BNSSG ICB Community Optometry Project

This notice is placed as a Prior Information Notice (PIN) to seek expressions of interest in being considered as the most suitable provider for the delivery of a SPOA digital platform for BNSSG residents with possible Macular pathologies.

This digital will enable the transfer of full volumetric OCT images and accompanying referral documents from Community Optometry practices to HES to facilitate clinical decision making and appropriate care.

BNSSG ICB is seeking to secure a Prime Provider who has the capability and capacity to deliver SPOA (Single point of Access) Macular referral services, in line with these specified requirements:

The HES (Hospital eye services) medical retina team should be able to review a complete good quality optical coherence tomography (OCT) of the macular area and colour fundus photo of the macula of both eyes from the referral and (along with the referral clinical information) for all applicable macular referrals. There should be DICOM (Digital Imaging and Communication in Medicine) compatible OCT files attached with the referral so that the full OCT can be reviewed. The electronic referral should be directly from the community optometrists to the hospital eye service.

All DICOM files must be extractable and viewable in other platforms to an appropriate level of quality for decision making.

The system(s) should have the potential to integrate with NHS e-RS, e.g. by creating a unique link to the required images which could be embedded into an NHS eRS referral.

System(s) should allow for mandatory fields within referrals, ensuring the required information is provided within a referral as per service specification.

The system(s) should be web-based and allow access from all supported browsers.

The system(s) should allow for tiered access permissions e.g. for non-clinical staff needing to operate the system.

The system(s) should not require an NHS email address to operate.

Optometrists in primary care will have access to patient demographic information

Optometrists in primary care have access to GP held clinical information.

The system(s) should allow download of the full patient referral so that it can be added to their primary care systems as required.

Automatic notification of referral and appropriate content will be provided to the patient's GP at point of referral

The system shall provide the capability for the sending system to select priority (on sending) and for the receiving system to be notified of the priority.

The system(s) should provide a single point of contact if any issues arise.

The system(s) should facilitate community optometrists in accessing easy to read financial statements

The referral will be able to be consumed by the hospital Patient Administration System (PAS).

Software systems(s) should allow for the standardisation of patient identification and in particular use of the NHS ID.

Any software system(s)s should provide a full record of any remote clinical opinions, feedback. OCT scans and colour images should be automatically stored in the established hospital eye service PAS/PACS system for future reference. This would include a record of the clinical opinion being entered in the hospital electronic patient record system.

The software system should support safe communication between providers. This includes the transmission of completed referrals and feedback. Transmission must come at least every 24 hours or as agreed.

The software system(s) should have the capability for bidirectional image and clinical information sharing between the hospital eye service and the local optometrists.

All of the digital system(s) used in any pathway should comply with information governance guidelines.

To ensure robust clinical judgment in medical retina cases at UHBW (University Hospitals Bristol and Weston NHS Foundation Trust), adherence to specific minimum requirements is imperative.

Failure to meet the above standards would hinder clinicians' ability to make decisions confidently without the need for repeat imaging or face-to-face consultations. Any platform that falls short of the above requirements would not satisfy the requirements of the pathway to deliver safe and effective care.

The service is only available to patients registered with a BNSSG GP. The service must also accommodate those who are not registered with any GP but are resident within the District Council boundary and eligible for NHS Care e.g. members of travelling communities and homeless people. The commissioner will be able to advise.

Patients who live in the ICB area but are registered with a GP out of area (i.e. a non-BNSSG GP) are not eligible for this service.

The Enhanced Imaging Referral Service will enable full volumetric DICOM (Digital Imaging and Communication in Medicine) files to be sent alongside a bespoke referral letter with a mandated minimum data set from community optometrists into University Hospitals Bristol NHS Foundation Trust SPOA for macular referrals.

Referrals will be reviewed and managed by the system of remote review by the retinal team at University Hospitals Bristol NHS Foundation Trust who will use the referral information and imaging to triage and manage patients.

It is anticipated that approximately 50% of macular referrals can be resolved without an appointment of any kind at University Hospitals Bristol NHS Foundation Trust. A further proportion are likely to be managed by a telephone consultation. Only a small proportion are anticipated to require a face-to-face appointment, some of whom could be brought straight to treatment clinics as appropriate. The new pathway will also provide feedback to the community optometrists which may avoid some unnecessary referrals in the future. GP time will be freed up as referrals will no longer need to go through them; instead, community optometrists will be able to refer directly to the HES via ERS. Patient travel will be reduced, with benefits to patients and the environment.

Community optometry pathw…