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Into the community: Director of Specsavers Newport, Craig MacKenzie, speaks to OT about the "first of its kind" age-related macular degeneration treatment centre that is based within the practice.

Last September, a partnership between an opticians and the NHS led to the opening of the Austin Friars Eye Treatment Centre on the second floor of a Specsavers practice in Newport's town centre.

The treatment centre is the first of its kind in the UK and sees the High Street opticians providing the screening and referrals for people with suspected wet age-related macular degeneration (AMD), with the NHS staff providing treatment in the same location.

With the aim of reducing the wet AMD waiting times for assessment, diagnosis and treatment for people living in Gwent, the centre was established after funding was secured from a Welsh Government Pathfinder project.

"Bringing the screening, referral and treatment of AMD into the community setting has not only reduced treatment times, but it is also more convenient and efficient for the patient," explained optometrist and director of Specsavers Newport, Craig MacKenzie.

"Patients can be in and out in less than an hour, they can park nearby and even pop into the shops--it normalises their condition."

It started with glaucoma

"As you would imagine, it involved a lot of hard work to see the centre through to fruition. It took around 18 months from concept to reality," Mr MacKenzie admitted, adding that the regulations that had to be met around the building, drugs delivery and cleaning were "tough."

However, for Mr MacKenzie the journey began far before the concept of the centre existed he said, highlighting his involvement in the local health board and previous eye care schemes as pivotal to the establishment of the centre.

"We have been working with the local heath board on a number of pilot schemes that stretch back to 2014, including the glaucoma shared care scheme," explained Mr MacKenzie, who sits as chair on his regional optometric committee which discusses eye health care in the area.

During regular meetings in 2014 with the Aneurin Bevan University Health Board, as well as local representatives from ophthalmology and third sector organisations, it became apparent that the area was struggling to cope with the volume of glaucoma patients being referred into the hospital.

"This struggle stemmed from consultants having an incomplete data set when they saw patients," Mr MacKenzie explained, adding how his suggestion of providing opticians with the technology to capture the data and send it to the hospital was well received. As a result, Mr MacKenzie's practice tendered for and secured its bid to deliver the pilot glaucoma referral refinement scheme, which was established in the area as a result of those conversations.

"Around six or seven practices were selected for the scheme and it was very successful -100% of patients said they had confidence in the optometrist they saw and 99% said they found it easy to book an appointment," Mr MacKenzie told OT.

Initially scheduled to run from September to December 2014, the pilot's success saw it extended to March 2016, when it was then adopted permanently as the health board's glaucoma pathway.

Mr MacKenzie shared: "Ahead of the pilot closing, the now Cabinet Secretary, Vaughan Gething, visited our practice to speak to myself and patients about how the service was going."

Coinciding with the success of the glaucoma referral refinement scheme, the Aneurin Bevan University Health Board had begun to look for innovative ways to improve its wet AMD pathway, an area where local hospital eye departments were failing to meet NICE guidelines.

"NICE guidelines recommend that, from the time a patient is referred with suspected AMD, to the time they are treated should take no longer than 14 days," the optometrist said, adding: "In our area, hospital waiting times were 34 days. This meant that at the point of referral a patient may be treatable, but by the time they were seen in hospital, the condition had progressed too far and it was too late."

Discussed at a meeting of the regional optometric committee, the concept of a referral refinement scheme linked to a treatment centre in the community was born.

The centre

Discussing the patient journey into Specsavers Newport, and the Austin Friars Eye Treatment Centre, Mr MacKenzie emphasised that it is a patient journey of two halves. "The first part is the referral refinement scheme, which sees practices in the Aneurin and Bevan health board area refer query wet AMD patients into our Newport practice, rather than the hospital," the store director explained.

On referral, in-store optometrists provide the initial screening for patients with suspected wet AMD and the results are then reviewed virtually by a hospital-based ophthalmologist, who can diagnose and refer for treatment if required.

If a patient is referred, they are treated by one of the NHS staff based at the centre.

Since opening, waiting times for treatment have been reduced by 43%, and follow up appointments now being met has increased by around 20%.

The scheme's future

Reflecting on the success of the service, the statistics speak for themselves. "Since the centre opened, waiting times have reduced by 19 days," Mr MacKenzie said.

While the scheme's success is already demonstratable, an official evaluation of the service will take place this October, with results expected to be published in January 2018. However, the optometrist is already confident about those findings. "I have no doubt that this will be a success and other areas will want to emulate it," he told OT.

Discussing the next steps for the service, Mr MacKenzie would also like to see more of these centres and "this type of work" in the future. "This is a proof of concept and demonstrates how optometrists can better utilise their skills and the kit they have for the benefit of their area and the patients that live within it--for me, it's the way forward for the profession," he emphasised.

Commenting on why the scheme has been beneficial to his optometrist employees, he added: "If I'm honest, refraction can be boring, and offering enhanced eye care services such as WECS, glaucoma and AMD, like we do, provides staff with variety in their day."

Video content

Watch OT's video of the official launch of the Newport centre

Caption: Left: Doug Perkins, Cabinet Minister Vaughan Gething and Craig MacKenzie
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Title Annotation:THE CHALLENGE
Publication:Optometry Today
Date:Apr 1, 2017
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