Amendments to Stafford & Cannock PEATS and GRR Guidance for Accredited Optometrists- 09/02/2016 at Staffordshire Local Optical Committee

Amendments to Stafford & Cannock PEATS and GRR Guidance for Accredited Optometrists- 09/02/2016




The following amendments to Stafford & Cannock PEATS and GRR Guidance have been agreed between the service commissioners and Primary Eyecare (Shropshire & Staffordshire) Ltd / SASPEC, following a services review meeting of 22 December 2015.  You will also find a couple of reminders about existing guidance mentioned below.


  1. Raised IOP referrals (or suspected raised IOP referrals) from GPs into PEATS central hub, or directly to PEATS practices, can be seen in PEATS.  Although raised IOP is not ostensibly a “PEATS Condition”, it is not appropriate to deflect these patients into the GRR service for Test A (pressure refinement only), because one cannot assume the absence of other signs of glaucoma.  Therefore, it is safest for all concerned if such patients are seen in PEATS, whereby the practitioner can undertake A/C angle measurement, IOP measurement (Goldmann or Perkins CT preferable, but not mandatory), stereo-view of discs, and (if appropriate) full threshold visual fields.  Following this, IOP > 30 mmHg is referred directly to secondary care (urgent).  IOP 22-30mmHg is referred routinely to secondary care (assuming open angles).  IOP <= 21mmHg is discharged, providing there are no other signs of glaucoma. 

PLEASE NOTE: This amendment is for GP referrals only.  Self-referral of raised IOP (or suspected raised IOP) into PEATS is NOT permitted.


2.  Referrals into PEATS for blurred vision, or recent onset transient vision loss, <= 48 hours to be seen as PEATS URGENT (within 24 hours).  Referrals into PEATS for blurred vision, or recent onset transient vision loss, > 48 hours to be seen as PEATS ROUTINE (within 14 days), regardless of source of referral.


3.  Whilst the commissioners are impressed with the significant deflection of referrals into secondary care demonstrated by both the PEATS and GRR pathways, they are disappointed with the low uptake of GRR by newly-accredited practices so far.  SASPEC fully understands that the time taken to complete the GRR episode form on the IT module exceeds the time taken to perform Test A, which can be a disincentive to its use.  However, GRR and PEATS subcontractor practices are advised to make full use of both services, as they are pilot schemes only, and there is a very real risk that they could be withdrawn by the commissioners if they are not fully utilised.  Such an outcome would be a great shame, not least as SASPEC’s directors and clinical leads have taken a significant amount of time out of their busy practices in order to mobilise both services.  It would also negatively impact upon SASPEC’s current efforts to seek commissioning of the same services via the company model elsewhere in Staffordshire.


4.   SASPEC has drawn up company policies to reflect the subcontractor practice requirements mandated by the QiO Level 1 and the Subcontractor Standard Contract General Conditions, Service Conditions, and Information Governance checklists.  These policies have been added to the secure page of the LOC’s website.  Subcontractor practice lead subcontractors and practitioners are all strongly advised to log in to the secure page and familiarise themselves with the policies.  Compliance with the terms of the policies is required by all subcontractor practices as a condition for ongoing participation in the PEATS and GRR services.


5.   When considering the quality, safety and effectiveness of the services, the commissioners will always pay particular attention to the Performance (KPI) Review of Quality Requirements. 


In the case of PEATS, the commissioners have noted that the date of contact has been recorded as occurring before the date of referral in some cases.  It is expected that the date of contact would be on the same day as the date of referral, or at a later date; therefore, inaccurate data entry by some practitioners must be to blame.  We would ask you all to enter dates and other data as accurately as possible, otherwise it will impact significantly on KPI’s.  


For GRR, the commissioners have requested that the following parameters are completed in the Webstar Health IT module:

i)                    The referral source

ii)                   The date of service contact

iii)                 The specific Optician/Practice the patient was referred to.


A reminder of the key Local Quality Requirements:

  • Service Users are contacted by the service within 48 hours of referral  (GRR)
  • Service Users are seen by the service within 2 weeks of referral  (GRR)
  • Service Users report positive experience of the service (responses to be either ‘extremely likely’ or ‘likely’).  (GRR)
  • Service Users are triaged by the service within 48 hours of referral  (PEATS)
  • Service Users are seen by the service for an initial appointment within 2 weeks of referral  (PEATS)
  • Service Users report positive experience of the service (responses to be either ‘extremely likely’ or ‘likely’) (PEATS)
  • < 40% Service Users which are referred onto secondary care (PEATS)
  • First to follow up ratio = 1:0.13 (i.e. 13%) (PEATS)

 Also, in terms of self-referrals into PEATS: self-referrals shouldn’t exceed 50% of all PEATS referrals into your practice without good reason.


 6.   PEATS E&D and PROMS Questionnaires, GRR PROMS Questionnaires.  When asking patients to complete patient satisfaction questionnaires for both services - in order to avoid the skewing of outcomes, please do not instruct the patient to hand the questionnaire to you or to one of your practice colleagues once it has been completed.   Instead, advise the patient to post the completed questionnaire into the survey collection box that was provided for use by your practice at the services launch meetings.  This will mean that the answers we receive from the patients completing the questionnaires will be more honest, and there will be less pressure on patients who might be worried that their genuine opinions could impact negatively on their future treatment by the practice and by the service.  


Once the patient has left the practice, we request that you or one of your colleagues kindly enters the data from the questionnaire on to the relevant module.  At the same time, please retain the paper copies of the completed questionnaires, in case SASPEC needs to run an audit of them in the future.  Please always enter questionnaire outcomes for BOTH PEATS AND GRR patient episodes.


Thank you for your attention and for your cooperation.  If you have any questions or concerns, please contact Alison Lowell (SASPEC secretary) at the LOC office.


Mark McCracken (Clinical Governance & Performance Lead for PEATS)

Irfan Razvi (Clinical Governance & Performance Lead for Glaucoma)

Monday, 25 January 2016

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