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Moorfields Eye Hospital's urgent care clinics maximize optometrists' clinical skill base.

The urgent care clinics at Cayton Street were set up in November 2017 to run alongside the A&E department at Moorfields Eye Hospital. They were established after the hospital recognised an increasing difficulty in consistently delivering the national four-hour A&E target.

Repeated clinical audits had shown that at least 30% of patients presenting to Moorfields A&E could be assessed more appropriately in planned urgent care clinics. Clinics now run at Cayton Street every weekday, only seeing new patients, while patients who require other specialist input and management are discharged and referred as a new patient to the relevant service.

The five clinics are staffed by 18 optometrists. Four optometrists each day will work alongside a consultant ophthalmologist and two health care assistants, who help work up the patients.

Working in other hospital eye clinics also means that many of the urgent care optometrists are able to bring with them an additional skill set to perform further tasks such as gonioscopy, scleral indentation, confocal microscopy, naso-lacrimal duct syringing and suture removal.

A recent audit of the clinic showed that 100% of conditions are being managed appropriately. Furthermore, 62% of conditions are managed independently by the optometrists in the urgent care clinic, while the remainder of conditions are managed jointly with the medic in the clinic.

Ophthalmology has recently been highlighted as the treatment specialty with the greatest number of attendances at 7.6 million visits in 2017-18. This raises the question: are optometrists an under-utilised resource and is there scope to increase the numbers of optometrists working in A&E services, either triaging patients out, or being employed in consultant optometrist posts?

The protocol for the urgent care clinics is due to be reviewed later this year, and the current audit has highlighted that there may be scope to broaden the list of conditions that optometrists in the clinic are able to review and manage independently. There is also the potential for the service to be expanded to accept direct referrals from GPs and to become involved with local minor eye conditions services. It could also provide training to optometrists in the primary care pathway to reduce the number of referrals made.

* Nathanael Anguige is a principal optometrist at Moorfields Eye Hospital NHS Foundation Trust

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Title Annotation:Perspectives: Voices from optics and beyond
Author:Anguige, Nathanael
Publication:Optometry Today
Date:Jun 1, 2019
Words:377
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