News


Early Day Motion 731 on Eye Health Research submitted by 26 MPs

Early Day Motion 731 on Eye Health Research submitted by 26 MPs

An Early Day Motion has been submitted by 26 MPs to the effect that " That this House expresses concern that funding for eye health research has hit crisis point; notes that already more than 40 people lose their sight every day in Britain, currently less than two per cent of combined national medical research funding is spent on the eye and that some three million over 65s, equating to one in six elderly people, will have a degree of sight loss by 2050 that will have a significant impact on their daily lives; further notes that sight loss currently costs the UK economy £22 billion annually and many of the 3.8 million people living with diabetes are at serious risk of poor eye health; and calls on the Government to make eye health a higher priority in the UK.” http://www.parliament.uk/edm/2014-15/731

The NHS in the News - yet again, and again, and again….

The NHS is set for a bumpy ride as 2015 starts (http://www.bbc.co.uk/news/health-30633677) and will inevitably become a puch bag in the run up to the general election (http://www.bbc.co.uk/news/uk-politics-30670633) and beyond it seems (http://www.telegraph.co.uk/news/politics/ed-miliband/11328344/Can-Ed-Miliband-save-the-NHS.htmlWT.mc_id=e_3815128&WT.tsrc=email&etype=politics&utm_source=email&utm_medium=Edi_PAM_New_2015_1_7&utm_campaign=3815128). Even Frank Field (former Labour Minister) is trying to play political games with a subject he tried to sort - and failed - (http://www.dailymail.co.uk/news/article-2895668/Why-party-leader-scared-tell-truth-crisis-hit-NHS-asks-Frank-Field-former-Labour-welfare-minister.html). While the Conservatives and thge LibDems dont want to miss the party (http://www.telegraph.co.uk/health/nhs/11331265/David-Cameron-hints-Tories-prepared-to-give-NHS-8bn-boost.html and http://www.theguardian.com/politics/2015/jan/05/nick-clegg-promises-nhs-8-billion-lib-dems-government-may-general-election) promising increasing amounts of additional funding. So While Labour, Conservatives and Lib Dems are fighting over the NHS, NHS England continues to work for its future (http://www.england.nhs.uk/2015/01/07/fyfv-national-leaders/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+NHSCBoard+%28NHS+England%29).

 

Optical Sector granted enhanced use of the NHS logo

Following extensive discussion between the Optometric Fees Negotiating Committee (OFNC), NHS England and the Department of Health, Community optics can now join with other primary care colleagues – including pharmacists, dentists and community audiologists – in being able to display the NHS logo on practice fronts and in certain communications, with immediate effect.

The Optical Confederation has worked with NHS England to develop guidance for practitioners about the correct use of the logo. This will be available on NHS England’s website shortly. 

Optical Confederation Chair Chris Hunt has said that: “As the main providers of primary eye care in the UK, it is only right that community optical practices and practitioners are recognised for the work they do on the front line of NHS care. I am delighted that NHS England and the Department of Health have acknowledged this. More importantly, this move will help people who need eye care to understand that community optical practices are part of the NHS. This is a great victory for joint working across optics and a good omen for our expanding role in delivering more NHS services in the community.” 

Furthermore, Mike George, Chair of the ONFC, said: “It has been a real group effort across optics to get this dispensation to use the NHS logo. We also thank our colleagues from pharmacy, and the Pharmaceutical Services Negotiating Committee (PSNC), for allowing us to draw heavily on their guidance. Many in optics have felt we should have been allowed the use of the logo for some time but it is one thing saying this and quite another achieving this change.” 

For more information on this see http://www.nhsidentity.nhs.uk/ and for use of the logo within the oprical sector see http://www.nhsidentity.nhs.uk/page/1117/all-guidelines/brand-guidelines-for-all-organisations

Take the test !

Nuffield Trust - How well do you think you know the NHS? Take the test !

With 1.7m employees, the UK’s NHS is reported to be the World’s 5th largest employer (http://www.bbc.co.uk/news/magazine-17429786) and accounted for £123n of our hard-earned cash in 2012. 

But how well do you think you know it? 

Try this Buzzfeed test - http://www.buzzfeed.com/nuffieldtrust/how-well-do-you-know-the- nhs-141sp

Some of the answers are provided by Nuffield Trust’s interactive charts illustrating key data on health care spending, hospital activity, performance, prescribing, and NHS staffing and other resources, for England and the rest of the UK: 

http://www.nuffieldtrust.org.uk/nhs-numbers 


Want to know how NHS expenditure was used in 2013-14?

Want to know how NHS expenditure was used in 2013-14?

If you would like to know how NHS expenditure was used to provide healthcare by the various NHS Trusts and Foundation Trusts, the the following link will provide the latest, published information.

https://www.gov.uk/government/publications/nhs-reference-costs-2013-to-2014





Monitor publish Performance of the 147 NHS Foundation Trusts (FTs) - 6/12 to end September 2014

FTs continue to experience  significant financial and operational pressures

NHS foundation trusts need to get better control over contract and agency staffing costs and increase their efficiency savings, says Monitor.

report to Monitor’s board on the performance of the foundation trust sector over the 6 months ended 30 September 2014 found:

  • the sector reported a deficit of £254 million compared with a planned deficit of £59 million
  • 81 foundation trusts reported a deficit of which 80% were acute trusts
  • the combined deficit of the 81 trusts was £396 million, offset by 66 trusts making a surplus of £142 million
  • trusts spent £831 million on contract and agency staff, double the £377 million they had planned
  • trusts made £492 million worth of cost savings, which is £126 million less than planned
  • trusts spent £854 million on items such as new facilities and estates, which is £357 million less than planned
  • 2.7 million patients received emergency care and more than 490,000 received non-emergency inpatient treatment, an increase of 124,000 and 6,000 respectively compared with the same period last year
  • 19,000 patients received inpatient cancer treatment, an increase of 1,000 compared with the same period last year, but the sector failed to treat 15% of them within 62 days of referral by a GP
  • the foundation trust sector as a whole breached the target to treat 90% of admitted patients within 18 weeks of referral
  • 27 trusts (18% of the sector) were subject to enforcement action by Monitor because of governance and performance concerns

For the full report, an executive summary and imfogram see here

CCG Commissioning

Yet another iteration of CCG Commissioning !!

