Enhanced Scheme Evaluation Project (ESEP)

Background

Regional schemes for eye care services that enable optometrists to perform (and be remunerated for) services beyond GOS sight tests have been in operation in various areas of England for a number of years. However, these schemes have largely gone without rigorous evaluation. 

As NHS services continue to be under pressure to demonstrate efficiency savings and evidence-based performance quality, such schemes need to demonstrate that they can deliver effective, high quality care that is either more cost effective than other approaches, or out-performs them in terms of patient experience and preferences. 

The Enhanced Scheme Evaluation Project (ESEP) was launched in October 2012 to conduct evaluations of different enhanced/community-based eye care service models. The project is being undertaken by a collaborative team from City, University of London and Manchester Royal Eye Hospital, and has provided insights into how the organisation of services impacts on clinical outcomes, patient experience and economic factors.  

Methodology

The project has included a literature review, clinical and economic analyses of Minor Eye Conditions and Glaucoma Enhanced Referral Schemes, and qualitative research into the views of participating medical professionals and patients.  

Key findings 

  • An in-depth analysis of the introduction of a Minor Eye Conditions Scheme (MECS) in south east London found the scheme was clinically effective, had high patient satisfaction and a drop of 26.8% in first attendance referrals to hospital ophthalmology departments by GPs (when compared to a neighbouring area without a similar scheme).1 
  • An economic comparison (between two neighbouring areas introducing the scheme and a third neighbouring area that did not) of the scheme’s transfer of services from hospitals to the community revealed a mixed picture, with costs increasing in one intervention area but by less than the non-intervention area, and costs decreasing in the other intervention area.2 
  • An evaluation of the same scheme’s clinical safety found a high quality of decision-making by the MECS optometrists, with a sample of clinical records graded by the project as 94.5% appropriately managed and 89.2% appropriately referred to the Hospital Eye Service.3 
  • Another type of community scheme, a Glaucoma Enhanced Referral Scheme in Manchester, was found to be an effective glaucoma filtering scheme with low false positive and false negative rates,4 suggesting a possible saving to the NHS if the cost of the scheme is outweighed by its reduction of false positive referrals.5 
  • Qualitative research found broadly strong stakeholder support for the development of community-based enhanced optometric services - amongst optometrists, ophthalmologists, GPs, commissioners and patients - if supported with a sufficient financial incentive, appropriate training, clear referral pathways and good communication.6,7 

…the scheme was clinically effective, had high patient satisfaction and a drop of 26.8% in first attendance referrals to hospital ophthalmology departments by GPs

Next steps 

The project will finish with a review of the most viable models for community cataract schemes. 

References 

 1 Konstantakopoulou E, Edgar DF, Harper RA, et al. Evaluation of a minor eye conditions scheme delivered by community optometrists. BMJ Open 2016;6:e011832. 

 2 Mason T, Jones C, Sutton M, et al.  Retrospective economic analysis of the transfer of services from hospitals to the community: an application to an enhanced eye care service. BMJ Open2017;7:e014089.   

3 Konstantakopoulou E, Harper RA, Edgar DF, et al. Clinical safety of a minor eye conditions scheme in England delivered by community optometrists. BMJ Open Ophthalmology 2018;3:e000125. 

4 Gunn PJG, Marks JR, Konstantakopoulou E, et al. Clinical effectiveness of the Manchester Glaucoma Enhanced Referral Scheme. British Journal of Ophthalmology 2019;103:1066-1071. 

5 Forbes H, Sutton M, Edgar DF, et al. Impact of the Manchester Glaucoma Enhanced Referral Scheme on NHS costs. BMJ Open Ophthalmology 2019;4:e000278.  

6 Konstantakopoulou E, Harper RA, Edgar DF, et al. A qualitative study of stakeholder views regarding participation in locally commissioned enhanced optometric services. BMJ Open 2014;4:e004781. 

7 Baker H, Harper RA, Edgar DF, et al. Multi-stakeholder perspectives of locally commissioned enhanced optometric services. BMJ Open 2016;6:e011934.