key: cord-0771726-wc3i399v authors: Harper, Robert A.; Dhawahir-Scala, Felipe; Wilson, Helen; Gunn, Patrick J. G.; Jinkinson, Matthew; Pretty, Iain A.; Fletcher, Sara; Newman, William D. title: Development and implementation of a Greater Manchester COVID19 Urgent Eyecare Service date: 2020-06-29 journal: Eye (Lond) DOI: 10.1038/s41433-020-1042-6 sha: 559247593d79a007d197ac276de3775fd6fabc95 doc_id: 771726 cord_uid: wc3i399v nan In this article, we describe the development of CUES in Manchester and Greater Manchester (GM), noting opportunities afforded with requirement for rapid implementation of a new service, albeit one building on existing collaborations, capitalising on new technology and the emergence of a critical mass of optometrists with Independent Prescribing (IP) accreditation. We emphasise the importance of collaboration, including clinicians in primary and secondary care, commissioners, and technology providers. Manchester has a longstanding tradition of locally commissioned services, being first to establish a glaucoma referral filtering service [4] , implementing a pathway refined over the years alongside changes in national guidance [5] [6] [7] [8] . Facilitated by this history of engagement, and indeed prior to COVID19, discussions had been held to establish ways in which primary and secondary care ophthalmic services might be enhanced, recognising capacity limitations within hospital ophthalmology, the evolving scope of practice of optometrists, and recommendations from: Royal College of Ophthalmologists [9] ; the Clinical Council for Eye Health Commissioning [10] ; NHSE's elective care transformation programme [11] ; and the Ophthalmology GIRFT Programme [12] . Local enablers in developing CUES included. First, the Manchester and GM locality is served by Primary Eyecare Services (PES), an Optometry Federation established by Local Optical Committees in England, and the largest provider of 'extended' PES delivered via a network of optometry practices. PES hold contracts with a number of CCGs to deliver extended PES including glaucoma, cataract and minor eye conditions. PES had a current contractual arrangement with Manchester CCG facilitating their ability to effectively commission CUES through a contract variation. Second is the availability of the OPERA (OPtometric Electronic Referral and Assessment) platform for managing referrals. The system brings NHS IT infrastructure into primary care optometry, facilitating appropriate role This arrangement confers feasibility for using a second level of optometric practitioner for inter-optometric referral of selected cases following initial telephone triage, allowing a more complex patient case mix to be assessed and managed within CUES than would otherwise have been the case. Finally, there is the local engagement such that in anticipation of the NHSE/I service specification on CUES published in mid-April 2020, a collaboration of GM LEHN, Manchester CCG and MREH worked on plans in March 2020 to develop an urgent eyecare service in supporting immediate and recovery phases of the Coronavirus Pandemic. Setting up CUES required collaboration across the system, with primary and secondary care clinicians working together to develop the pathway (see Fig. 1 ). The intention is to safely deliver urgent eye care in the community using remote triage and consultations by telemedicine, minimising face-to-face appointments, making use of technology to allow for advice around referrals via e-RS, and reducing burdens on the rest of primary care and within secondary care. While the Manchester CUES was intended to align with the generic NHSE/I specification, it was intended to make use of local opportunities, as outlined above, with clinicians within MREH's acute services developing clinical guideline documentation and a prescribing formulary ( Table 1) . The launch event for the service in Manchester and elsewhere also reflected our collaboration, in having optometrists expressing an interest in providing CUES attend a joint MREH and PES webinar via Microsoft Teams, providing explanations of the pathway and clinical scenarios, as well as reviewing administrative and contract related requirements. The service has now been implemented in six CCGs (as of 1st June 2020) within the GM conurbation, with referrals including images and SCR through e-RS and NHSmail. CUES is commissioned in Manchester for 6 months but is expected to have relevance thereafter, being flexible enough to accommodate changes or additional arrangements around referral, whether urgent, as is the case here, or routine, capitalising on the collaboration and IT capabilities beyond CUES. We believe that a key strength of the development and implementation described herein is stakeholder engagement in an increasingly complex NHS commissioning landscape. NHSE/I have proposed a number of expected benefits of CUES, not least safe and effective reduction in ophthalmology attendances. An evaluation across primary and secondary care is planned to address the all-important question of whether CUES will reduce the queues. COVID-19 Urgent Eyecare Service -CUES. (NHS England Publication approval reference: 001559) eyeca re-service-in-response-to-covid-19-supporting-management-of-a ppropriate-referrals-from-eye-care-hubs-to-ophthalmology-eye-units Community refinement of glaucoma referrals A qualitative study of stakeholder views regarding participation in locally commissioned enhanced optometric services Multi-stakeholder perspectives of locally commissioned enhanced optometric services Clinical effectiveness of the Manchester Glaucoma Enhanced Referral Scheme The impact of the Manchester Glaucoma Enhanced Referral scheme on NHS costs The Way Forward-Emergency Eye Care Clinical Council for Eye Health Commissioning (CCEHC) System and Assurance Framework for Eye-health (SAFE)-Emergency and Urgent Care Transforming elective care services ophthalmology Conflict of interest IAP is the clinical lead at FDS Consultants, responsible for the OPERA system. MJ is Clinical Director at Primary Eyecare Services, holder of the contract with Manchester CCG in relation to CUES and other primary care optometry delivered services.Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.