NHS England are asking CCGs asked to consider their next steps on primary care co- commissioning.

The “The Next Steps Towards Primary Care Commissioning" document has been published on Monday 10 November. It has been developed by the joint CCG and NHS England primary care co- commissioning programme oversight group in partnership with NHS Clinical Commissioners.

The purpose of the document is to give CCGs the opportunity to choose afresh the co-commissioning model they wish to assume. It clarifies the opportunities and parameters of each co- commissioning model and the steps towards implementing arrangements.

The document is accompanied by a suite of practical resources and tools to support local implementation of co-commissioning arrangements. 

 

Jeremy Hunt’s optimism vs Norman Lamb’s pessimism/realism...

Jeremy Hunt’s optimism vs Norman Lamb’s pessimism/realism... 

The Government has said that it has already increased NHS funding by about £5billion. The Tories have promised to protect funding for NHS but not committed to increases beyond inflation.

The head of NHS England Simon Stevens recently warned that an extra £8 billion a year will be needed by 2020.

Minister of State for Care and Support Norman Lamb: “NHS will 'crash' without emergency £1.5billion funding next month”.

Mr Lamb said: “The NHS could crash, this is the risk. If we don't get the additional resource, then you would see increasing numbers of trusts getting into financial difficulty, you would see growing numbers of people waiting longer for access to treatment, and longer waiting lists to get to see your GP.”

http://www.telegraph.co.uk/health/11224317/NHS-will-crash-without-emergency-1.5billion-funding-next-month-says-health-minister.html

While we are on the subject of money, The National Audit Office have come out and said Financial risk is increasing in NHS trusts and foundation trusts. Those in severe financial difficulty continue to rely on cash support from the Department of Health."

This report finds that the financial position of the NHS has worsened since 2012-13, with growing financial stress in NHS trusts and foundation trusts. It notes that financial risk is increasing in NHS trusts and foundation trusts, and those in severe financial difficulties continue to rely on in-year cash support from the Department of Health. In 2013-14, over £0.5 billion extra money was issued to 21 NHS trusts and 10 foundation trusts to ensure that organisations in difficulty have the cash they need to pay staff and creditors. 

http://www.nao.org.uk/report/financial-sustainability-nhs-bodies-2/

The NHS - money and IT. Haven’t we been here before?

The NHS - money and IT. Haven’t we been here before?

Health Secretary, Jeremy Hunt’s recent speech to the KIng’s Fund outlined his thoughts on the latest iteration for the future of the NHS (https://www.gov.uk/government/speeches/innovation-and-efficiency). He talked about big challenges needing big solutions and outlined the Governments 4 pillars for the NHS. 1) The need for a strong economy; 2) the need for integrated care closer to home at the heart of a response to an aging popultaion; 3) Innovation and value for money - seeking £22Bn saving; and 4) Getting the right culture of compassion and care within the NHS.

This was then followed by NHS England setting the direction for NHS information technology and informatics so that commissioners, providers and suppliers can make informed investment decisions, identifying, amongst the alternative approaches, those that deliver the highest quality care for patients. Frontline clinicians leading this agenda will ensure that systems are designed around optimal clinical workflows, enabling health and care professionals to do their jobs more effectively. In other words, it all becoming much more IT savvy. 

Also, Health and social care leaders set out plans to transform people’s health and improve services using technology - http://www.england.nhs.uk/2014/11/13/leaders-transform/

Key deliverables for the Strategic Systems and Technology Directorate include:

  • enabling and supporting people to access and interact with their individual health records online should they wish to do so
  • facilitating the widespread adoption of modern, safe standards of electronic record-keeping
  • the re-launch of the Choose and Book service to make eReferrals available to patients and health professionals for all secondary care by 2015
  • enabling primary care providers to offer the facility to book GP appointments and order repeat prescriptions online
  • supporting hospitals to implement safe and effective electronic prescribing services for their patients
  • ensuring  that integrated digital care records (IDCRs) become universally available at the point of care for all clinical and care professionals
  • encouraging and facilitating the widespread adoption of the Electronic Transfer of Prescriptions (EPS) programme which allows prescribers, such as doctors and practice nurses, to send prescriptions electronically to a dispenser, such as a pharmacy, of the patient’s choice
  • commissioning the nationally provided  IT infrastructure which underpins NHS services, such as the Spine (the national system which enables information to be shared across NHS care settings), N3 (the underlying network) and NHSmail (the secure email service).



Pocklington for Professionals

Pocklington for Professionals - The Thomas Pocklington Trust

The Thomas Pocklington Trust has published a new guide “Homes and living spaces for people with sight loss: a guide for interior designers” to change the lives of people with sight loss and related sensory-impairments.

