MECS / CUES

CUES

COVID -19 Urgent Eyecare Service (CUES service) delivered by Primary Eye Care Service launched in the West Midlands on Friday 24th July. MECS is now suspended – any episodes completed on Optomanager will not be paid. Patients with urgent ocular symptoms, such as a red eye, painful eye, flashes and floaters, foreign body etc. can be signposted to CUES at a local participating optical practice. The Service will provide initial contact, telephone triage, remote consultations and where necessary face to face assessments providing management of recent onset symptomatic or urgent ocular presentations. 

  • Developed by LOCSU, NHE E/I and the Clinical council (Endorsed by RCoO and CoO)
  • Symptom led service for urgent and emergency eyecare, to overtake MECS
  • Eligibility screening conducted when patient contacts the practice. Triage form can be found here
  • Contact with optometrist within 2 hours of eligibility screening
  • Telemedicine is the first port of call
  • Minimises patient contact where possible
  • For sight threatening symptoms – see face to face on same day or within 24 hours
  • Initially for the COVID / recovery period
  • May be extended due to additional benefits and future possibilities

The purpose of the remote consultation is for the optometrist to conduct a clinical triage and obtain history and symptoms, this will reduce the amount of time spent face to face with the patient. Initially when the service was first developed in the red phase of College of Optometrist guidelines it was found to be Optometrists themselves answering the phone so a clinical contact within 2 hours was not an issue. Now practices are using front of house staff to conduct the eligibility screening the timescale has been relaxed for up to 4 hours but patient safety continues to be at the forefront of any decisions made. Ideally a telemedicine appointment will be arranged within 2 hours but at least within 4. Also ensure there is enough time available in case the optometrist wants to see the patient the same day. Just be mindful of the patient’s anxieties of waiting for a call as opposed to MECS which they would be waiting for a Face to Face appointment. Patients will be seen according to the urgency of their symptoms, within 24 hours or 48 hours for less serious symptoms. We have included separate one-page service summary for your information.

We would appreciate it if all practices could display a CUES wall poster on their door to help signpost patients to the service. If your practice is currently closed, it would be much appreciated if something could be added to your answerphone message, directing patients to CUES.  Please see posters available to download to the right (below on mobile devices)

Pathway and protocols

PRACTICE REGISTRATION (ONBOARDING)

Please note that the Primary Eyecare Services website is being continually updated with details of CUES service providers, we are continuing to register Practices in this area.

Please ensure you have completed the onboarding process. Any queries about this, please email onboarding@primaryeyecare.co.uk as soon as possible

Registering onboarding process

Registration step by step guide

FIND A PRACTICE

CUES has been live since Friday 24th July and is now the only service that can be used to assess urgent and symptomatic ocular presentations (such as flashes and floaters, eye pain etc)

The list of accredited optical practices currently providing the service is available on the Primary Eyecare Website primaryeyecare.co.uk using the ‘Find a Practice’ tool. This shows the most up to date information.

If you are a current CUES practice – please check your details are correct on the website.

If you were previously providing MECS and not CUES, and your practice is still listed, please email onboarding@primaryeyecare.co.uk with your full practice address to ensure it can be removed. Please signpost any patient presenting with symptoms suggestive of an urgent eye condition to a nearby participating CUES practice.

Current list of of practice providers can also be found here:  BSOL HOWM

NOTIFICATION PROTOCOL

Steps to take if optical practice is unable to deliver service due to staff absence or period of closure.

  • At the earliest opportunity where a period of non-service delivery occurs the optical practice should notify Primary Eyecare Services at COVID@primaryeyecare.co.uk. Further information will be requested regarding the situation of the practice.
  • Practice should put sign at entrance (as well as on your website) instructing patients trying to access First Contact Services (E.g. MECS or CUES) where to find contact details for alternative optical practices (e.g. Primary Eyecare website), where possible.
  • A telephone answer machine message should include details of where alternative practice contact details can be found (e.g. Primary Eyecare website), where possible.
  • Where a practice remains open but a practitioner is unavailable then alternative arrangements must be made for the patient by another optical practice.

PHARMACY PROVIDER UPDATE: 29TH JULY 2020

Please call the pharmacy first before sending across signed orders to warn them of the new service and that it has superseded MECS. They should find the platform under ‘COVID-19 Urgent Eyecare Service (CUES) – Update to MECS’ on PharmOutcomes.

Here is a list of pharmacies which have been dispensing NHS exempt written orders under MECS over the past 12 months and so you may wish to refer patients to these first.

As PharmOutcomes is an optional service, not all pharmacies are participating.

Pharmacy nhs.net email addresses will be sent to you in the coming weeks. For the meantime, please print out any written orders and give to the patient by hand or post to the pharmacy of choice.

OPERA

Any technical issues, please contact Opera via the speech bubble in the bottom right hand corner of the Opera screens

IT platform pathways and outcomes quick guide

Opera HELP videos:

https://help.optom-referrals.org
https://help.optom-referrals.org/category/249-cues-introduction-videos

Admin access guidance:

https://help.optom-referrals.org/article/270-create-an-administrator-role

Clinical Process

For every CUES contact, you must enter the triage/eligibility form on to OPERA whether the patient has telemedicine or is signposted [deflected] from CUES

Telemedicine – EVERY patient has an eligibility screening (screening form) and IF eligible for CUES needs to have a remote consultation (Telemedicine form). It is vital this is done, even if you feel they need to come in for face to face assessment. History & symptoms can be gathered to minimise the time required in practice. (To clarify – if the patient is deflected to self-care/pharmacy with advice and guidance – this does not require a telemedicine but advise the px to contact again in 5 days for telemedicine if not resolved).

Telemedicine-Guidance-V4.pdf

Diagnosis input – please avoid using shortened diagnosis names in the conditions boxes e.g. avoid FB and start typing Foreign Body and the autocomplete list will appear to allow you to select, this ensures complete and consistent data gathering.

Completion of Referrals – where the outcome of the assessment is Refer to HES / Refer to GP / Refer to anther CUES provider (e.g. for OCT) , you MUST complete the referral step. This requires you to go to the manage referral page and select the ‘Refer to..’ tab and add the further referral information and location (for GP referral this will by send via DocMan – please ignore the travel time). Non completion of this element will lead to delays in patient care.

Please call the eye clinic to inform them that an urgent or emergency referral has been emailed to them. The referral forms generated from Opera will be updated in mid August.

Image upload – one of the unique elements of the Opera platform is that for patients being referred they can have images attached to their referral and we would encourage you to add any images you have taken anterior segment, posterior segment, PDFs of VFs & full OCT scans. When a patient has been seen on the OCT pathway due to central distortion / wavy vision and requires referral you MUST upload the DICOM OCT file to the Opera system at the time of referral (please check with your sales rep about how to do this).

Please see documentation relating to CUES to the right.

GP practice letter BSOL

Hospital letter BSOL

Optometry letter template BSOL

Pharmacy letter BSOL

PE UES Poster 1

PE UES Poster 1 – practice poster

PE UES Poster 2

PE UES Poster 2 – practice poster