Document Profile io n Ac t 19 82 Elective Services Filing Status: Final Drawer: Service Improvement Date: 04/03/2019 Folder: Ophthalmology\DHB Improvement Plans\Tairawhiti Title: FW: Are you observing any File Location: increase in referrals Unit: Ministry of Health Author: Lynsey Bartlett DHB Performance Support and Document Type: Email Infrastructure Summary: DHB Performance and Knowledge Content: Med Support\Electives and National Services\Electives Service Improvement Maintainer(s): Chris Stewart rm at fyi al In From: Graham Wilson   Sent: Sunday, 3 March 2019 8:17 PM To: Lynsey Bartlett  Subject: RE: Are you observing any increase in referrals fo Lynsey Bartlett    Clinical Care Manager, Surgical Services.  Contact s 9(2)(a) he O ffi ci Yes Since two of the three practices now have OCT they are detecting things they know nothing about or are  picking up early but not necessarily clinically significant disease. Thanks graham de rt From: Lynsey Bartlett Sent: Sunday, 3 March 2019 4:59 PM To: Graham Wilson; Rachel Cook Subject: FW: Are you observing any increase in referrals un Your thoughts?  Ta  se d Lynsey Bartlett    Clinical Care Manager, Surgical Services.  Contacts 9(2)(a) R el ea From: Chris_Stewart@moh.govt.nz   Sent: Thursday, 28 February 2019 8:03 AM To: RebecSteve@adhb.govt.nz; chris.bark@bopdhb.govt.nz; alison.watkins@cdhb.health.nz;  belinda.bennett@ccdhb.org.nz; terri.england@middlemore.co.nz;  jane.hawthorn@hawkesbaydhb.govt.nz; carolyn.braddock@huttvalleydhb.org.nz;  manager@rotoruaeyes.co.nz; katherine.gibbs@midcentraldhb.govt.nz; derek.sherwood@nmhs.govt.nz;  mark.mcginley@northlanddhb.org.nz; mkhalid@scdhb.health.nz; brad.aitcheson@southerndhb.govt.nz;  leigh.cleland@tdhb.org.nz; Lynsey Bartlett ; stephen.ng@xtra.co.nz;  Kieran.McCann@wairarapa.dhb.org.nz; janine.bacon@wairarapa.dhb.org.nz;  19 82 Peter.Wood‐Bodley@wdhb.org.nz; janice.donaldson@siapo.health.nz; joce.carr@healthshare.co.nz;  satbhama.narayan@tas.health.nz; jp.craig@auckland.ac.nz Cc: Simon_Duff@moh.govt.nz; Chris_McEwan@moh.govt.nz; Sue_Morgan@moh.govt.nz Subject: Are you observing any increase in referrals Good Morning Everyone On behalf of the Collaborative Team, some DHBs have let us know they have noticed an increase in referrals through optometrist presentations. If this is happening at your DHBS - we are inviting you to let us know through your anecdotal observations. Ac t Please send an email back to me if you have any thoughts on this. io n Thanks in advance. Regards al In fo rm at Chris Stewart Senior Advisor Electives and National Services DHB Performance, Support and Infrastructure Ministry of Health Mobile s 9(2)(a) ci http://www.health.govt.nz mailto:Chris_Stewart@moh.govt.nz de rt he O ffi **************************************************************************** Statement of confidentiality: This e-mail message and any accompanying attachments may contain information that is IN-CONFIDENCE and subject to legal privilege. If you are not the intended recipient, do not read, use, disseminate, distribute or copy this message or attachments. If you have received this message in error, please notify the sender immediately and delete this message. **************************************************************************** se d un This e-mail message has been scanned for Viruses and Content and cleared by the Ministry of Health's Content and Virus Filtering Gateway ea Please consider the environment before printing this email Statement of confidentiality: This e-mail message and any accompanying attachments may contain information that is in confidence and subject to legal privilege. If you are not the intended recipient, do not read, use, disseminate, distribute, or copy this message or R el attachments. If you have received this message in error, please notify the sender immediately and delete this message. Document Profile io n Ac t 19 82 Elective Services Filing Status: Final Drawer: Service Improvement Date: 01/03/2019 Folder: Ophthalmology\DHB Improvement Plans\Hawke's Bay Title: RE: Are you observing any File Location: increase in referrals Unit: Ministry of Health Author: Jane Hawthorn DHB Performance Support and Document Type: Email Infrastructure Summary: DHB Performance and Knowledge Content: Med Support\Electives and National Services\Electives Service Improvement Maintainer(s): Sue Morgan R el ea se d un de rt he O ffi ci al In fo rm at We have def noticed an increase, I will get the data Kind regards   Jane Hawthorn Clinical Nurse Specialist‐ Ophthalmology Villa 3  Hawkes Bay District Health Board Private Bag 9014, Hastings 4156 T: 06 8788109 