This guide the first in a series called 'Pocklington for Professionals' which will be published in the coming months, summarises key design principles and contains checklists for specific areas such as kitchens, bathrooms, stairs and living rooms. Pocklington commissioned the interior designer, Jaqui Smith (who, having lost the sight in her left eye, uses her experiences to produce eminently-usable advice). The guide includes advice on:

  1. How to use colour contrast to improve navigation
  2. Current regulations on the light reflectance value of surfaces and how lighting affects them
  3. How to use lighting to make the most of people's sight and avoid glare that can make it harder to see
  4. How to make design flexible, especially in community settings where people's individual needs are varied. 

http://www.pocklington-trust.org.uk/Resources/Thomas%20Pocklington/Documents/PDF/Research%20Publications/pocklington-for-professionals-interior-design-guide.pdf


Don’t it make my Brown eyes blue…...

Don’t it make my brown eyes blue…….

A recent edition of the Los Angeles Times ran a story that caught the seasonal, optometric imagination. That of the phenomenon of reindeer eyes changing colour from brown in the summer to blue in the winter.

Was it really about this that the American, Country pop singer Crystal Gayle sang about in her 1977 song?

It appears that, in the summer, the reflective layer behind the retinae of reindeer, the tapetum lucidum, an interior part of the eyes of Arctic reindeer appears gold, and around Christmas it turns a deep blue. Biologists have discovered that it is a unique adaptation that helps these animals deal with the strange light conditions at the top of the world.

The reindeer’s world is one of extremes. Above the Arctic Circle, Christmas falls in the midst of a 10-week period of perpetual twilight in which the sun never rises and the landscape is cast in bluish hues. But from mid-May to late July, the sun never sets, creating a long, endless day.

Biologists at the Norway's University of Tromso, in one of the largest cities situated north of the Arctic Circle, wondered how the reindeer managed the transition from a world of near-total darkness to one of blinding light, when springtime sunlight reflects off still-unmelted snow.

To find out, they collected reindeer eyes from the Sami, indigenous herders who often slaughter the animals around the solstices. The Norwegian researchers collected eyes during both the winter and summer months, then mailed them off to Glen Jeffery, a neuroscientist who studies vision at University College London.

Humans don’t have this structure, but lots of other animals do. It helps nocturnal animals see at night by bouncing light back inside the eye, giving the light receptors in the retina a second chance to be stimulated. The tapetum lucidum is responsible for the flash of “eye shine” you see when a cat looks into a car’s headlights.

Scientists had always assumed that this piece of ocular anatomy's color was fixed.

“This is the first time that a change in color in the tapetum has been shown in a mammal,” Jeffery said.

In a study published in the Proceedings of the Royal Society B, Jeffery and his colleagues in Norway explained that when a reindeer’s tapetum is blue, 50% less light is reflected out of the eye than when the tapetum is gold. A reindeer with a blue tapetum sees less clearly than one with a gold tapetum, but its eyes are 1,000 times more sensitive to light.

“Clinically, the reindeer become glaucomic,” Jeffery said.

Perhaps Santa should find animals of another species to pull his sled on one of the darkest nights of winter.

But the scientists argue that losing acuity and gaining light sensitivity is probably a worthwhile trade-off for reindeer on the ground because it allows them to detect a moving predator in the darkness — even if they can’t see it clearly.

“Reindeer are very plastic, so it is not surprising the eye would change,” said Perry Barboza, who studies Arctic animals at the University of Alaska at Fairbanks and was not involved with the study. “Many of their external characteristics change as winter approaches — their coats fill out and go from brown to white, they put on a lot of body fat. The eye color change is just another part of that story.”

The scientists determined that the color of light reflected by a reindeer’s tapetum likely depends on how much fluid pressure there is in the eye itself. It took Jeffery and his colleagues in Norway nearly 10 years to figure this out.

In the dark winter months, the reindeer's pupils dilate completely to let in as much light as possible. That action also causes a flap to descend over the back of the eye where fluid normally drains out. Since the fluid has no way to escape, the pressure inside the eye increases. That, in turn, causes collagen fibers in the tapetum to squish together, which changes its color from gold to blue.

But blue and gold are not the only colors in the reindeer tapetum spectrum. The researchers also checked the eyes of a small herd of reindeer that lived on the campus of the University of Tromso, and who were exposed to permanent distant urban lighting. Instead of turning blue in the winter, they became green.


http://www.latimes.com/science/sciencenow/la-sci-sn-reindeer-eyes-change-christmas-20131220,0,1233478.story#ixzz2oIlGzyJh

Age-related Macular Degeneration linked to Erectile Dysfunction !!

Rather worryingly for men of a certain age, neovascular age-related macular degeneration (AMD) is strongly associated with erectile dysfunction (ED), according to researchers in Turkey.

Harun Cakmak, MD, and colleagues at Adnan Menderes University Medical Faculty in Aydin, prospectively studied 195 men, of whom 90 had neovascular AMD and 105 were healthy volunteers. They used the International Index of Erectile Function (IIEF) questionnaire's erectile function domain to assess ED. The AMD and control subjects had mean ages of 62 and 60 years, respectively. IIEF questionnaire results indicated that 85 men in the AMD group (94.4%) had some degree of ED compared with 68 (64.8%) in the control group, a significant difference between the groups, the investigators reported online ahead of print in the Journal of Ophthalmology.

