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URGENT ADVICE: PLEASE READ AND TAKENOTEThe following advice should be noted for practices thatuse the FPS Optometry Portal to access the OphthalmicClaims System (OCS) for GOS claims and for practicesthat hold clinical records in electronic format.Please be aware of potential scams by phone, email or pop-ups on theircomputers from unsolicited parties, particularly anyone claiming to workfor a computer supplier, internetprovider, bank etc. Emails, websitesand pop-ups can be made to lookofficial with logos, text etc. lifteddirectly from the actual company. It isalways safer to ignore or contact thecompany in question through officialmeans (e.g. phone number or emaillisted on their official website) toverify the contact is genuine, ratherthan dealing with any issues on anunsolicited phone call or email chain.Any genuine caller will understand thisprecaution and not have a problemwith you hanging up the phone to verify their identity or contact thecompany directly yourself. Under no circumstances should you giveanyone remote access to your system unless you know who they are, forexample; your IT supplier, practice management supplier or, theeBusiness team at BSO.Optometrists are reminded that ‘loss’ of patient related information/datais an adverse incident. Should your practice computer becomecompromised by a scam or, for any other reason, you should report thisas an adverse incident using the usual AI Reporting Forms available htm7

FOR ACTION: 2017 NORTHERN IRELAND SIGHTTEST & OPHTHALMIC PUBLIC HEALTH SURVEYOphthalmic Contractors mayremember the 2014 Northern IrelandSight Test and Ophthalmic PublicHealth Survey which took place duringin June 2014. The Survey is arequirement of Objective 4 of Developing Eyecare Partnerships andthe Department of Health are undertaking the next Survey in early 2017.Practices will be contacted by email in early January 2017 advising of theSurvey and providing full details of how many survey returns arerequested from each practice. The Survey will be an electronic Surveythrough a secure weblink, with all information provided being accessibleby Department of Health statisticians.You will be asked to complete the Survey (s) for one particularidentified week during late January / early February. Completed Surveyreturns are important as they provide information on eyecare serviceprovision including; numbers of eye examinations, patient demographics/profiles, referrals and ophthalmic public health information. Thisinformation is valuable as it will assist the Health and Social Care Board inassessing demand, planning eyecare services and in provision of evidencefor service developments. Your support in completing the Survey (s) fromyour practices is very much appreciated.**JANUARY 2017**HSCB ASK THAT YOU ACTION THE EMAIL AND COMPLETE THE2017 SIGHT TEST & OPHTHALMIC PUBLIC HEALTH SURVEY (s)AS REQUESTED BY DEPARTMENT OF HEALTH8

NorthernIrelandDry EyePreparationOurrecent CET afternoonon the Formulary:20th October at Greenmountwas wellattended and forthoseAdvicewho did notonmakeRecommendationsit, you missed a very interesting afternoonof talks. Ms Aliciaand PrescribingThompson (ABDO) gave a very practical talk on dispensing to children, Dr Sara McCullough,University of Coleraine, discussed the long term trends in refractive errors in NorthernIreland and Professor Bruce Evans enlightened us all on the role of the optometrist indyslexia. The feedback received was excellent with everyone giving positive commentsaboutthethe dayfindingThisPracticefeedback isvery importantWithlastandissueof thethelecturesHSCB beneficial.OptometryNewsletterall and alsoallows us to plana programmesuits thewithneedsaofcopyour localpractitioners. If you wereOptometrypracticeswerethatprovidedof theunable to attend or indeed have any ideas or needs for training please email JaniceNIFormularyDry EyeClinicalPreparationsguidance and advice. with any ideas youMcCrudden,OphthalmicAdviser; janice.mccrudden@hscni.netmay have and they can be considered for future events.Brief InterventiontrainingSmokingCessationAll Optometristsare asked toreviewinthisguidanceand implement it inThe HSCB in conjunction with the Public Health Agency (PHA) held a CETtheir clinical practice. In particular the Health and Social Care Boardaccredited training session for Optometrists on Brief Intervention training (BIT) inwouldaskthat practitionersnotewhotheworkadvicerespectof self-caresmokingcessation.Eight Optometristsin a invarietyof clinicalsettings as afirstline recommendatione.g. lidhygieneonmeasuresfor lid conditions.attendedthe training which providedinformationthe risk of smokingfor eyehealth,the issues toasconsiderwhen talkingthatto a patientwho cansmokesand resolvehow to aThisis importantit is evidencedself-careoftenaccess supportservices for patientswhowish to consider stoppingsmoking. Theconditionif compliancewith therecommendationsfor self-careareHSCB and PHA will obtain feedback from the optometrists who attended and aadhered to by the patient.further training session is planned for early Summer 2016. If you are interested inattending BIT please contact margaret.mcmullan@hscni.net or 028 9536 3239.SINCERE THANKS TO THOSE WHO SUPPORTED THIS VALUABLE PUBLILC HEALTHPharmacy colleagues in the Health and SocialINIATIATIVECare Board monitor the prescribing ofophthalmic preparations by GPs and byIndependent Prescribing (IP) Optometrists.In recent months it has been noted that in certain areas of NorthernIreland GP prescribing of eye-lid ‘cleansing’ preparations has increasedand it is important that if you have patients who present with signs andsymptoms of lid disease, such as blepharitis and MGD, that you advisepatients that self-care is an important first step in trying to treat andresolve their eye problem.The NI Formulary guidance is available .0/Pages/default.aspx)9

