Evidence submitted by the Association
of British Dispensing Opticians (ABDO), the Association of Optometrists
(AOP), the College of Optometrists and the Federation of Ophthalmic
and Dispensing Opticians (FODO) (EPR 44)
1. OVERVIEW
1.1 ABDO, AOP, the College and FODO together
represent the 10,000 optometrists and over 5,000 dispensing opticians
who provide high quality and accessible eye care services to the
whole population across the UK. There are over 6,900 opticians'
premises in the UK, ranging from large stores with multiple consulting
rooms to small practices in local shopping centres or in the high
street as well as domiciliary eye care services who provide care
to those confined to their home.
1.2 Overall we support the introduction
of a national NHS-wide IT system which will enable healthcare
information to be shared between clinicians. We believe the potential
benefits to improve patient care and safety are important goals.
However we do have a number of concerns about the development
and timescale of the IT system. Optical practices must be linked
to the national data spine and be fully integrated on the NHS
Care Records Services.
1.3 Solutions for connecting optical practices
need to be found which do not conflict with existing practice
software infrastructure. At present, when PCTs occasionally try
to connect to optical practices, they usually insist on a separate
stand alone PC isolated from the practice network. This solution
is NOT part of an integrated network and requires re-typing of
all information, with the associated potential for error. Better
and more workable security solutions will need to be found to
integrate practices into the Care Records Services.
1.4 In the short term, optical practices
should be given access (with specific patient consent at the time
of access) to the summary care record. This should be piloted
as soon as possible.
2. What patient information will be held
on the new Local and National Electronic Record Systems, including
whether patients may prevent their personal data being placed
on systems
2.1 Patient information held by optical
practices should in due course be recorded on the NHS Care Records
Service. Increasingly optometrists co-manage patients with GPs
and ophthalmologists and therefore an electronic system of sharing
information will ensure all those involved in the care of a patient
are fully informed and have access to the most up to date information.
2.2 The government recently consulted on
proposals to give optometrists independent prescribing rights.
All the optical bodies submitted their views on behalf of the
profession, calling on the government to adopt prescribing rights
for optometrists. Once optometrists have prescribing rights it
will be imperative that they have access to information including
repeat prescriptions, acute prescriptions, significant and recent
diagnoses, as well as any adverse and allergic reactions to medication.
2.3 We believe that patients should agree
to information being shared between professionals, although any
potential problems should be explained to the patient, e.g. if
there are any adverse implications from withholding information
about medications. Patients should have clear information about
the electronic sharing of health information.
3. Who will have access to locally and nationally
held information and under what circumstances?
3.1 All optical practices should be included
in the Connecting for Health IT programme—whether they provide
NHS or private services—to ensure the same level of care
for all patients. Many patients who are paying privately for eye
care will be NHS patients for other healthcare services such as
when they visit their GP. As mentioned above, once optometrists
have prescribing rights it will become increasingly important
for them to have access to a patient's medical history. Optometrists
should have access to relevant sections of the patient's electronic
record (subject to informed consent) and NHS electronic GP and
hospital referral systems and "choose and book" systems.
This should be centrally funded through the Connecting for Health
programme in the same way as for other sectors.
3.2 Providers of domiciliary eye care services
must also be included. Visiting optometrist and dispensing opticians
provide a vital service to vulnerable people in their own homes
who are often suffering from multiple health problems.
4. Whether patient confidentiality can be
adequately protected
4.1 We believe it is imperative that adequate
measures are put in place to maintain patient confidentiality.
Optical practices already obtain and process confidential data
in patient records and have a long history of maintaining confidential
information securely. Currently in most practices this is in written
form but we believe that any issues arising from a transfer to
an electronic record can easily be addressed.
5. How data held on the new systems can and
should be used for purposes other than the delivery of care eg
clinical research
5.1 We support the plans for information
to be used anonymously for clinical research, public health, strategic
planning, commissioning and clinical audit. As long as the information
is strictly anonymised and only used for the purposes outlined
above, we believe this could provide a very beneficial and useful
service for the whole of the NHS.
6. Current progress on the development of
the NHS Care Records Service and the National Data Spine and why
delivery of the new systems is up to two years behind schedule
6.1 Optical practices are due to be included
in the NHS Care Records Service, however there has been no commitment
to an agreed timetable for this to happen. In a written answer
on 16 June 2006, Health Minister Caroline Flint confirmed that
the national programme was designed to "support all the clinical
services in and around the national health service, including
dentists and opticians" but no date has yet been set. The
Minister added that "The national programme is on target
to achieve full integration of health and social care systems
in England by 2010", but we do not believe this is achievable
given that optical practices have not been notified when they
will be integrated. (Hansard 16 June 2006, Column 1561W)
6.2 We believe that the NHS Care Records
Service must be properly piloted and we strongly believe that
a pilot system for integrating optical practices must commence
as a matter of urgency if the deadline of 2010 is to be met.
7. ADDITIONAL
POINTS
7.1 A further long-standing issue has been
that—unlike dentists and pharmacists—there is no centralised
electronic claims and payment system for optical practices.
7.2 The main problem for optical practices
is that PCTs have different cut-off dates for submitting claims
and many are very slow when making payments. Some PCTs hold up
whole batches of payments which can severely affect cash-flow
particularly for smaller practices. Payments, and hence cash-flow,
are also subject to the vagaries of PCT staff absences, half-term
and computer breakdowns at local level. All these additional costs
have of course ultimately to be passed on to the patient or the
NHS.
7.3 Far better all round would be for a
national system with standardised methodologies which ensured
that optical practices received payments regularly and on time
and which, as a by-product, generated useful data for PCTs so
that they could concentrate on their core strategic function of
service planning rather than data processing.
7.4 The optical bodies very much welcome
the government's commitment to carry out a feasibility study to
improve the streamlining and standardisation of the claims and
payments system. We look forward to participating fully in the
optional appraisal and hope very much it will lead to a national,
centralised system for the beneficial reasons for patients, practices
and the NHS, as outlined above.
Heather Marshall
Association of Optometrists
16 March 2007
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