The study is the first to find an association between neovascular AMD and ED. The two conditions share similar risk factors, such as diabetes mellitus, hypertension, and cardiovascular disease. Additionally, they pointed out that both conditions share some pathologic and epidemiologic similarities. For example, the choroid—the nourishing vascular layer of the eye—and penis have a rich vasculature, and impaired microcirculation has been found in the choroids of patients with neovascular AMD and in the penises of men with ED.

Sir David Nicholson outlines priorities for CCGs and NHS England

If you want to know what the priorities and issues being pushed at your hospital and CCGs are, then this is a good start. The Head of NHS England has written to all the NHS Chief Execs and CCGs telling them: to improve outcomes on some key indicators, make five year plans, that they’ll get their new budgets soon and to get a move on using joint funds to get services in to the community and more. 

http://www.england.nhs.uk/wp-content/uploads/2013/10/david-letter-comm.pdf    

Reseach by the KIngs Fund shows how to co-ordinate care for the most complicated patients and long term conditions

Most eye patients are elderly and most have other long term conditions asides from their eye ones.  How can the system look after better? King’s Fund has done some research to tell you:

http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/co-ordinated-care-for-people-with-complex-chronic-conditions-kingsfund-oct13.pdf    

Dr David Geddes, Head of Primary Care NHS England, tells Secondary Care and GPs to get ready for 7-day working

David Geddes is Head of Primary Care in England so he pays the GOS and the GP contract.  Secondary care is being told to sort out seven day working because people are much more likely to die in hospital if they are admitted to hospital at the weekend (don’t tell I told you but actually the lowest death rate is Monday then it rises steadily towards the weekend).  Now primary care is being told the same.  Optoms should be cheering loudly about being ahead of the game here really:

http://www.england.nhs.uk/2013/10/23/david-geddes/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+NHSCBoard+%28NHS+England%29    

Here today, gone tomorrow - NHS Direct

It has been on the cards for a while.  NHS Direct was a nationally commissioned service.  The Health Act broke it up and replaced it with NHS 111, which was commissioned locally to link it up to ambulance services.  In a typically confusing NHS way however, NHS Direct limped on in organisational form by winning some of the local contracts to provide 111 services.  However, NHS Direct  could not meet their obligations and have wound up.   Nurses say 111 is poorer quality as it isn’t usually staffed by Clinicians and Labour say NHS Direct’s break up and demise personifies Tory ‘vandalism’ of the NHS.  

Simon Stevens to be the new Head of NHS England

After a lengthy search where leading health figures competed to not take the job, a successor to Sir David Nicholson, Chef Executive of NHS England and de facto boss of the NHS in England has been found. 

See http://www.telegraph.co.uk/health/nhs/10400660/Blair-advisor-Simon-Stevens-appointed-new-NHS-chief-executive.html

Simon Stevens is currently a boss at United Healthcare in the States and is best known for his work advising Tony Blair and his Labour Government on how to reform the NHS.  So someone who has worked in the NHS, in other countries’ health systems and who should understand the politics too.  Initial reaction has been warm from health trade press. 

NHS England starts BIG CONVERSATION on future of the NHS and it's £60bn pounds shortfall.

NHS England, the body at the heart of the reformed NHS in England, is publishing a five year strategy later this year.  It is also flexing its new muscles, asserting its independence from the Department of Health and is bruised from a battering in the media after mid-Staffs and the curious departures in recent and coming months of its Chief Exec (David Nicholson), its number two and some of its directors. 

To lay the ground and share the blame for some bad news about the financial sustainability of the NHS (its needs to save £60bn by 2025, its spent £106bn this year), some inevitable new scandals, to build support for what will need to be some big changes if the NHS is to survive (“bold clinical changes” = hospital closures), and to try to save David Nicholson’s legacy, NHS England is trying to ‘start a conversation’ on the realities facing the health service and what to do about it. 

Those of you misfortunate enough to follow NHS chitter chatter will have heard it all before, but it’s not you they are after: http://www.england.nhs.uk/2013/07/11/call-to-action/

http://www.england.nhs.uk/wp-content/uploads/2013/07/nhs-belongs.pdf


Four months in & Clinical Commissioning Groups still don't know their budgets...

It’s almost four months since CCGs took control of local health budgets - but there is still a degree of uncertainty about how much they have to spend.

According to the GP online magazine "Pulse" analysis this month focuses on this uncertainty, and examines why CCGs still haven’t had their 2013/14 budgets sorted out, as highlighted by the National Audit Office this month. They  also discuss the distant clouds on the horizon forming as a result of the Chancellor’s plan for a £3bn pooled social care budget. These uncertainties are causing problems – one CCG claims its budget has been cut by £7m as a result.

All this comes in the same month that NHS England chief executive Sir David Nicholson set out plans for CCGs to find a further £30bn in savings.

Better news is that CCGs are taking proactive moves already to increase the amount of money given to primary care in the form of an increased local enhanced services budget, although there is a word of warning – Dr James Kingland argues that Section 75 could put paid to this.

This month has been a key month for commissioners and NHS England. Sir Bruce Keogh’s review into 14 failing hospitals will have significant repercussions for commissioners, and, according to "Pulse"  our five minute digest explains just why.

The debate on the A&E crisis shows no signs of abating. Our blogger Dr Jonathan Shapiro argues thatincentivising CCGs directly to reduce admissions is themost efficient way forward – something the health committee didn’t consider in its report on the subject,although it did brand NHS England plans ‘inadequate’.

There has also been a raft of news stories regarding commissioning in July – foremost, the news that NHS Direct has pulled out of NHS 111 and so commissioners will be forced to retender. And elsewhere, the King’s Fund offered an arresting finding that half of GPs have changed their clinical practice since becoming CCG members.

