Table 1 (A) Outlines the primary aims of the Panopia feasibility study. (B) Outlines the secondary aims of Panopia feasibility study and results.
A. Primary aims | Onboarding experience (n = 23) |
|---|---|
To assess the feasibility of recruitment and retention of optometry practices | •Eighteen local practices welcomed the scheme •Six optometric practices committed to the feasibility study and were our early adopters •Twelve practices could not participate in the initial phase due heavy administrative burden from the newly introduced MECS scheme •None of the practices dropped out during the course of the study |
To assess the acceptability of the pathway among optometrists | •CET-accredited onboarding events were utilised to present the status quo and gather optometrists views on the intervention •Delays into HES and high first visit discharge rates were identified as a key motivator for change by optometrists •Additional time required to export and upload images to nhs.net email was not expressed as a concern and could be done during allocated administrative time •The referral proforma was co-created with optometrists |
To investigate pre-existing resources within the community that would facilitate the pathway | •There was a heterogeneity of equipment in all six practices •Two of six optometric practices had OCT capabilities and a decision was made to utilise optic disc photographs instead •Only practices with visual field machines and fundus cameras were able to participate •Visual fields from any type of field analyser were accepted •Although GAT was initially specified, we also accepted NCT measurements |
To assess the feasibility of data transfer and interpretation | •All practices were able to export data from their VF machines and fundus cameras and upload them on to nhs.net email •All practices utilised a bespoke referral proforma, which served as a checklist to ensure all information was provided in the referral •Data interpretation was possible on all referrals |
To evaluate financial projections for scaling up | |||||
|---|---|---|---|---|---|
Current scheme | Panopia scheme | ||||
Based on 853 referrals to Moorfields at Barking Glaucoma clinic in a year | Costs £ | Notes | Based on 853 referrals to Moorfields at Barking Glaucoma clinic in a year | Costs £ | Notes |
Community Optom costs | 17,913 | 853 referrals × £21 | Community Optom costs | 39,238 | 853 referrals × £46 |
Additional optometry training and equipment costs | 0 | Additional optometry training and equipment costs | 0 | ||
HES first visit cost | 150,981 | 853 referrals × £177 | HES virtual review | 102,360 | 853 referrals × £120 HES Virtual tariff (68% of multiprofessional first visit cost) |
HES follow-up visit cost | 34,494 | 665 referrals (78% that would not be referred to HES if Panopia utilised) ×0.57 × £91 1.57 extra visits prior to discharge from HES (1 New + 0.57 F/U) £91 = F/U tariff | HES follow-up visit cost | 17,108 | 188 referrals seen in HES × £91 |
Total | 203,388 | Total | 158,706 | ||
Cost saving for 853 patients £203,388–158,706 = £44,682 | |||||
Cost saving per patient £44,682/853 = £52 | |||||
NB: 1.57 visits prior to discharge is for all ophthalmology outpatients and is taken from the Manchester glaucoma Enhanced referral scheme [14] | |||||
NB: If we calculate costs based on 1.0 visits prior to discharge, rather than 1.57 visits per discharge, the scheme still makes a saving of £12 per patient | |||||
The figure for HES virtual review quoted as £120 represents 68% of an F2F first visit appointment and is a baseline figure suggested on the NHSE/I tariff release for 2019;, this figure would need to be agreed at a local level and in the context of any local arrangements such as block contracting to ensure that providers are appropriately remunerated for this high volume work. This still allows a saving at the CCG level while ensuring any reduction in ‘new F2F activity’ in a HES setting does not impact negatively on the secondary care providers | |||||
We anticipate that reduced F2F activity would allow improved RTT and access to service, meaning that HES would never be below its functional capacity | |||||
B. Secondary aims | |||
|---|---|---|---|
To assess whether remote decisions can be made on new glaucoma referrals with a complete dataset from referring optometrists | Remote decisions could be made on all referrals. | ||
Provisional diagnosis, n = 23 | Referral outcome, n = 23 | Referral to HES, n = 5 | |
Glaucoma suspect (suspicious disc, normal IOP, normal VF) 43% (10) | Discharge 26% (6) | Referral time frame::urgent (<2 weeks)/soon (2–4 weeks)/routine (<12 weeks) | |
Narrow angles 17% (4) | Annual review with optom 35% (8) | ||
Primary open-angle glaucoma 13% (3) | (annual review with optom 17% (4)—narrow angles) | Urgent: 4% (1 pt.) | |
Normal tension glaucoma 4% (1) | HES review 22% (5) | Soon: 17% (4 pts) | |
Primary angle closure 4% (1) | Routine: 0% (0 pts) | ||
Ocular hypertension 4% (1) | |||
Non-glaucomatous disc 4% (1) | |||
No abnormality detected 9% (2) | |||
To set up a Learning Network and embed learning into the pathway, to facilitate upskilling of optometrists | •Onboarding events included practical skills training for GAT, VH, disc assessment •All optometrists received referral advice and feedback within 5 days •One to two referrals were chosen monthly as an educational case/s with annotated disc images and VF communicated via email to all optometrists | ||
