2 An integrated approach to commissioning high-quality care for people at risk of developing glaucoma

2 An integrated approach to commissioning high-quality care for people at risk of developing glaucoma

The commissioning of services for people at risk of developing glaucoma sits within the wider commissioning strategy for eye care services. Figure 1 outlines the areas of care for people with glaucoma and suspected glaucoma covered in the NICE quality standard for glaucoma.

Figure 1 Areas of care for people with glaucoma and suspected glaucoma

Commissioners should work with a range of partners and stakeholders, including emerging clinical commissioning groups, health and wellbeing boards, general practice, the Hospital Eye Service, community optometry services, social care and service users and carers, when planning services for people at risk of developing glaucoma. Partners should develop an effective and integrated local pathway which takes into account patient safety, patient experience, timely access to assessment and treatment, and effectively manages demand pressures on the Hospital Eye Service. Commissioners should take into account regional and local plans for Quality, Innovation, Productivity and Prevention (QIPP) workstreams, in particular for long-term conditions and safe care.

Commissioners should work with service providers to carry out clinical audit using the audit support for NICE clinical guideline 85 on glaucoma. This will enable commissioners to identify where recommendations from NICE clinical guideline 85 on glaucoma have been implemented and highlight areas for improvement.

The terms 'referral refinement' and 'repeat measures' are used in this guide. They are specific to glaucoma management and are defined in box 1.

Box 1 Definitions of referral refinement and repeat measures[a]

Referral refinement

A two-tier assessment in which initial evidence of abnormality during case-finding assessment or screening is validated by a subsequent enhanced assessment which adds value beyond that achieved through a simple 'repeat measures' scheme. A referral refinement service involves the undertaking of tests sufficient for diagnosis of ocular hypertension and suspected chronic open angle glaucoma and the interpretation of these clinical findings, with specialist practitioners who are delivering this service independently, being qualified and experienced in accordance with NICE guidance.

Repeat measures

Primarily describes the repeated measurements of eye pressures, but may also include repeated measurements of visual fields and other relevant ocular parameters when clinically necessary.

[a] National Institute for Health and Clinical Excellence (2011) Glaucoma quality standard. London: NICE

  • NICE has accredited the process used by NICE to produce guides for commissioners. Accreditation is valid for 5 years from November 2011 and applies to guides produced since November 2008 using the processes described in 'Process manual for developing guides from NICE for commissioners: Information for internal NICE teams' (2011). More information on accreditation can be viewed at www.nice.org.uk/accreditation
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