The Community Eye Care website and app have been developed by NHS Grampian and NHS Forth Valley, with the support of the Optometry department of NHS Education for Scotland (NES Optometry) and the Scottish Centre for Enabling Technologies, University of the West of Scotland. The guidelines give advice to support the management and care of patients in a primary care setting and have been based on the Scottish General Ophthalmic Services contract. Every professional must act within the boundaries of their own clinical competence and seek advice, or refer patients on, when this is reached. Some medication can only be utilised by Independent Prescribers or as part of a NHS Board’s Locally Enhanced Scheme.
In 2016, the Access Support Team, Directorate for Health Workforce & Performance Scottish Government Health & Social Care Directorates, as part of the National Ophthalmology Workstream- “Working Together to Deliver Eyecare Services across NHS Scotland” to improve new and return out-patient waiting times, agreed to fund NHS Grampian’s ophthalmology department’s request to develop an app/website for NHS Grampian’s Eye Health Network clinical guidelines.
The aim of the website and app is to improve standardisation, accessibility, usability and currency of primary care optometry clinical guidelines and pathways so that they can be better accessed by primary and secondary care on computers, mobile phones and tablet devices.
The guidelines have been adapted, with permission, from the College of Optometrist’s clinical management guidelines, to incorporate pragmatic experience gained from NHS Grampian’s Eye Health Network.
Since 2007, NHS Grampian’s Eye Health Network has provided care for many thousands of patients and, through the introduction of Local Enhanced Service Agreements, has allowed the treatment of acute anterior uveitis, herpes simplex keratitis and marginal keratitis, in association with general practice, within the primary care setting.
Elsewhere in Scotland, community optometrists are increasingly working in partnership with their colleagues in ophthalmology. Independent prescribing for optometry was introduced in 2008. The introduction of standardised pathways will not only help guide optometric independent prescribers to use their new-found skills in the most appropriate manner, but also help guide whether to treat in the community or refer onwards.
Each Topic is divided into four areas: differential diagnosis, possible management by optometrist (treatment and advice), management category and possible management by ophthalmologist.
It is not expected that all optometrists will wish, or be able, to manage patients in the full manner outlined. Furthermore, much of the advice is derived from clinical experience, rather than evidence, and thus is not set in stone- local protocols and pathways should always be followed.