NHS Wales University Eye Care Centre (NWUECC), which is run by Cardiff and Vale University Health Board (UHB), scooped the Enhanced Optical Service Award at the Optician Awards 2022 for offering excellent enhanced services and primary care in the community. Gareth Bulpin, national architect for eye care digitisation at NHS Wales, says the Cardiff and Vale UHB team was ‘overjoyed’ to win the ‘prestigious’ award.
‘I believe it is the first NHS organisation to have received such an attainment and industry recognition for our work, which is amazing,’ Bulpin says.
The judging panel commended the Health Board for driving enhanced eye care services throughout the UK.
‘By promoting specialist services in a primary care setting, it is actively reducing pressure on secondary care. It has also passed this ability on to other ECPs through its teaching,’ the panel said.
In 2018, Cardiff and Vale UHB announced a five-year plan to address patient waiting times and outcomes by increasing optometrist training and enable primary and secondary care to work ‘shoulder to shoulder’. The plan was accelerated by the pandemic and the subsequent 40% reduction in hospital capacity.
Four independent prescribing optometrists were mobilised to move 94% of unscheduled care patients into primary care, treating some 3,000 patients. A further 2,750 glaucoma patients were treated in five ophthalmic diagnostic treatment centre practices. The optometrists updated the electronic patient record system, OpenEyes, with a ‘fast and secure messaging service to call upon expert consultant advice and guidance, including sharing images’.
Shared care model
According to Welsh government monthly performance reports to assess the prioritisation and timely treatment of eye care patients, in June 2022 NHS Wales’ average was 48.3% while Cardiff and Vale UHB achieved 69.2%.
‘This evidenced, even during these unprecedented times, that the shared care model works,’ says Bulpin.
As the footprint of the Eye Care Outpatients Suite in the University Hospital of Wales could not be expanded, the board piloted and subsequently launched the NHS Wales University Eye Care Centre (NWUECC) in September 2021 to reach more patients.
Located within Cardiff University’s School of Optometry and Vision Sciences, the centre, open to patients and optometrists, is equipped with top-of-the-range equipment from Topcon, Carl Zeiss and Optos across 10 consulting rooms.
‘The development of the teach and treat NWUECC, a partnership between the Health Board and Cardiff University, provides our nation with a short, medium and long-term platform for the continued development of skills and experience of our optometrists (qualified, undergraduate and those studying for an MSc), providing a highly skilled workforce for the future,’ says Bulpin.
The number of optometrists training for the higher certificates in medical retina and glaucoma has climbed from two in 2018/2019, 10 in 2019/20 and 12 in 2020/21 to an incredible 50 in 2021/22, including independent prescribing optometrists. In 2022/2023, a further 20 optometrists are in training, supported by senior tutors at Cardiff University and consultants from the Cardiff and Vale UHB.
A number of exciting developments are under way at the NWUECC, including extending the number of oculoplastic clinics to four sessions a month and the glaucoma and medical retina outpatient clinics to four and two sessions a week, respectively.
In February, the NWUECC commenced a hydroxychloroquine (HCQ) pilot clinic, following the Welsh government’s procurement of 18 Optos Monaco multi-modality retinal imaging devices in 2022 to enable monitoring of HCQ patients in primary care across Wales.
‘Supported by Optos, we are training the higher certificate optometrists in the monitoring of HCQ in readiness for the NHS Wales Optometry Contract changes and the Optos Monaco devices will be located in local optometry practices,’ says Bulpin.
‘These multi-modality imaging devices will be used to support the treatment of stable diabetic retinopathy patients again in primary care,’ he adds.
Government collaboration
Elsewhere, the board and the NWUECC are working with the Welsh government to develop a laser simulation unit and a ‘clean room’ for eye injection training, linked to its AMD referral refinement clinic.
‘We continue to train optometrists with the diploma in glaucoma at the University Hospital of Wales, and these optometrists also learn to do selective laser trabeculoplasty,’ says Bulpin. ‘The AMD referral refinement unit has been a great success and the business case is being developed to support the training of optometrists to undertake injections,’ he adds.
Furthermore, the NWUECC has trained a specialist optometrist in cross linking, ‘we believe the first in our nation’, and his first keratoconus outpatient clinic commenced this May at the University Hospital of Wales. ‘He has also been trained in the injection of patients with Ozurdex steroid, apart from anti-vascular endothelial growth drugs,’ Bulpin adds.
Reflecting on the achievements over the past five years, Bulpin says: ‘We have proven that the ‘shared care’ model works and the acute and primary care sectors working together will address this imbalance. The secret ingredient is the upskilling of our optometrists and by working together we will provide a timely service to our nation’s citizens.’