Ophthalmology

The request was successful.

Dear East Suffolk and North Essex NHS Foundation Trust,

Intravitreal injections for eyes

1. Does your Ophthalmology department provide an intravitreal eye injection service?

2. During 2017/18 financial year what is your total numbers of injections administered?

3. If patient is indicated for treatment in both eyes do you deliver injections bilaterally at one appointment?

4. Does your Ophthalmology department provide a one stop service for follow up patient? (i.e. patient has diagnostics, clinician review and an injection if indicated at one appointment)

5. Does your Ophthalmology department provide a one stop service for a new appointment? (i.e. patient has diagnostics, clinician review and an injection if indicated at their first appointment- 1st loading dose)

6. Who injects the patients eyes and how many sessions do they deliver on a weekly basis (session is equivalent to 4 hours):

a. Consultant Ophthalmologists?

b. Trust Grade or Specialty Doctors (non deanery trainees)?

c. Junior (deanery) trainee doctors?

d. Nurses?

e. Opticians?

f. Orthoptists?

g. Other (please specify)?

7. How does your pharmacy department provide the intravitreal injection drugs:

a. Specific for each patient i.e. have a patient label attached?

b. In batches, not labelled specific for patients?

8. Do you have an automated system that supplies the drug or is used to restrict access to the drug at the point of injection?

9. If you do have automation who is your provider of the automation system?

10. During 2017-2018 financial year have you had any financial losses associated with the loss of these drugs through fridge failures? If so please quantify estimated cost.

11. During 2017-2018 financial year have you had any financial losses associated with the loss of these drugs through inability to internally reconcile? If so please quantify cost.

12. During 2017-2018 financial year have you had any financial losses associated with the loss of these drugs through inability to reconcile with commissioners? If so please quantify cost.

13. Do you use blueteq to get prior approval from the commissioners before administering the drug?

14. How are you paid for the injection activity?

a. Do you have a locally agreed tariff with commissions that includes the cost of the drug? If so please specify separately the income for one attendance including market forces factor for new 1st injection appointment and follow up appointment.

b. Do you have a locally agreed tariff with commissions that excludes the cost of the drug for follow up appointments?

i. For diagnostic (usually Ocular Computerised Tomography) and clinician review? (Please specify income for one attendance including market forces factor)

ii. For diagnostic (usually Ocular Computerised Tomography), clinician review and injection delivered at the same appointment? (Please specify income for one attendance including market forces factor)

iii. For diagnostic (usually Ocular Computerised Tomography), clinician review and injection delivered bilaterally at the same appointment? (Please specify income for one attendance including market forces factor)

15. How many patients do you have on your waiting list for "follow up" injections that are past their due date?

Virtual OCT
1. Does your Ophthalmology department provide a “virtual” Optical Coherence Tomography (OCT) clinic for patients. i.e. patient attends for dilation and OCT, with a review carried out by a medic who does not see the patient?
2. If you do and the patient needs to be seen by a medic are they seen on the same day (one stop) or brought back on a subsequent appointment (different day)?
a. If seen on the same day do you achieve the standard OCT tariff or an enhanced locally agreed tariff.
b. If locally agreed tariff please can you provide the tariff for new ( 1st) appointments and follow appointments.
3. What patient pathways do you provide a Virtual OCT for? e.g. R1M1 diabetics, stable AMD (please list as many as are available)

Yours faithfully,

Jenny Price

FOI Requests CGH, East Suffolk and North Essex NHS Foundation Trust

Dear Jenny,

 

I am writing to acknowledge receipt of your request under the Freedom of
Information Act 2000 to East Suffolk and North Essex Foundation Trust
(ESNEFT), received on 20/07/2018. Your enquiry has been logged and
forwarded to the appropriate department for action. Please note that the
Act allows 20 full working days to provide a response, although we will
endeavour to do so before then. The deadline is calculated to be
17/08/2018.

 

If you have any queries regarding your request, please do not hesitate to
contact me on this email address or 01206 745205.

 

Regards,

 

Freedom of Information Team

East Suffolk and North Essex Foundation Trust

 

show quoted sections

FOI Requests CGH, East Suffolk and North Essex NHS Foundation Trust

Thank you for your recent enquiry regarding information held by the East
Suffolk and North Essex NHS Foundation Trust:

 

Your enquiry has been dealt with in accordance with the Trust’s Freedom of
Information Act 2000 Policy and Procedures. We are pleased to enclose the
information you requested:

 

This response is on behalf of the Ipswich Hospital site

 

1.            Does your Ophthalmology department provide an intra-vitreal
eye injection service?

Yes

2.            During 2017/18 financial year what is your total numbers of
injections administered?

Wet AMD - 4453

Diabetic macular/RVO - 1667

3.            If patient is indicated for treatment in both eyes do you
deliver injections bilaterally at one appointment?