REFERRALSFOR YOUR URGENT ATTENTION PLEASETAKE NOTE OF THE FOLLOWING ADVICE!! INFORMATION & ADVICE ON REFERRALS TO:1. THE MACULAR SERVICE REGIONALLY2. THE PAEDIATRIC OPHTHALMOLOGY PRIORITYCONSULTATION CLINIC (POPCC - Belfast HSC Trust **************1. MACULAR SERVICE REFERRALS: USE OF THE CORRECT RAPIDACCESS MACULAR REFERRAL FORMIn the June 2016 issue of the HSCB Optometry PracticeNewsletter you were advised of the implementation of arevised and updated referral form for use when a patientrequires referral to the Rapid Access Macular Service forassessment and/or treatment for the followingconditions: Wet Macular DegenerationRetinal Vein OcclusionDiabetic Macular OedemaAudit of recent referrals has demonstrated that some practices are notusing the correct referral form. (available at the below linkhttp://www.hscbusiness.hscni.net/pdf/Macular Service Referral form revised May 2016.pdf).10

By using the correct referral form Optometrists will be prompted toconsider and provide information on all relevant clinical findingsincluding patient symptoms and this in turn will assist in triage of thereferral by secondary care clinicians.IT IS ESSENTIAL THAT YOU USE THE CORRECT REFERRALFORM WHEN REFERRING A PATIENT TO THE MACULARSERVICE FOR THE CONDITIONS NOTED ABOVE.FOR PRACTICES USING eREFERRAL VIA THE CLINICALCOMMUNICATIONS GATEWAY (CCG) THE RELEVANT CLINICALINFORMATION & QUESTIONS ARE NOTED ON THE MACULARREFERRAL TEMPLATE ON CCG.Audit of referrals to the Macularservice in Belfast HSC Trust hasalso demonstrated that thereare too many false positivereferrals. The HSCB intend toscope out options to deal withthese false positive referralswhich are placing significantdemand on the macular service.The Glaucoma & Macular ECHOKnowledge Network: 19 Optometrists across the region are partof ECHO and HSCB hope tobring forward macular servicedevelopments involving them11It is hoped that the 19optometrists who areparticipating in Project ECHO and form the Glaucoma &Macular ECHO KnowledgeNetwork ECHO can be involvedin service developments withinthe ‘Macular’ care pathwaythrough the work of DevelopingEyecare Partnerships.

2. PAEDIATRIC REFERRALS VIA THE PAEDIATRICOPHTHALMOLOGY PRIORITY CONSULTATION CLINIC (POPCC)In the December 2015 issue of the HSCB Optometry Newsletter you wereprovided with information on the Paediatric Ophthalmology PriorityConsultation Clinic provided by the Belfast HSC Trust (POPCC). In additionall Optometry practices were provided with Paediatric OphthalmologyGuidance developed by the Paediatric team in Belfast HSCT Trust.This guidance was developed to assist primary careoptometrists in consideration of their referrals whenpresented with children who it is suspected mayhave an ophthalmic problem which requiresreferral. The guidance covers many ophthalmicpresentations and in particular provides clear andvaluable advice on referral pathways including advice on the urgency ofreferrals.A recent audit of referrals to POPCC has demonstrated an alarmingincrease in “urgent” priority referrals for ‘suspicious’ discs with over twice(x2) as many referrals in the first six months of this year comparedto all of 2015-16.This has placed immense strain and pressure on aservice which is there to address urgent paediatric ophthalmic conditions.Feedback from BHSCT is that the majority of these referrals are sometimesrequested for “reassurance” and there are very many false positives. Thishas the effect of causing:1. Service and staff pressures in the triage and accommodation of thechildren who are referred in to clinics which are already full to capacity.2. Children and parents/guardians suffering undue worry and anxiety andpotentially being exposed to unnecessary diagnostic tests e.g. radiationfrom CT scans.3. Increased pressure on the POPCC service which will result in longerwaiting times for those children who are in need of urgent ophthalmic care.12

