Commissioning advice for implementation
of the common pathway for NHS Diabetic
Eye Screening Programme (DESP)
Version 1.1 06 March 2012
To provide commissioners with advice on upcoming changes and a checklist for
action that they will need to take during 2012/13 to move the NHS DESP on to the
new common pathway (Appendix 1)
Project/Category
New Pathway Implementation
Document title
Commissioning advice for implementation of the common pathway for
NHS Diabetic Eye Screening Programme (DESP)
Version and date
v1.1, 6 March 2012
Release status
Author
Final
Sue Cohen and Anne Stevenson
Owner
Sue Cohen
Type
Guidance
Authorised By
NHS DESP National Programme Team
Valid from
6 March 2012
Review Date
NHS DESP, Clinical Leads, Programme Managers, Commissioners,
SHA Screening Leads
Audience
Distribution
Name / group
Responsibility
Clinical Leads, Programme Managers
SHA Screening Leads, Commissioners
Lynne Lacey at Essential Workshops
Anne Stevenson
Amendment history
Version
Date
Author
Description
Review / approval
Version
v1.1
Date
Requirement
6 March 2012
Signed
2
Commissioning advice for implementation of
the common pathway for NHS Diabetic Eye
Screening Programme (DESP)
1 Purpose
In November 2011, the UK NSC approved a new common pathway for the NHS
Diabetic Eye Screening Programme (previously known as the English National
Screening Programme for Diabetic Retinopathy)
The purpose of this document is to provide commissioners with advice on upcoming
changes and a checklist for action that they will need to take during 2012/13 to move
the NHS DESP on to the new common pathway, (Appendix 1).
Commissioners are advised if they require further information on the new pathway,
they contact their local Public Health Lead or Regional QA team.
PCTs and DsPH have been asked to produce transition plans for screening
programmes. Commissioners should ensure that the advice and action that arise
from the commissioning checklist is reflected in PCT transition plans.
2 Advice for commissioners
2.1 Service Specification
The UKNSC has requested all national screening programmes to produce a national
service specification for use by the NHS CB from April 2013. The National Team of
the DESP is intending to produce a national service specification by summer 2012.
The national service specification will reflect the new common pathway and any
changes that have been indicated nationally.
2.2 Procurement of surveillance (OPDR) module
The National Team have negotiated central resource for the capital costs for
procurement of the surveillance module (OPDR) from software suppliers. This
software module will provide a call and recall functionality to manage these patients
outside the call and recall used for annual digital screening.
Installation and revenue costs will need to be negotiated between commissioners
and providers.
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Further information will be provided to programmes and commissioners on how to
obtain the surveillance module.
Authorisation to software suppliers for the provision of the surveillance module to
local programmes will be based on the return from the programme and
commissioners of a satisfactory implementation plan. (Template appendix A)
2.3
Commissioning of surveillance clinics for OPDR and Slit lamp biomicroscopy
Programmes may already be providing OPDR or a dedicated slit lamp service from
acute providers or optometrists. There is no reason why the delivery model should
change, however the commissioning and funding flows may need to be amended.
The funding for these services will be by the NHS CB as part of the screening
programme and will be picked up under the NHS CB contract (see below).
Local DES Programmes are advised that they should have an SLA with the provider
of OPDR or dedicated SLB services.
The SLA as a minimum should cover:
 Clinical supervision
 Agreed protocols
 Use of surveillance modules
 Return of activity data
Commissioners should consider a payment schedule for OPDR/SLB where it occurs
in HES. It is recommended that this should not be paid for under tariff and a local
negotiated rate should be agreed. This is a transitional arrangement which is likely
to be reviewed following transfer of commissioning to NHS CB in 2013.
2.4 Use of OCT
OCT is not included in the new common pathway. It is recognised that some
programmes have linked OCT in to OPDR clinics or may wish to do this in the future.
Before OCT could be considered as a standard component of the screening
programme surveillance clinics, further research will be required including assessing
cost-effectiveness, affordability and model for delivery. Lack of this information does
not preclude the commissioning of OCT from HES as part of the diagnostic and
treatment pathway.