Yes, if possible medically.

4.            Does your Ophthalmology department provide a one stop
service for follow up patient? (i.e. patient has diagnostics, clinician
review and an injection if indicated at one appointment)

Yes for Diabetic Macular patients

Not always for Wet AMD patients

5.            Does your Ophthalmology department provide a one stop
service for a new appointment? (i.e. patient has diagnostics, clinician
review and an injection if indicated at their first appointment- 1st
loading dose)

Yes for Wet AMD patients

6.            Who injects the patients eyes and how many sessions do they
deliver on a weekly basis (session is equivalent to 4 hours):

a.       Consultant
Ophthalmologists?                                                                  
         Yes

b.       Trust Grade or Specialty Doctors (non-deanery
trainees)?                             Yes

c.       Junior (deanery) trainee
doctors?                                                                      
No

d.      
Nurses?                                                                                                                   
No

e.      
Opticians?                                                                                                          
    No

f.       
Orthoptists?                                                                                                      
     No                         

g.       Other (please
specify)?                                                                                
        n/a

7.            How does your pharmacy department provide the intravitreal
injection drugs:

a.       Specific for each patient i.e. have a patient label attached?

Yes, for Bevacizumab, Ozurdex, and Methotrexate

b.       In batches, not labelled specific for patients?

Yes, for Lucentis and Eyelea

8.            Do you have an automated system that supplies the drug or is
used to restrict access to the drug at the point of injection?

No

9.            If you do have automation who is your provider of the
automation system?

n/a

10.        During 2017-2018 financial year have you had any financial
losses associated with the loss of these drugs through fridge failures? If
so please quantify estimated cost.

£Nil

11.        During 2017-2018 financial year have you had any financial
losses associated with the loss of these drugs through inability to
internally reconcile? If so please quantify cost.

We are not able to provide this data.

12.        During 2017-2018 financial year have you had any financial
losses associated with the loss of these drugs through inability to
reconcile with commissioners? If so please quantify cost.

£Nil – we have a Guaranteed Income Contract with the CCG.

13.        Do you use blueteq to get prior approval from the commissioners
before administering the drug?

Yes

14.        How are you paid for the injection activity?

a.       Do you have a locally agreed tariff with commissions that
includes the cost of the drug? If so please specify separately the income
for one attendance including market forces factor for new 1st injection
appointment and follow up appointment.

b.       Do you have a locally agreed tariff with commissions that
excludes the cost of the drug for follow up appointments?

i.                     For diagnostic (usually Ocular Computerised
Tomography) and clinician review? (Please specify income for one
attendance including market forces factor)

ii.                   For diagnostic (usually Ocular Computerised
Tomography), clinician review and injection delivered at the same
appointment? (Please specify income for one attendance including market
forces factor)

iii.                 For diagnostic (usually Ocular Computerised
Tomography), clinician review and injection delivered bilaterally at the
same appointment? (Please specify income for one attendance including
market forces factor)

None of the above. Ipswich Hospital has a locally agreed tariff with
commissioners that excludes the cost of the drug for First and Follow up
appointments. The local tariff price is £224.66 (with MFF)

15.        How many patients do you have on your waiting list for "follow
up" injections that are past their due date?

295 Wet AMD patients

 

Virtual OCT

 

16.        Does your Ophthalmology department provide a “virtual” Optical
Coherence Tomography (OCT) clinic for patients. i.e. patient attends for
dilation and OCT, with a review carried out by a medic who does not see
the patient?

Yes

17.        If you do and the patient needs to be seen by a medic are they
seen on the same day (one stop) or brought back on a subsequent
appointment (different day)

Patients are brought back on a subsequent appointment

a.       If seen on the same day do you achieve the standard OCT tariff or
an enhanced locally agreed tariff.

b.       If locally agreed tariff please can you provide the tariff for
new ( 1st) appointments and follow appointments. 

 

18.        What patient pathways do you provide a Virtual OCT for? e.g.
R1M1 diabetics, stable AMD (please list as many as are available)

We provide this for Wet AMD patients

 

This response is on behalf of the Colchester Hospital site

 

1.            Does your Ophthalmology department provide an intra-vitreal
eye injection service?

Yes

2.            During 2017/18 financial year what is your total numbers of
injections administered?

5591

3.            If patient is indicated for treatment in both eyes do you
deliver injections bilaterally at one appointment?

