Co Management / Shared Care Intro

Optoms should have an in-depth knowledge of diseases that are the focus of current co-management schemes, the necessary skills required for the schemes and understanding of their current state in UK optometry

There was a change in how shared care related to optometrists in the year 2000. Before then it only involved the optician spotting an injury/disease of the eye and referring the person to a medical practitioner. In 2000 the GOC put forward the following:

If in the pro. judgement of a registered optician there is no justification to refer a person consulting him to a registered medical practitioner the registered optician may at his discretion decide not to refer that person but in that event:

• He shall record a sufficient description of the injury or disease in his records
• his reason for not referring
• details of advice tendered
• if appropriate and with the consent of the px inform the GP

Legal posn - The NHS (General ophthalmic services amended 1986)

Optom having accepted persuant to the regs an application for the testing of sight make such examination of the patient's eyes as may be required and in doing so exercise proper care and attention. Where a contractor is of the opinion that a patient whose sight he has tested

• Shows on examination signs of injury or disease in an eye or in its immediate vicinity or any other abnormality of the eye or the rest of the visual system which may require medical treatment
• If px not likely to attain a satisfactory standard of vision notwithstanding the application of corrective lenses he shall so inform the px's doctor

Optoms have always been involved in px management, they are actually often the initial point of contact for a patient in the community. There are four levels of management which the optom is involved in

1. Detection with non-specific referral of the abnormality. This is like basic entry level!
2. Detection with informed referral for advice/management - this is where you're indicating diag/diff diag with maybe some signs and symptoms, level of urgency, suggest what will be done/who will do it. Ideally this is what you're aiming for. Doing (1) is just weak mang. Acceptable, but weak.
3. Detection w/a directed management plan in which you (a) advise the GP of the status of an ocular condition that you plan to monitor - diagnosis/plan or (b) advise the GP of an ocular condition and provide prioritized referral advice - w/diagnosis/plan, referral pathway and urgency and a note of where you participate in the scheme (maybe later on - like post cataract check)
4. Formal Shared Care Scheme - this is set up thru the health board/NHS and involves specific training, criteria for px inclusion, examination requirements and criteria for referral and monitoring. This can include delegation of medical management to the optometrist