Programmes currently operating OCT clinics can continue to link these into
surveillance clinics, however the commissioning and funding for OCT will not be by
the NHS CB and local negotiations will need to take place to agree funding under
diagnosis and treatment contracts under the auspices of Clinical Commissioning
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Groups. This will include additional funding for any software interfaces from the
OPDR module into OCT equipment
2.5 Impact of introduction of surveillance (OPDR) on HES activity.
In programmes that do not have OPDR, OCT or dedicated slit lamp clinics,
commissioners should consider that provision of a surveillance module for digital
imaging (OPDR) and slit lamp clinics will reduce demand on HES which will be
picked up within the screening programme.
Commissioners may wish to take this opportunity to discuss with their providers of
HES the following areas:



How the reduction in demand for OPA can be used to develop quality and
failsafe functions within the HES.
The delivery of HES Diabetic Retinopathy services should be in line with
Royal College of Ophthalmology Preferred Practice Guidelines and Quality
checklist.
May require movement of resource from the HES contract into screening
programme to support additional activity in surveillance for OPDR/SLB.
3 Commissioning Checklist
3.1 Contracts and Finance
Commissioners should review their contract(s) with screening programmes and
hospital eye services (HES) and in the light of the new pathway identify those
elements that in the future will be commissioned by the NHS CB (administration,
screening, grading and surveillance i.e. OPDR and SLB clinics) and those that will
fall under the HES (e.g. OCT, diagnosis and treatment) and will be commissioned by
the Clinical Commissioning Groups. Commissioners will need to identify the activity
and the estimates of funding flows to both contracts.
If the PCT maintains any function in-house (see below e.g. IT support, Programme
Management, administration), plans should be in place to transfer these functions to
appropriate provider organisations and that the function and associated funding is
reflected in contracts.
3.2 IT
Commissioners should review ownership of IT and associated service contracts and
if necessary reconfigure under an appropriate provider. E.g. contracts held by PCTs
should be transferred to the most appropriate provider.
Commissioners should ensure that programmes are operating the latest version of
software offered by their suppliers and are dataset compliant as only these will
support the new pathway.
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Programmes operating Orion must migrate this year. If they are running old DHC
software they must upgrade this year.
3.3 Estates
Commissioners should review the accommodation and rental required for screening
and ensure that this is covered in contracts for the appropriate provider.
3.4 Call/Recall and identification of Cohort
Commissioners should review provision of call/recall and information sources to
support identification of cohort. Where there is a PCT or PH contribution to this
activity the commissioner should consider transfer of function to a provider function. .
3.5 Governance and Roles of Clinical Lead and Programme Manager
Commissioner and Programme should review responsibilities and accountabilities for
the Clinical Lead and Programme Manager and ensure that clinical responsibility for
the screening programme is clearly identified within a clinical governance framework
with an appropriate provider organisation.
3.6 Failsafe
In preparation for the separation of responsibility between HES and the screening
programme, the commissioners should carry out a review of failsafe provided by the
screening programme. In circumstances where the Screening Programme is
providing failsafe for the HES, the cost of this service should be identified and
included in the contract for the HES. Commissioners and providers should also
consider whether the function should be transferred to the HES.
Failsafe activities that commissioners may wish to consider include:





Making appointments in HES
Contacting GP or patients re appointments at HES
Follow up of DNA in HES
Contacting HES to confirm that the patient is still being clinically managed by
the HES
Extracting outcome information from discharge letters.
Sue Cohen
National QA Director
Anne Stevenson
National Programme Manager
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Appendix A
Template
Outline implementation plan
For introduction of common pathway.
Programme Name:
Programme Manager:
Clinical Lead:
Lead Commissioner:
For each activity please outline how you intend to deliver the proposed change.
Please include service model, training, resource requirements, IT provision etc.
Outline any contingencies or barriers to successful implementation and timescale
including start and completion date.
If your programme already has this in place please state ‘in place’.
Upgrade to most recent version of software
Provide dedicated surveillance SLB clinic with call/recall
Provide surveillance imaging clinic (OPDR) with call recall
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Adequate governance arrangements, including Clinical Lead and
Programme Manager
Introduction of new grading criteria and features based grading.
Grading pathway: include Referral Outcome Grade
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