Dear Optometry Colleagues
Apologies firstly for the delay in sending updates. As you can imagine much has changed, more so than any of us could have envisaged. Our head office, whilst open, have had to mainly move to home working with over 50 VPN connections which have been slow and making processing administration task difficult. We have spent the past 10 days or so ensuring this move is robust and can stand the test of time.
The NHS, especially eye services, has been left in flux through limited but changing information. As things are beginning to stabilise we now have a clearer idea (as much as possible) on which direction we changes are happening.
Effectively almost all high street optometrists are either fully closed or ‘open’ offering telephone advice. It remains uncertain how long the current flux in the UK will last, but we have been told to expect at least a further 3-4 weeks of major disruption. By now many of us will know or have loved ones or friends affected by Covid-19. Our thoughts go out to those who are affected at this difficult time.
NHSE have released updates almost daily relating to how providers are to be maintained in this current environment. As you can imagine, each CCG has interpreted the guidance in different ways. You may have seen the attached already which helps with how NHSE is helping high street optometrists maintain some functionality.
As an ophthalmic provider, we finally received guidance in the last 2 days which stated all non-essential patient contact and treatments should cease from April 1st to 31st July 2020. This is a 4 month period that the NHS seems to be suggesting that Business as usual (BAU) will not happen and as such social distancing rules to some degree will be in place, likely to a much less harsher level.
Whilst Community Eyecare maintain our hospitals and practices for emergencies only, they do remain open with all nurses and doctors still available to help and advice. Many of you are regularly contacting the team to query patient pathways on how patients are managed. Please continue to do so as they receive up-to-date information.
A few practical Covid 90 is infecting people between 30-60 years of age, although the death rate is highest in over 80 year olds, particularly men being 75% likely to suffer demise than women. This is important in risk stratifying patients you maybe seeing, were elderly men with comorbidities are likely to be suffer the ultimate consequence of CV-19.
The NHS standard for PPE for suspected Covid patients includes: eye protection (either visor/goggles), non-sterile gloves, disposable aprons and a moisture resistant face mask. If you are on the front line, disposable gowns and N95 ventilator masks are recommended for greater barrier control. All items should be disposed of in between patients and the environment cleaned down with disinfectant.
PPE is still in short supply and the NHS is in desperate need with worldwide usage significantly exceeding manufacturer from the workshop of the world in China. China has increased production of face masks from 20m per day to 113m per day which is still a fraction of what is required. Just as a comparison of the demand, we are currently paying over £1.20 per surgical face masks where previously this was a penny or two.
Many CCGs have stated that they will not be paying for telephone consults as this is not factored into contracts. This is a major issue which we are trying to resolve. Whilst not ideal for anyone, we will continue to pay for telephone consults if through our portal until further notice. The numbers have decreased as expected and practitioners will need to abide by the inclusion and exclusion criteria. Follow-ups will for obvious reasons not be paid. Face to Face will be paid as normal if through our portal/EPR. The Commissioners have stated pre/post of cataracts and glaucoma patients should cease immediately which we have implemented immediately. Only urgent eye conditions should be seen or consulted via telephone. The difficulty is that you will not know if they are urgent unless you undertake the consult in the first place so we have taken the view that if a patient contacts you it is likely to be urgent.
Getting ready for restart
One of our goals at Community Eyecare during this downtime is to ensure that all of our structures internally are updated including training, policies, asset registers and investigating new technologies for when we get ready to start again. Our team has not remained dormant at this time, but have been busier than usual on other tasks rather than face to face patient contact.
As part of this, there will be a demand for optometry and ophthalmology services immediately after lockdown ends and BAU resumes, and planning is in place to support our accredited community optometrists with advice and some PPE. We have been lucky that we have sourced 2000 KN95 re-useable ventilation masks and 120 slit lamp shields. Our engagement officers, once available, will start distributing these to our accredited/referring optometrists. Resources are limited, so slit lamp shields will be provided to until we have depleted the 120, and KN95 will be limited to 2 per practice. This does depend on where practices are in the UK and whether we have enough.
It is unlikely further updates are required unless something changes drastically, at which point I will of course be in touch.
In the meantime, please stay safe and apart!
Imran Rahman MB BS FRCOphth
CEO and Consultant Ophthalmologist