So I'm Dr Hasan Chowhan, I'm a GP in Colchester and the Clinical Lead for NHS North East Essex
CCG.
We're here to discuss the Community Referral Pathways for dermatology and ophthalmology.
Several years ago we looked at a procurement of something called Care Close to Home, which
really was based around the premise of bringing care closer to the community, closer to the
patient's home.
The reason for looking at some of that was firstly, as I said, for trying to bring care
closer for patients, but also trying to help a struggling hospital, a struggling health
care system.
So through helping the hospital, through redirecting some of their services back towards the community
it helps them manage the conditions that need to be there.
But it also then helps patients and patients get treatment and get seen where they want
to -- nearer their GP surgeries or nearer their home.
When we were looking at all of this there were several different services that we looked
at that would fit better within the community.
Two of those were ophthalmology and dermatology.
So with ophthalmology the pathway that we've introduced really is centred around making
better use of the community opticians and our community practitioners.
So in the past, where it may be the patient goes to see their optician or see their eye-care
practitioner out in the community, they may decide, okay, this person maybe needs a secondary
care opinion from the hospital.
They would then send a form to us, we would then look at the form as GPs, or here within
the GP surgery, and then we'd refer, send the form on towards the hospital.
It just added another step in the process and wasn't really seamless and not necessarily
the best pathway.
What we've now got is, that same referral pathway is still in place -- so if you're
a patient, you'd still go see your GP or your optician, but ideally you're better placed
to see your optician.
Whether you see your GP or your optician, a referral is then made to a centrally-based
triage service.
That triage service then decides whether that is a referral that should go to the hospital,
or should in fact go back to one of the community practitioners.
What that does is it makes better use of our community practitioners, and it also alleviates
some of the pressure on the hospital so they're able to deal with the conditions that they
need to.
So with the dermatology service, this service is now completely commissioned out in the
community.
Again, better for patients and alleviating some of the pressures on the hospital in terms
of clinics.
What it means is that if you refer a patient as a GP or as a practitioner out in the community
to the dermatology service, it is triaged and then seen within the community.
The benefits to patients specifically with the ophthalmology pathway is that it means
that they should hopefully be seen quicker, because if a referral is made from myself
to the hospital and they're waiting several weeks to see an ophthalmology consultant,
it may be that they're better placed to see a practitioner out in the community.
So through triaging that referral and getting them seen by a more appropriate practitioner,
it means that makes it quicker for them and easier for them to be seen out in the community.
That also makes it quicker, and it also means that they're seen closer to home and a benefit
to them.
What it means for me as a GP is that when I'm making that referral I know that, actually,
if I'm uncertain whether it needs to necessarily be done at the hospital there is somebody
sense-checking it, saying: "actually, I think you could manage this in the community" or
there is a community-based service.
So it makes it easier for me to refer that patient on without having to worry about trying
to figure out where best to send them for that particular eye condition.
For our patients what we've seen is, of all the referrals that are made to the hospital,
something like 26 percent are now redirected towards the community.
So that means rather than a patient having to wait several weeks sometimes to see a consultant
at the hospital just to be told that, actually, this is something that we manage in the community,
we're stopping that process right at the start having set up the community service for them,
so that they can then be seen in the community.
So they're seen quicker, and they're seen closer to their home.
Firstly, with the ophthalmology pathway, it alleviates that unnecessary step where you're
receiving a form from a community practitioner that is probably better skilled than you at
looking at eye conditions, and having to then forward that referral on to the hospital.
But it also means you have that better interaction with your patient.
You'll going forwards be better educated about where those patients could be seen.
And so if in time the intention is that we're able to build up the knowledge and expertise
within general practice and understand where these conditions are better directed towards
primary care, so perhaps stopping that referral in the first place.
For me it's made it a lot easier in terms of managing the workload, so I don't have
an unnecessary bit of paperwork that I've got to do.
But actually it's about my interaction with the patients.
I'm here to provide a good service for my patients, and through doing this I know that,
actually, I can help my patient have their care delivered in the community, closer to
me and closer to them, so I'm not having to refer them to the hospital.
Through providing this out with the community practitioners, we hope to then upskill those
local practitioners in terms of what they are able to manage.
So we know in future we're looking at increasing the number of patients that are able to be
seen in the community at the moment from 26 to 30 percent.
But if we're able to move further conditions out towards the community as time and clinical
skill allows, we would be looking at moving more and more activity towards the community
-- and that benefits the patients.