ext 6932 F: 06 8781674 Email: jane.hawthorn@hawkesbaydhb.govt.nz Tauwhiro  Raranga te tira  He Kauanumanu  Akina         From: Chris_Stewart@moh.govt.nz [mailto:Chris_Stewart@moh.govt.nz]  Sent: Thursday, 28 February 2019 08:03 To: RebecSteve@adhb.govt.nz; chris.bark@bopdhb.govt.nz; alison.watkins@cdhb.health.nz;  belinda.bennett@ccdhb.org.nz; terri.england@middlemore.co.nz; Jane Hawthorn  ; carolyn.braddock@huttvalleydhb.org.nz;  manager@rotoruaeyes.co.nz; katherine.gibbs@midcentraldhb.govt.nz; derek.sherwood@nmhs.govt.nz;  mark.mcginley@northlanddhb.org.nz; mkhalid@scdhb.health.nz; brad.aitcheson@southerndhb.govt.nz;  leigh.cleland@tdhb.org.nz; lynsey.bartlett@tdh.org.nz; stephen.ng@xtra.co.nz;  Kieran.McCann@wairarapa.dhb.org.nz; janine.bacon@wairarapa.dhb.org.nz;  Peter.Wood‐Bodley@wdhb.org.nz; janice.donaldson@siapo.health.nz; joce.carr@healthshare.co.nz;  satbhama.narayan@tas.health.nz; jp.craig@auckland.ac.nz Cc: Simon_Duff@moh.govt.nz; Chris_McEwan@moh.govt.nz; Sue_Morgan@moh.govt.nz Subject: Are you observing any increase in referrals Good Morning Everyone On behalf of the Collaborative Team, some DHBs have let us know they have noticed an increase in referrals through optometrist presentations. If this is happening at your DHBS - we are inviting you to let us know through your anecdotal observations. Please send an email back to me if you have any thoughts on this. Thanks in advance. 19 82 Regards io n Ac t Chris Stewart Senior Advisor Electives and National Services DHB Performance, Support and Infrastructure Ministry of Health Mobile s 9(2)(a) http://www.health.govt.nz mailto:Chris_Stewart@moh.govt.nz ci al In fo rm at **************************************************************************** Statement of confidentiality: This e-mail message and any accompanying attachments may contain information that is IN-CONFIDENCE and subject to legal privilege. If you are not the intended recipient, do not read, use, disseminate, distribute or copy this message or attachments. If you have received this message in error, please notify the sender immediately and delete this message. **************************************************************************** O ffi This e-mail message has been scanned for Viruses and Content and cleared by the Ministry of Health's Content and Virus Filtering Gateway R el ea se d un de rt he ____________ DISCLAIMER: This emailed information is private and protected by law. If you are not the intended recipient, you are hereby notified that any disclosure, copying, or distribution, or the taking of any action based on the content of this information, is strictly prohibited. Please let us know immediately if you have received this by mistake and destroy this message. Document Profile rm at io n Ac t 19 82 Elective Services Filing Status: Final Drawer: Service Improvement Date: 01/03/2019 Folder: Ophthalmology\DHB Improvement Plans\Auckland Title: RE: Auckland Are you observing File Location: any increase in referrals Unit: Ministry of Health Author: Chris Stewart DHB Performance Support and Document Type: Email Infrastructure Summary: DHB Performance and Knowledge Content: Med Support\Electives and National Services\Electives Service Improvement Maintainer(s): Sue Morgan Hi Rebecca thanks for this update. "Rebecca Stevenson (ADHB)" In al ci Hi Chris, yes we have had a definit... 28/02/2019 01:52:39 p.m. "Rebecca Stevenson (ADHB)" "'Chris_Stewart@moh.govt.nz'" , "Sarah Welch (ADHB)" 28/02/2019 01:52 p.m. RE: Are you observing any increase in referrals de rt he From: To: Cc: Date: Subject: O ffi http://www.health.govt.nz mailto:Chris_Stewart@moh.govt.nz fo regards Chris Stewart Senior Advisor Electives and National Services DHB Performance, Support and Infrastructure Ministry of Health Mobile s 9(2)(a) R el ea se d un Hi Chris,  yes we have had a definite increase in referrals and are trying to work through where these  referrals are coming from.  It is widely thought that the majority are from Optometrists (especially with  increased OCT availability) but our referrer data hasn’t been well captured so it is difficult to confirm at  this stage.    