Whilst it is appreciated that the assessment of children can sometimes bechallenging and the recent Optometric legal case involving a misseddiagnosis of papilloedema is a concern for Optometrists (and indeed for allHealth Care Professionals), you are advised to review and give dueconsideration to the Belfast HSC Trust Paediatric Ophthalmology Guidancereceived last December. Please ensure that you fully consider the guidancewhen presented with a child with a suspected ophthalmic condition forwhich you may feel referral is necessary.Please ensure that ALL optometric staff (full time, part timeand locum) working in your practice have access to and areaware of this guidance. The guidance can be accessed at thefollowing IC OPHTHALMOLOGY Guidance document forPrimary Care Optometry December 2015.pdf or click here.Paediatric Ophthalmology services in Belfast HSC Trust will continue toaudit referrals being received into the POPCC service, with a view toadvising the HSCB if there is further need to address specific referraltrends and patterns from primary care optometrists.Thank you for your consideration of the above information inrelation to the use of the correct Rapid Access Macular ServiceReferral form and the consideration and application of thePaediatric Ophthalmology Guidance when generatingophthalmology referrals for children.13

AOP National Awards - RepresentationFrom Northern IrelandThe Health and Social Care Board are delighted to see the representationfrom Northern Ireland at national level for the upcoming AOP Awards.**Charity of the Year**See Belfast has been shortlisted for the award category “Charity of theYear”. See Belfast was established in September 2015 as a charityassisting in the provision of eyecare to more marginalised communitiessuch as the homeless, refugee and asylum seeking groups.One year on, See Belfast has facilitated access to much needed eyecarefor patients helped by a team of volunteer optometrists. If you areinterested and have the time to offer your services to See Belfast pleaseemail seebelfast2015@gmail.comYoung Practice of the Year and Practice of the YeariCare Opticians has been shortlisted for two award categories “Practice ofthe Year” and “Young Practice of the Year”. iCare Opticians is owned byMr Stephen Vandevyver and was established in April 2014 and since thenStephen has invested in his own personal professional development andnow holds two additional qualifications; the Professional Certificates inMedical Retina and Glaucoma. In addition to this investment in clinicalknowledge and skill Stephen has committed further to the quality ofeyecare provision through investment in OCT for clinical diagnosis andmonitoring of his patients.The Health and Social Care Board wish both See Belfast and iCareOpticians every success for the Awards. The winners will be announced ata ceremony in London on 5th February 2017. You can register your votefor all the AOP award categories at the following op-awards/201714

ADVERSE INCIDENTSAdverse incident reporting plays an important part ofhealth and social care’s safety and learning culture. Theaim of encouraging the reporting of incidents is to identifylearning, share good practice, improve quality of care andto prevent recurrence where possible.The HSCB recently received an adverse incident report from a generalpractitioner relating to a patient who had previously attended their localoptometrist. The patient was seen in their local optometry practice butlater presented to their GP who directed them to eye casualty following aconsultation. The patient was diagnosed and treated for a retinaldetachment.The elderly gentleman had presented to his optometrist complaining ofoccasional flashers and floaters. He was seen as an emergency and dealtwith promptly in line with all the appropriate guidelines. Dilatedfundoscopy etc was undertaken and a possible posterior vitreousdetachment was identified. The patient was appropriately advised andgiven a leaflet on the signs and symptoms of a detachment and told toreturn, seek medical advice or present to casualty should the conditionchange as detailed.Subsequently the patients symptoms changed and he presented to his GPand then the local regional acute eye service where he was treated for aretinal detachment.The learning from this incident is for practitioners to ensure they follow theappropriate guidelines for dealing with flashes and floaters. Both theCollege of Optometrists and Association of Optometrists for exampleproduce guidance and patient leaflets that you can assess and use.15

A significant number of patients present at their optometrist with symptomsof flashers and floaters. In a recent audit of SPEARS patients in the Southernarea 15.8% presented in practice with such a complaint. Proper managementaccording to College of Optometrist guidelines and using leaflets to givepatients additional information is essential to ensure safe and appropriatecare of such patients. Additionally it is important that accurate andcontemporaneous notes of the consultation and advice are kept.Anybody can report an adverse incident and in this case it was not raised bythe patient but the GP. I would encourage you to see this system as alearning culture and not a blame culture. It is an excellent means to highlightissues that can happen to us all and hopefully we can all learn as a result.Should you require additional information on reporting Adverse Incidentsplease do not hesitate to contact any of the Ophthalmic Advisers or theABSM Governance leads in any Health Board Office.SAVE THE DAY—POINTS MEAN REGISTRATIONThe next full day’s optometry CET is planned for Tuesday 25th April 2017 atGreenmount College. Many of the lectures will be case presentation basedbut the full program is not quite ready.Details will follow but in the mean time put the date in your diary.16

Optometry Practice Newsletter "Systems, Not Structures " November 2016 was a quietly momentous month for the North's General Ophthalmic Services (GOS). You may not have felt or heard the earth tremor, but it was then that the first wave on GOS practices made direct electronic referral of their patients into secondary