Elective Care Pathway Case Study: Dr Hasan Chowhan, Ophthalmology and Dermatology

So I’m Dr Hasan Chowhan, I’m a GP in Colchester
and the Clinical Lead for NHS North East Essex CCG. We’re here to discuss the Community Referral
Pathways for dermatology and ophthalmology. Several years ago we looked at a procurement
of something called Care Close to Home, which really was based around the premise of bringing
care closer to the community, closer to the patient’s home. The reason for looking at some of that was
firstly, as I said, for trying to bring care closer for patients, but also trying to help
a struggling hospital, a struggling health care system. So through helping the hospital, through redirecting
some of their services back towards the community it helps them manage the conditions that need
to be there. But it also then helps patients and patients
get treatment and get seen where they want to — nearer their GP surgeries or nearer
their home. When we were looking at all of this there
were several different services that we looked at that would fit better within the community. Two of those were ophthalmology and dermatology. So with ophthalmology the pathway that we’ve
introduced really is centred around making better use of the community opticians and
our community practitioners. So in the past, where it may be the patient
goes to see their optician or see their eye-care practitioner out in the community, they may
decide, okay, this person maybe needs a secondary care opinion from the hospital. They would then send a form to us, we would
then look at the form as GPs, or here within the GP surgery, and then we’d refer, send
the form on towards the hospital. It just added another step in the process
and wasn’t really seamless and not necessarily the best pathway. What we’ve now got is, that same referral
pathway is still in place — so if you’re a patient, you’d still go see your GP or your
optician, but ideally you’re better placed to see your optician. Whether you see your GP or your optician,
a referral is then made to a centrally-based triage service. That triage service then decides whether that
is a referral that should go to the hospital, or should in fact go back to one of the community
practitioners. What that does is it makes better use of our
community practitioners, and it also alleviates some of the pressure on the hospital so they’re
able to deal with the conditions that they need to. So with the dermatology service, this service
is now completely commissioned out in the community. Again, better for patients and alleviating
some of the pressures on the hospital in terms of clinics. What it means is that if you refer a patient
as a GP or as a practitioner out in the community to the dermatology service, it is triaged
and then seen within the community. The benefits to patients specifically with
the ophthalmology pathway is that it means that they should hopefully be seen quicker,
because if a referral is made from myself to the hospital and they’re waiting several
weeks to see an ophthalmology consultant, it may be that they’re better placed to see
a practitioner out in the community. So through triaging that referral and getting
them seen by a more appropriate practitioner, it means that makes it quicker for them and
easier for them to be seen out in the community. That also makes it quicker, and it also means
that they’re seen closer to home and a benefit to them. What it means for me as a GP is that when
I’m making that referral I know that, actually, if I’m uncertain whether it needs to necessarily
be done at the hospital there is somebody sense-checking it, saying: “actually, I think
you could manage this in the community” or there is a community-based service. So it makes it easier for me to refer that
patient on without having to worry about trying to figure out where best to send them for
that particular eye condition. For our patients what we’ve seen is, of all
the referrals that are made to the hospital, something like 26 percent are now redirected
towards the community. So that means rather than a patient having
to wait several weeks sometimes to see a consultant at the hospital just to be told that, actually,
this is something that we manage in the community, we’re stopping that process right at the start
having set up the community service for them, so that they can then be seen in the community. So they’re seen quicker, and they’re seen
closer to their home. Firstly, with the ophthalmology pathway, it
alleviates that unnecessary step where you’re receiving a form from a community practitioner
that is probably better skilled than you at looking at eye conditions, and having to then
forward that referral on to the hospital. But it also means you have that better interaction
with your patient. You’ll going forwards be better educated about
where those patients could be seen. And so if in time the intention is that we’re
able to build up the knowledge and expertise within general practice and understand where
these conditions are better directed towards primary care, so perhaps stopping that referral
in the first place. For me it’s made it a lot easier in terms
of managing the workload, so I don’t have an unnecessary bit of paperwork that I’ve
got to do. But actually it’s about my interaction with
the patients. I’m here to provide a good service for my
patients, and through doing this I know that, actually, I can help my patient have their
care delivered in the community, closer to me and closer to them, so I’m not having to
refer them to the hospital. Through providing this out with the community
practitioners, we hope to then upskill those local practitioners in terms of what they
are able to manage. So we know in future we’re looking at increasing
the number of patients that are able to be seen in the community at the moment from 26
to 30 percent. But if we’re able to move further conditions
out towards the community as time and clinical skill allows, we would be looking at moving
more and more activity towards the community — and that benefits the patients.

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