SMDRSS, SMDRSS, the past year…the past year…

Headlines & HighlightsHeadlines & HighlightsAngela ChicamisseAngela Chicamisse

Programme ManagerProgramme Manager

South Manchester DiabeticSouth Manchester Diabetic Retinopathy Screening ServiceRetinopathy Screening Service

Issues to discussIssues to discuss

• Programme performanceProgramme performance• Service improvementsService improvements• Day to Day service managementDay to Day service management• Contractual issues (PCT-Optom SLA)Contractual issues (PCT-Optom SLA)• National pathway changesNational pathway changes• Future provisionFuture provision

SMDRSSSMDRSS

Programme PerformanceProgramme Performance

• New National StandardsNew National Standards

• EQA recommendations implementedEQA recommendations implemented

• Incident reporting and follow-up of Incident reporting and follow-up of failsafe issuesfailsafe issues

• Team staffingTeam staffing

SMDRSSSMDRSS

Service ImprovementsService Improvements

• Failsafe – robust processes to Failsafe – robust processes to minimise riskminimise risk

• Vector Medical Retina Vector Medical Retina reconfiguration – improving HES reconfiguration – improving HES clinical data completenessclinical data completeness

• Minimising list of exclusionsMinimising list of exclusions• Better data quality & validationBetter data quality & validation• Review of SMDRSS core team Review of SMDRSS core team

functions & processesfunctions & processes

SMDRSSMDRSSS

Day to Day Core Service Day to Day Core Service ManagementManagement

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•Current S.Mcr diabetic population=Current S.Mcr diabetic population=7340073400

•74000 invitations, 35000 reminders, 74000 invitations, 35000 reminders, 22000 no response, 4700 DNA letters, 22000 no response, 4700 DNA letters, 3000 DNA reminders/NR, 110000 results, 3000 DNA reminders/NR, 110000 results, 3500 copy results3500 copy results

•5000+ letters per week5000+ letters per week

•Average 400 calls per week – 15% Average 400 calls per week – 15% abandonment rateabandonment rate

•Monthly uploads from 290 GP Monthly uploads from 290 GP practicespractices

•Process 200 referrals to HES and Process 200 referrals to HES and 450 DNAs & cancellations per month450 DNAs & cancellations per month

Core Service issuesCore Service issues• Unnecessary remindersUnnecessary reminders• Inappropriate DNA lettersInappropriate DNA letters• Unknown missing images/episodesUnknown missing images/episodes• Inappropriate appointmentsInappropriate appointments• Images not gradedImages not graded• Screening inactive or ineligible patientsScreening inactive or ineligible patients

Adds to the inefficiencies within the Adds to the inefficiencies within the serviceservice

SMDRSSSMDRSS

DRS Service ContractDRS Service ContractThe DRS service comprises:– measuring a patients visual acuity;– taking a minimum of two digital photographs per eye in

accordance with National Screening Committee Guidelines;– undertaking a First Full Disease Grade in respect of each of

the digital photographs obtained from a Patient or as may otherwise be required by the Commissioner;

– recording the Retinopathy Grade in respect of such First Full Disease Grade;

– where required by the Commissioner, the Relevant Associate PCT or SMDRS, undertaking a Second Full Disease Grade in respect of the digital photographs obtained from a Relevant Patient;

– recording the Retinopathy Grade in respect of such Second Full Disease Grade;

– where authorised, undertaking SLBIO immediately following digital imaging in respect of those Patients where the images are Ungradeable

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ProviderProvider obligationsobligations: equipment, premises

•private consultation area

•access to a broadband connection

• fully sourced and operational digital retinal camera – PASA approved

• IT hardware

•high resolution monitors

•notify SMDRS within twenty four (24) hours of any serious faults in DRS software system

ProviderProvider obligationsobligations: servicesservices

• notify the Programme of any changes in the identity of notify the Programme of any changes in the identity of the Qualified Personnel the Qualified Personnel priorprior to such changes taking place to such changes taking place (minimum of 30 days notice of a Qualified Personnel (minimum of 30 days notice of a Qualified Personnel

leaving)leaving) • ensure that ensure that onlyonly Qualified Personnel provide the Services Qualified Personnel provide the Services

• QP is QP is C&G qualified or enrolledC&G qualified or enrolled on the course – and on the course – and completes within 2 yearscompletes within 2 years

• Keep the Programme notified about that personnel’s Keep the Programme notified about that personnel’s progress on the relevant course progress on the relevant course

• If miss deadlines, the Commissioner can require such If miss deadlines, the Commissioner can require such personnel to be removed from the Provider’s list of personnel to be removed from the Provider’s list of Qualified PersonnelQualified Personnel

ProviderProvider obligationsobligations: servicesservices

• provide any necessary information relating to the provide any necessary information relating to the Provider’s provision of the Services as may be required Provider’s provision of the Services as may be required by SMDRS Manager from time to time;by SMDRS Manager from time to time;

• input as soon as reasonably possible all necessary input as soon as reasonably possible all necessary information onto the diabetic retinopathy screening information onto the diabetic retinopathy screening software system and inform the Commissioner or the software system and inform the Commissioner or the Relevant Associate PCT of any changes to the Patient Relevant Associate PCT of any changes to the Patient Information;Information;