Custom 3D printed glasses are only a venture capital campaign away from reality

I have been watching the development of 3D printing for several years. Technology has been developed that enables almost anyone to 'manufacture' or print in 3D, using layer upon layer of material, 'printed' on top of the preceding layer to create objects in 3D. It has reached the stage that £D printering devices can be now be bought for as little as £750.

A start-up company, Protos, have turned their attention to creating spectacle frames using this technology. Read more at http://venturebeat.com/2013/07/30/protos-crowdfunding-3d-printed-glasses/#qeJAu5FfUjhOJKQR.99 .

The following link http://www.youtube.com/watch?feature=player_embedded&v=pgp0-wRgG3w (if cut and pasted itno your browser) shows how the user would interface with Protos to enable them to capture sufficient facial characteristics to enable them to custom "print" your spectacle frame.

Protos wants to bring its 3D printed eyewear to the masses, but first it needs a bit of cash. Using its own proprietary material, Protos creates light, flexible glasses frames that can be tweaked to give wearers a custom fit.

In an effort to get the project off the ground, Protos has launched a crowdfunding campaign, which it hopes will help it raise $25,000. (Notably, the campaign is powered by Crowdhoster, an interesting new platform that lets fundraisers run campaigns from their own domains.)

Protos says that much of the funding will be used to pay developers, which it needs to create a more elaborate and user-friendly interface for the fitting process.

Protos’s efforts show one of the reasons why 3D printing is so darn neat: It lets manufacturers create smaller, more custom batches of products without having to worry about some of the scale constraints core to larger manufacturing operations.

With eyewear, traditional manufacturing processes have dictated that companies must make thousands of the exact same frames at once, regardless of whether those frames are particularly well-suited to any one person’s face. By using 3D printing, Proto’s turns that process on its head, which is why it’s worth paying attention to.

This technology is one to watch for the future.





USA Study shows Vision-related diseases cost $140 billion annually; more costly than cancer and heart disease

A study (http://costofvision.preventblindness.org/downloads) published by Prevent Blindness America and conducted by National Opinion Research Center specialists from the University of Chicago determined that the national annual eye and vision health costs were around $140 billion. That is more costly than at least 3 of the top 7 major chronic illnesses. The list includes Alzheimer’s, heart disease, diabetes and cancer. In 2007, eye care costs were at about $51.4 billion, indicating that the cost has increased by $80 billion in only 5 years.

Study author and research scientist at the University of Chicago’s research center, John Wittenborn, says ”I think a lot of chronic conditions get a little more attention. What people don’t realize is that some of those boring conditions really account for the bulk of medical costs in our country.”

The range of vision disorders people suffer from include slight vision impairments that require glasses or contact lenses to glaucoma, macular degeneration and blindness.

The chief operating officer of Prevent Blindness America, Jeff Todd, said that only a portion of that increase is related to new technology and treatments. The majority of the cost is from the long term care of older patients with diseases such as glaucoma.

He also added, “The longer you live with a vision problem, the more expensive it gets. Eye disorders are ranked fifth for highest cost, yet we’re not getting that attention. No one dies from eye disorders, but they greatly impact quality of life. The federal government foots the bill on a portion of the nation’s burden. They pay about $47.4 billion while insurance companies pay about $20.8 billion in direct medical costs, as well as an additional $1.3 billion for long term care costs. Patients and their families are left paying the remaining $71.6 billion every year. That averages out to about $238 for every person each year".

Todd suggested that the best way to reduce these costs is to focus on preventative care and more research, but obtaining funding for prevention research is the “biggest challenge”.

“What’s lacking is early detection or early diagnosis. Vision problems are detected too late.” Wittenborn said. “Right now we can’t restore vision, we can only retain vision that has not been lost, and preventative care can really save and prevent people from losing a significant amount of vision and money.”

Budget cuts have greatly affected research funding. The Department of Defense’s Vision Trauma Research Program saw an increase in funding. However, the National Eye Instititute had their funding cut by $36 million, which potentially eliminated about 90 grants.

The switch of Chloramphenicol to OTC has not reduced NHS Drug Budget

The switch to OTC has not reduced NHS prescription demand for Chloramphenicol.

A Cardiff University Study (Int J Pharm Pract 2013; available online 17 April) has repopened the debate over increasing access to antibiotis. There has been a sustained surge in the use of the antibiotic chloramphenicol since it was made available over the counter (OTC) for eye infections in 2005.

The Welsh study showed a steady year-on-year increase in overall supply in chloramphenicol the three years after it started being sold in pharmacies.

Although use subsequently levelled off slightly, it remained 40% up on previous levels over the next two years. The study also showed no signficant reduction in NHS drug costs or GP workload after the introduction of the OTC antibiotic.

The researchers suggested that widespread ‘misdiagnosis’ by pharmacists could be behind the rise (e.g. mistaking Allergic Conjunctivitis for Bacterial Conjunctivitis, etc.).

The GP magazine, Pulse, previously reported concerns among GPs and public health experts after a 48% increase in overall use of chloramphenicol was found two years after it was made available OTC.

Ministers subsequently moved to ban further OTC antibiotics, after plans were announced by the MHRA to reclassify trimethoprim and nitrofurantoin for treatment of urinary tract infections as pharmacy-only medicines.

