choice of provider relevant to their condition
• ensures patients are sent to an appropriate provider first time.

Simplification of the referral pathway has led to changes in referral patterns which will potentially lead to cost savings for the ICB. While the improvements in robust data provision by establishing an OCS is helping to identify gaps in provision.

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