Yes

4.            Does your Ophthalmology department provide a one stop
service for follow up patient? (i.e. patient has diagnostics, clinician
review and an injection if indicated at one appointment)

Yes

5.            Does your Ophthalmology department provide a one stop
service for a new appointment? (i.e. patient has diagnostics, clinician
review and an injection if indicated at their first appointment- 1st
loading dose)

Yes

6.            Who injects the patients eyes and how many sessions do they
deliver on a weekly basis (session is equivalent to 4 hours):

This is variable as it depends on the numbers of appointment needed for
that particular week. We run singular doctor only clinics and also
combined clinics of Consultant, trainee doctor, NP, Optometrist and Nurse
injectors. Rough estimate is below.

a.       Consultant Ophthalmologists? Yes - 2.5 sessions weekly

b.       Trust Grade or Specialty Doctors (non-deanery trainees)? Yes – 5
sessions weekly

c.       Junior (deanery) trainee doctors? Yes – 2 sessions weekly

d.       Nurses? Yes – 1.5 sessions weekly

e.       Opticians? No

f.        Orthoptists? No

g.       Other (please specify)? N/A

 

7.            How does your pharmacy department provide the intravitreal
injection drugs:

a.       Specific for each patient i.e. have a patient label attached?

Yes, for Bevacizumab, Ozurdex, and Methotrexate

b.       In batches, not labelled specific for patients?

Yes, for Lucentis and Eyelea

8.            Do you have an automated system that supplies the drug or is
used to restrict access to the drug at the point of injection?

No

9.            If you do have automation who is your provider of the
automation system?

N/A

10.        During 2017-2018 financial year have you had any financial
losses associated with the loss of these drugs through fridge failures? If
so please quantify estimated cost.

£Nil

11.        During 2017-2018 financial year have you had any financial
losses associated with the loss of these drugs through inability to
internally reconcile? If so please quantify cost.

£Nil

12.        During 2017-2018 financial year have you had any financial
losses associated with the loss of these drugs through inability to
reconcile with commissioners? If so please quantify cost.

£Nil – both Trusts have a Guaranteed Income Contract with the relevant CCG

13.        Do you use blueteq to get prior approval from the commissioners
before administering the drug?

Colchester do not use Blueteq. They have an agreement to start treatment
in patients meeting NICE criteria.

14.        How are you paid for the injection activity?

c.       Do you have a locally agreed tariff with commissions that
includes the cost of the drug? If so please specify separately the income
for one attendance including market forces factor for new 1st injection
appointment and follow up appointment.

d.       Do you have a locally agreed tariff with commissions that
excludes the cost of the drug for follow up appointments?

iv.                 For diagnostic (usually Ocular Computerised
Tomography) and clinician review? (Please specify income for one
attendance including market forces factor)

v.                   For diagnostic (usually Ocular Computerised
Tomography), clinician review and injection delivered at the same
appointment? (Please specify income for one attendance including market
forces factor)

vi.                 For diagnostic (usually Ocular Computerised
Tomography), clinician review and injection delivered bilaterally at the
same appointment? (Please specify income for one attendance including
market forces factor)

None of the above. The Guaranteed Income Contract is set at a value which
covers all clinical services including drugs.

15.        How many patients do you have on your waiting list for "follow
up" injections that are past their due date?

At the end of July there will be none and there is usually none because of
extra clinics being done.

 

Virtual OCT

 

1.            Does your Ophthalmology department provide a “virtual”
Optical Coherence Tomography (OCT) clinic for patients. i.e. patient
attends for dilation and OCT, with a review carried out by a medic who
does not see the patient?

We run a virtual for new patients who are then streamlined as appropriate.
We are in the process of setting up a virtual for follow up patients where
we have stopped treatment and only need monitoring

2.            If you do and the patient needs to be seen by a medic are
they seen on the same day (one stop) or brought back on a subsequent
appointment (different day)

We see new active wet AMD on the same day. For follow up patients who are
just being monitored, we bring them back for a second appointment if they
need seeing

a.       If seen on the same day do you achieve the standard OCT tariff or
an enhanced locally agreed tariff. Block contract

b.       If locally agreed tariff please can you provide the tariff for
new ( 1st) appointments and follow appointments. Block contract

3.            What patient pathways do you provide a Virtual OCT for? e.g.
R1M1 diabetics, stable AMD (please list as many as are available)

R1 M1, R2 M0, R3s, stable non treated AMD, glaucoma, selected VR cases

 

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We hope that we have been able to answer your query to your satisfaction
and that you find the information provided useful.

 

Regards,

 

Amy Witham

Information Governance Administrative Assistant

East Suffolk and North Essex NHS Foundation Trust

Based at: Ipswich Hospital NHS Trust

Email: [2][email address]

 

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