Stopping the inappropriate use of antibiotics has become even more of a priority over the past year, with doctors called on by the chief medical officer to help combat the ‘catastrophic threat’ of antimicrobial resistance, by reducing their prescribing and introducing diagnostics to target antibiotic use.

The latest findings question how appropriately chloramphenicol drops and ointment are being used for eye complaints, and experts have again warned of the risks of fuelling demand for antibiotics.

The Cardiff University researchers analysed NHS Wales data on primary care prescribing between June 2004 and December 2010, and OTC sales data from June 2005 to December 2010.

Both prescribed and sold supplies of chloramphenicol eye drops rose after OTC sales began in 2005, with overall packs used at around 90,000 in 2004 to 2005 and rising to a peak of 140,000 in 2007 to 2008, before settling at just over 130,000 in 2008 to 2009 and 2009 to 2010.

Although the amount of eye drops supplied on prescription dipped in the first year after they were available OTC, they subsequently returned to similar levels as before the antibiotic went OTC.

An increase in sales of chloramphenicol eye ointment after it became available from pharmacists in 2007 followed a similar pattern, as did overall sales of both types of preparation for the full five-year period.

The researchers concluded: ‘Over the five-year period following OTC availability sales of ophthalmic chloramphenicol grew substantially before appearing to stabilise. Their apparent lack of impact on prescription use meant that there was no saving to the NHS drug budget nor a reduction in GP workloads.’

Noting that conventional signs and symptoms that pharmacists rely on to distinguish bacterial from viral conjunctivitis are not very informative, they added: ‘It is not improbable that some of the increase in OTC ophthalmic chloramphenicol sales has arisen because of misdiagnosis and therefore reflects inappropriate use.’

Dr Nicholas Brown, president of the British Society for Antimicrobial Chemotherapy, said although chloramphenicol was generally ‘well marshalled’ by pharmacists, its OTC availability would still increase the risk of increasing resistance to the antibiotic.

He said: ‘The BSAC does not support widening access to antibiotics by making them available over the counter, and extreme caution is needed when doing so. 

‘This paper demonstrates increasing availability of antimicrobial agents increases usage, which will in turn increase pressure on selection for resistance. It is this topic that is of paramount concern to us and we have and continue to work to ensure antimicrobial agents remain prescription only medicines to preserve their efficacy in fighting infectious diseases now and in the future.’

Dr Anthony Brzezicki, a GP in South Croydon and chair of Croydon CCG, said in some cases OTC chloramphenicol does seem to be used inappropriately. He said: ‘I do not see most cases who attend pharmacy for chloramphenicol. I do, however, see people who have been advised to take drops with too much time between them – for example, once daily – so they do not work, or who have sensitised their eyes by taking them for too long, sometimes for two weeks or more.

‘So I think there is scope for improving the advice given to people who buy OTC drops.’

Int J Pharm Pract 2013; available online 17 April

 

Total items chloramphenicol supplied (thousands)

 

                             2005–6     2005–6*     2006–7     2007–8**     2008–9     2009–10

Total                      144.4         181.7         189.2          210.6          203.4        202.0

OTC                           -              45.7           56.3            79.0            66.6          65.6

On prescription     144.4         136.0         132.9          132.0          136.8        136.4

*Chloramphenicol eye drops available OTC

** Chloramphenicol eye ointment available OTC

 

"Big Brother" is watching you

Eyes impact bahaviour

Bike thefts have been reduced by putting pictures of staring eyes above cycle racks, researchers have found.

A team from Newcastle University decided to test the theory that people behave better when they think they are being watched.

For two years they studied crime rates at campus racks and found a drop of 62% at those which displayed eye posters.

The crime-fighting idea is now being tested at various train stations by British Transport Police (BTP).

For the first year the Newcastle team monitored bike thefts from all racks across campus for a control figure, then placed the eye signs in three locations, leaving the rest of the racks without signs.

'Behave better'

The idea for the research was inspired by a 2010 study which showed diners in a canteen were more likely to clear away their tray when there were eyes watching them.

Equally, A 2006 study found that staring eyes made people pay almost three times as much into a tea-room honesty box.

Academics found that bike racks which had eyes placed above them experienced 62% fewer thefts than the previous year, while those without eyes saw thefts increase by 63%.

Lead researcher Prof Daniel Nettle, said: "We don't know exactly what is happening here but this just adds to the growing evidence that images of eyes can have a big impact on behaviour.

"We think that the presence of eye images can encourage co-operative behaviour. One strong possibility is that the images of eyes work by making people feel watched.

"We care what other people think about us, and as a result we behave better when we feel we are being observed."

Changes to Ophthalmic Service Regulations as PCTs transfer to NHSCB

No need for optometrists to routinely inform GPs after examining Pxs with diabetes or glaucoma

As Primary Ophthalmic Services (POS) pass from PCTs to the NHS Commissioning Board NHSCB), changes to the POS Regulations see the abolishment of the vestigial requirement optometrists and ophthalmic medical practitioners (OMPs) to routinely notify GPs after testing the sight of a patient with diabetes or glaucoma has now been abolished.

However, if there is a change to a patient’s clinical status which the GP should know about, practitioners should still refer the patient as normal. 

In effect, this now formally removes the now-redundant requirement to inform GPs as the eyecare landscape has changed and the vast majority of patients with diabetes are enrolled in a diabetic retinopathy screening service, while patients with glaucoma will be seen in secondary care, therefore their care is adequately provided for without routine notifications of sight tests unless there is something significant to report.

The second change under the same regulations, after a trial in the North West, is to add receipt of the incoming Universal Credit for entitlement to an NHS sight test and voucher towards the cost of spectacles and contact lenses. 