• input onto the central database the details of any input onto the central database the details of any Patient appointments which it has completed and any Patient appointments which it has completed and any Patients that did not attend their appointment with the Patients that did not attend their appointment with the Provider;Provider;

ProviderProvider obligationsobligations: servicesservices

• not allow an unreasonable waiting list or backlog to not allow an unreasonable waiting list or backlog to develop (it being agreed that for the purpose of this develop (it being agreed that for the purpose of this clause, clause, 60 days60 days is to be considered a reasonable is to be considered a reasonable period of time);period of time);

• provide a choice of appointment times to its provide a choice of appointment times to its Patients;Patients;

• not link sight tests with the provision of the Servicesnot link sight tests with the provision of the Services

• If screening another Practice’s patient, not solicit If screening another Practice’s patient, not solicit further business from that Patient (e.g. a sight test) further business from that Patient (e.g. a sight test)

• Not solicit referral of patients from GP practices, Not solicit referral of patients from GP practices, health centres, diabetes clinics, etchealth centres, diabetes clinics, etc

Qualified Personnel: Qualified Personnel: obligationsobligations• 2 images each eye, FDG, immediate 2 images each eye, FDG, immediate

SLBIO, patient consentSLBIO, patient consent

• Minimum 500 imagesets, online EQA Minimum 500 imagesets, online EQA test sets, C&G qualification, maintain test sets, C&G qualification, maintain competence & accreditationcompetence & accreditation

• Comply with national timescales & Comply with national timescales & targetstargets

• Do not solicit businessDo not solicit business

Core Service issuesCore Service issues• Unnecessary remindersUnnecessary reminders• Inappropriate DNA lettersInappropriate DNA letters• Unknown missing images/episodesUnknown missing images/episodes• Inappropriate appointmentsInappropriate appointments• Images not gradedImages not graded• Screening inactive or ineligible patientsScreening inactive or ineligible patients

Adds to the inefficiencies within the Adds to the inefficiencies within the service service how can we improve?how can we improve?

SMDRSSSMDRSS

MISSING IMAGES

10

10

4

29

11

5

14

8

22

64

20

6

01

2 2

10

17

0

4

02

1

8

10 0

10 0 0 0

6

0 0 02

0

5

8

0 0

8

2

0

5

10

15

20

25

30

35

DATE CHECKED

NUM

BER

OF P

ATIE

NTS

NUMBER OF INSTANCES WHERE IMPORT IMAGES WAS ADDED TO LOGON

4

54 56

33

43

102

8288

9

4134

77

2921

0

20

40

60

80

100

120

SMDRSS CommunicationsSMDRSS Communications

Pointers breakdown

Appointments on Vector Apr-08 May-08 Oct-08 Nov-08 Feb-09 Mar-09 Jun-09 Nov-09 Feb-10 Oct-10 Apr-11 Nov-11 Dec-11 Jan-12

Appts not DNA'd Apr-08 May-10 Jun-10 Jul-10 Nov-10 Dec-10 Oct-11 Nov-11

Broadband Jul-08 Aug-08 Apr-09 May-09 Jul-09 Sep-09 Oct-10 Dec-10 Jun-11 Jul-11

Pregnant Patients May-10 Jun-10 Dec-11

Domi Visits Mar-09 Oct-11 Nov-11

Patients under HES Aug-08 Feb-10 Aug-11 Oct-11 Nov-11 Dec-11 Mar-12

Uploading images Nov-10 Dec-10 Oct-11 Nov-11 Mar-12

Appts/patient demographic Mar-09 Apr-09 May-09 Jun-09 Feb-10 May-10 Jun-10 Jul-10 Oct-10 Nov-10 Apr-11 May-11 Nov-11

SMDRSS CommunicationsSMDRSS Communications

Going forward….Going forward….

SMDRSS ObjectivesSMDRSS Objectives 2012-132012-13• Remove inefficienciesRemove inefficiencies• Eliminate risksEliminate risks• More robust contract performance More robust contract performance

managementmanagement

SMDRSSSMDRSS

We need your cooperation!!We need your cooperation!!Remember…. Remember…. National screening service, National National screening service, National standardsstandards

National pathway changesNational pathway changes

• National programme – new nameNational programme – new name• NDESP NDESP National Diabetic Eye Screening National Diabetic Eye Screening

ProgrammeProgramme

• Eliminate variation in pathways Eliminate variation in pathways between programmes in England – between programmes in England – no ‘postcode lottery’no ‘postcode lottery’

• Will bring consistency, comparable Will bring consistency, comparable data, better benchmarkingdata, better benchmarking

• Avoid confusion, minimise risksAvoid confusion, minimise risks

SMDRSSSMDRSS

Local ChangesLocal Changes

• Implement NDESP common pathwayImplement NDESP common pathway

• Grading protocolGrading protocol

• Local name changeLocal name change

• Transition to a new provider, new Transition to a new provider, new locationlocation

• New CommissionersNew Commissioners

• New contractNew contract

FinallyFinally

• Bear in mind….Bear in mind….

• We have a very busy year aheadWe have a very busy year ahead

• Wider changes within the NHSWider changes within the NHS

• Keep up the good work!Keep up the good work!

Thank youThank you

Any questions?Any questions?