IOP Referral Refinement

IOPRR Contract and Protocol Key Points

Purpose
The prime purpose of IOPRR is to reduce onward referrals to secondary care. Experience in other similar services, including the Stockport scheme, is that up to 76% of patients are managed in the practice and only 20 – 25% are referred to secondary care. There is no point is seeing these patients and then referring the majority anyway. The IT system will be monitoring this, both by practice and by practitioner.
The schemes are only available to those who are registered with a Walsall GP.

Key contract points:
• All provision of service must be recorded on the IT system (it’s the only way you will get paid)
• All contacts regarding IOPRR should be recorded. This is for your own protection, so that there is a record.
• The service will provide assessment and management of those who attend for a sight test and are found to have IOP >21mmHg. See specifications.
• Patients found to have elevated IOP by NCT are expected to have Goldman/Perkins at the same visit. If further readings are necessary follow up appointments should take place within two weeks.
• Should a patient fail to arrive for an appointment , the provider must contact the patient within 24 hours to rebook.
• You must complete the Patient Satisfaction questionnaires in order to receive the fee. Any referral will be processed, but the record will not be processed for fees until the questionnaires are completed. The company has a target for completed questionnaires and will be monitoring for any practice marking an unreasonable number of them as not completed.

To be accredited to provide this service the following is required:

Documentation
Both contractors and practitioners are required to provide some documentation

Practitioners
The following documents are uploaded when registering to provide IOPRR

• WOPEC/LOCSU Cataract accreditation certificate
• DOCET Children safeguarding certificate
• DOCET Adult safeguarding certificate

Use of IOPRR
The development of the IOPRR scheme enables contractors to be paid for consultations that were previously private, provided out of charity or simply passed on to secondary care. It is important that the service is not abused. It is not suitable for every slightly out of the ordinary case that crops up during a routine sight test, but you may certainly use it for a case you might otherwise have referred.

It should not normally be used in the following cases:
• Patients not registered with a Walsall GP or not resident within Walsall.
• Children under the age of 16.
• Patients who have previously been seen in the scheme within 6 months unless clinically appropriate. In these cases the clinical reason must be recorded and may, for example , include significant rise from previously recorded IOP.
• Patient with significant other ocular pathology requiring specialist referral.
• Patients presenting with evidence of Glaucoma that the Optom would normally refer to HES; that is elevated IOP and/or optic disc changes and/or visual field defect. The aim of the scheme is to refine IOP measurement only. Referral to HES should be made if suspicious optic disc changes or visual field defects are detected.
• Patients already under the care of an ophthalmologist for Glaucoma , OHT or suspected Glaucoma.

The use of IOPRR is constantly monitored within the IT system and outliers may be asked for explanations.

Referrals
Routine referrals
Routine referrals are made via Optomanager automatically from the IOPRR system. In all consultations a report is generated to the GP. There are text boxes you can provide more detailed information. These routine referrals may either be to the GP (not for onward referral) or to ophthalmology.

Urgent Referrals
Urgent referrals are made in Optomanager direct to Wolverhampton Eye Infirmary Acute Referral Clinic. These will be triaged by staff at ARC who will contact the patient to offer an appointment within the appropriate timescale. It is vital that the referring optometrist ensures the correct contact telephone number is recorded for the patient and that they are aware of the process involved and the requirement for urgency. The patient should contact the optometrist in the event that an appointment is not offered by ARC or there is a breakdown in communication.

If you have an urgent referral outside the normal hours of the eye casualty service (e.g. evening, Saturday afternoon or Sunday) then phone ARC for assistance. You should contact them by phoning New Cross Hospital switchboard on 01902 307999 and asking for ARC or the on-call ophthalmology doctor.