A massive 1% increase on General Ophthalmic Service fees and more !!!

GOS fees edge up 1%

A slight & rather disappointing 1% increase in General Ophthalmic Services (GOS) fees will be introduced from 1st April 2013. A 1% increase to the NHS sight test fee has been confirmed for England and Wales (from £20.70 to £20.90). The Optometric Fees Review Committee (OFRC) reached agreement with the DoH for 2013-14 fees late last week.

An identical increase for domiciliary visits in the two countries sees the fee rise to £36.82 for the first and second visit, and £9.22 for additional visits thereafter.

It was also agreed that the continuing education and training (CET) grant would increase by 2.5 per cent (from £503 to £516), while a grant for training pre-registration optometrists would also rise 2.5 per cent (from £3,245 to £3,326). Practitioners should make their claim between July 1 and October 31. The increases were exempt from the government's 4 per cent efficiency target.

OFRC chair Claire Slade said: 'We know this is disappointing. However, given the very tight envelope the government has set for public sector pay, including GOS, we have nevertheless managed to negotiate the full 1 per cent fee increase on offer, without any offsetting efficiency gains. 'As everyone in our sector knows, there is absolutely no more efficiency to be squeezed out of GOS fees.'

The committee agreed a cash-neutral change to GOS contract compliance with the NHS Commissioning Board. After a Year 1 catch-up, this would result in three yearly self-reporting by contractors against quality in optometry (QIO) Level 1 in return for much less likelihood of a visit for most practices unless they were a significant outlier, for example on complaints.

'The marginally higher increases on CET and pre-registration grant are at least some small acknowledgement of the investment the profession is making in quality and in training optometrists for the future,' added Slade.

In reality, these increases represents a small cut in real terms, with inflation currently standing at between 2.7% and 3.3%, depending on which index you use (RPI or CPI).

It has already been confirmed that NHS optical voucher values are to rise by 1 per cent.

A "burning Issue" !! - GPs to lose reimbursement for filling out cremation forms

Pulse reports….GPs are set to lose out on reimbursement fees for filling out cremation forms from 2014 despite retaining much of the burden of the paperwork involved. Something that appears to have slipped under almost everyone's radar.

The Government has confirmed that the reforms of the death certification process, set out to coroners in September last year and due to come into effect from April 2014, will mean only the ‘medical examiner’ will be allowed to fill out cremation forms and GPs will no longer be paid the £76 for each form - called form 4 and 5 - that they currently fill out. Birmingham LMC executive secretary Dr Bob Morley is reported as saying: ‘I don’t think this is a major source of income for most GPs. There are a few with specialist roles, for example those who provide care for hospices for whom it potentially is a more significant source of income. But it is all part of the overall squeeze on income in general practice at the moment, a small part of a much bigger picture.’

A Department of Health spokesperson said: ‘A unified and robust system of scrutiny of deaths by a local medical examiner will replace the current system of checks and forms for cremations that do not need a coroner investigation. The new local medical examiner service that will carry out this work will be run by local authorities.’

However, GPs have warned that practices will still have to provide paperwork and contact next of kin.

The Full DH advice to Coronors is set out here.


Better data, better care: ophthalmic public health data report 2013

The College of Optometrists has published 'Better data, better care: ophthalmic public health data report 2013’.

'Better data, better care: ophthalmic public health data report 2013' has been compiled through research and discussion within the ophthalmic public health sector. A workshop of optometrists, ophthalmologists and other representatives from the sector studied a review of the available literature on ophthalmic public health data, and the findings of the review and the discussions from the workshop led to the report.

The report makes the following recommendations for optometrists:

  1. Work to improve the quality of data obtained from the Certificates of Vision Impairment (CVI) process to ensure that the eye health indicator remains in the Public Health Outcomes Framework beyond 2016.
  2. Move to electronic systems for General Ophthalmic Services (GOS) payment claims.
  3. Include information about ethnicity on, and record all data from, GOS forms to better understand the eye health needs of the local population.
  4. Work with Government to include the NHS number in a way that is feasible to operate in community practice.
  5. Move to electronic systems to enable community optometrists to communicate with hospitals and GP surgeries and include back-up information with referrals.
  6. Encourage the completion of the Department of Health project to produce a standardised data set for referrals.
  7. Design a system which will allow referrals from optometrists to be clinically audited by subspecialty.
  8. Reintroduce a system to provide a more accurate estimate of private sight tests.
  9. Help optometrists understand how the collection of full and accurate data will protect the future of the profession and raise its profile with key decision makers, other health professions and the public.

The publication of this report follows on from the optical sector joint strategy published in 2011. The strategy identified three priority areas for the sector to focus on: knowledge, capacity and communication. 'Better data, better care: ophthalmic public health data report 2013' is a College contribution to the area of 'knowledge'.

Having good quality data on sight loss and blindness allowed an eye health indicator to be included in the Public Health Outcomes Framework for England in 2012. The fact that the sector could use data and evidence to make sure eye health was included in the wider public health agenda shows the opportunities that improved information can give. Professionals in the eye sector should support the indicator and the data set it is based on, to make sure that eye health continues to be recognised as part of public health.

NHS Commissioning Board - Clinical Senates

Plans for Clinical Senates published

Plans for 12 regional networks covering all of England, made up of clinical leaders from a range of clinical professions and charged with advising commissioners to get the best outcomes for their populations have been published.  They will be called ‘clinical senates’ and the idea fro them came from the "Future Forum" which was set up during the Government’s "listening period" for the Health Bill.  They can only advise Commissioners and it will be up to local areas to decide who is represented on them. They will look at the totality of healthcare (e.g. "What would be the impact of closing this hospital ?") rather than specific individual services or specialities.   It remains to be seen how influential they will be.  It is probably fair to say that the plans did not set too many pulses racing across the health sector. 

 For more information see: http://www.commissioningboard.nhs.uk/files/2013/01/way-forward-cs.pdf 


Private companies dominate 'any qualified provider' contract bids

Nearly half of all providers running services under the any qualified provider (AQP) policy are private companies, DH figures have revealed.

Figures show how hard it is for small providers such as GP practices to compete with companies for contracts. Of the 87 providers running services under AQP in England, 26 are within the NHS, 18 are charities, four are social enterprises, one is a voluntary organisation and/but 38 are from the independent sector.

The number of providers and contracts is likely to increase from the figures taken last month because PCTs are currently advertising contracts on the NHS Supply2Health website.

The DH confirmed that a further 18 providers have been approved by PCTs but are not yet running services. A DH spokesman said the department could not reveal what type of provider these were.

A spokesman for Virgin Care Ltd told GP that the company had been approved by PCTs as a potential provider for ten services. But it has yet to decide whether to bid for services under AQP. He said: 'If we feel that we can make a really positive difference to patient care in those areas, we will look to take those services forward. We are taking a look at AQP but it isn’t our main focus.'

GPC negotiator Dr Chaand Nagpaul said: ‘To gain approved provider status requires considerable investment of time and expense. Clearly large commercial organisations have considerable advantage because the process for AQP application is time consuming, expensive and bureaucratic.

‘We have had feedback from GP practices and they have described the process and it does disadvantage small providers. This does pose many questions about the AQP process about whether it can be less bureaucratic and more sensitive to smaller providers.’

Last autumn, the DH expanded the policy to 39 services which include some child and adolescent mental health services, diagnostics and dermatology.

If a service is put out to AQP, providers can be from the NHS, private or voluntary sectors. It leaves the patient to choose the provider of their care from a list, all of which have to be Choose and Book compliant.

One can only wonder as to the impact of private companies on optometry's attempts to compete.

Family & friends test coming to Primary Care

David Cameron reiterated his support for the friends and family patient satisfaction test (i.e. asking patients if they would recommend the healthcare provider they’ve just used to their friends and families). The test is being rolled out in English hospitals this year.  Cameron has now said he’d like it used in community nursing and GPs surgeries too - "as soon as possible". Copperfield from the online GP Journal Pulse has an interesting perspective on this.

It has since emerged that a Department of Health commissioned report had advised against introducing the ‘friends and family test’ into the NHS last year.

No obvious indication of this concept coming to optometry yet, but another sign that the era of saying all NHS services are the same quality is long gone and it is now about comparing outcomes, comparing safety and tackling poor performers. Rather similar in direction As do reports that every surgeon will have to publish death 


GOC needs 2 new Registrant Council Members

The General Optical Council are seeking 2 new registrant Council Members to replace vacancies that will arise in the first quarter of 2013. 

From personal experience, this is a rare opportunity to contribute to the strategy of the GOC, helping to  fulfil the Council’s role, exercising oversight and ensuring effective corporate governance, and making high-level policy decisions and (especially important for registrants) help shape the future of optical regulation in the UK.

The successful candidates will

The GOC will look for experience of hands-on delivery of a range of services in optical primary and secondary care and will welcome applications from registrants who:

  • are reflective of the mix of registrants and patients, especially women and/or ethnic minorities;
  • live or work wholly or mainly in Scotland, Wales or Northern Ireland; and/or 
  • have other specialist knowledge and experience such as:
    • small optical business issues;
    • specialist optometry training, such as therapeutic prescribing;
    • working with patients with optical disabilities or who have particularly complex optical needs; or
    • educating optometrists/dispensing opticians and supervising pre-registration optometrists/dispensing opticians.

Full details will be published by 4 January 2013, so check the optical trade press or the current vacancies section of the GOC website after that date.

GOC CET deadline 31st December 2012

As of today, with only 11 days left of the current CET cycle, 9% of the General Optical Council registrant community of Optometrists, Contact lens and Dispensing Opticians (of 19727 registrants) have yet to submit sufficient CET points to remain on the GOC register for the coming year, 2013.

This effectively means that nearly 1:10 registrants face a last-minute dash to obtain and upload their remaining CET points or face an uncertain future.

Proxymetacaine recalled

The Medicines and Healthcare Products Regulatroy Agency (MHRA) has issed a Class 2 drug alert. Bausch & Lomb minims Proxymetacaine hydrochloride 0.5%w/v eye drops (batch F50052) are being recalled. See http://www.mhra.gov.uk/Publications/Safetywarnings/DrugAlerts/CON213220

Welsh Eyecare

The Tories in Wales are claiming waiting times in North Wales health board for eye care have trebled as a result of the current Labour Government’s cuts. 

This is the latest story about access to care, rationing and cuts from the across the UK and they’ll keep coming. 

More here: http://www.welshconservatives.com/news/swift-rise-eye-op-waits

Data on waiting times in Wales for the keen here:

https://statswales.wales.gov.uk/Catalogue/Health-and-Social-Care/NHS-Hospital-Waiting-Times/Referral-to-Treatment

© Dr Rob Hogan 2017                                                                                                                              info@icare-consulting.co.uk