19 82 Ac t io n rm at fo In al ci O ffi he rt de un d se ea R el     Rebecca Stevenson Business Manager, Ophthalmology & GCC Outpatients s 9(2)(a)    RebecSteve@adhb.govt.nz Auckland District Health Board  Level 1   Building 8   Greenlane Clinical Centre   19 82                     fo rm at io n Ac t From: Chris_Stewart@moh.govt.nz [mailto:Chris_Stewart@moh.govt.nz] Sent: Thursday, 28 February 2019 8:03 a.m. To: Rebecca Stevenson (ADHB); chris.bark@bopdhb.govt.nz; alison.watkins@cdhb.health.nz; belinda.bennett@ccdhb.org.nz; Terri England (CMDHB); jane.hawthorn@hawkesbaydhb.govt.nz; carolyn.braddock@huttvalleydhb.org.nz; manager@rotoruaeyes.co.nz; katherine.gibbs@midcentraldhb.govt.nz; derek.sherwood@nmhs.govt.nz; Mark McGinley (NDHB); mkhalid@scdhb.health.nz; brad.aitcheson@southerndhb.govt.nz; leigh.cleland@tdhb.org.nz; lynsey.bartlett@tdh.org.nz; stephen.ng@xtra.co.nz; Kieran.McCann@wairarapa.dhb.org.nz; janine.bacon@wairarapa.dhb.org.nz; Peter Wood-Bodley (Whanganui DHB); janice.donaldson@siapo.health.nz; joce.carr@healthshare.co.nz; satbhama.narayan@tas.health.nz; jp.craig@auckland.ac.nz Cc: Simon_Duff@moh.govt.nz; Chris_McEwan@moh.govt.nz; Sue_Morgan@moh.govt.nz Subject: Are you observing any increase in referrals In Good Morning Everyone On behalf of the Collaborative Team, some DHBs have let us know they have noticed an increase in referrals through optometrist al presentations. If this is happening at your DHBS - we are inviting you to let us know through your anecdotal observations. ci Please send an email back to me if you have any thoughts on this. O ffi Thanks in advance. he Regards un de rt Chris Stewart Senior Advisor Electives and National Services DHB Performance, Support and Infrastructure Ministry of Health Mobile s 9(2)(a) se d http://www.health.govt.nz mailto:Chris_Stewart@moh.govt.nz R el ea **************************************************************************** Statement of confidentiality: This e-mail message and any accompanying attachments may contain information that is IN-CONFIDENCE and subject to legal privilege. If you are not the intended recipient, do not read, use, disseminate, distribute or copy this message or attachments. If you have received this message in error, please notify the sender immediately and delete this message. **************************************************************************** R el ea se d un de rt he O ffi ci al In fo rm at io n Ac t 19 82 This e-mail message has been scanned for Viruses and Content and cleared by the Ministry of Health's Content and Virus Filtering Gateway Document Profile Ac t 19 82 Elective Services Filing Status: Final Drawer: Service Improvement Date: 17/07/2018 Folder: Ophthalmology\Communications Title: Re: OCT and specsavers File Location: Unit: Ministry of Health Author: Stephen Ng Service Commissioning Document Type: Email Integrated Service Design\Electives Summary: and National Services\Electives Knowledge Content: Med Service Improvement Maintainer(s): Sue Morgan io n Dear Sue, rm at At the meeting with Specsavers' Garry Fitzgerald, we discussed their upcoming commissioning of Ocular Coherence Tomography (OCT) scanners in all their 50 or so NZ branches. In fo Their business model is to perform an OCT on all customers as they walk in the door. Our concern is that will inevitably lead to an increase of patients being referred to DHBs for unexpected findings or findings they cannot interpret. There was an analogous surge in referrals when Specsavers installed retinal cameras into their stores a few years ago. O ffi ci al This is not "screening' as Specsavers call it, but opportunistic testing. RANZCO has addressed this issue in its "Choosing Wisely" statement: "In the absence of relevant history, symptoms and signs, ‘routine’ automated visual fields and optical coherence tomography are not indicated" rt he However, since RANZCO cannot stop Specsaver's OCT commercial move, it recommends RANZCO members in DHBs should audit Specsaver referrals to determine whether referrals resulting from the Specsaver OCT rollout are appropriate or not. There is a view that OCTs may in fact detect disease that would not otherwise be found. de Sarah Welch, Dianne Sharp & I agreed that an audit will be undertaken. se d un In summary, RANZCO is not happy with the likely increased referral workload to DHBs, but is powerless to stop it. If RANZCO audits demonstrate that significant numbers of unnecessary referrals result from it, then RANZCO will respond as required. ea Regards R el Stephen On 13 July 2018 at 11:09 Sue_Morgan@moh.govt.nz wrote: Hi Stephen I hope Dunedin wasn't too cold for you. 19 82 Specsavers have asked for a meeting with the Minister. Is there anything from the RANZCO meeting with Specsavers that I should put in the briefing? io n Ac t Cheers Sue Sue Morgan Portfolio Manager, Service Improvement, Electives and National Services, Integrated Service Design Service Commissioning, rm at Ministry of Health, 133 Molesworth Street, Thorndon, PO Box 5013, Wellington 6140, NZ DDI: 04 816 2543, Mobile:s 9(2)(a) , http://www.moh.govt.nz mailto:Sue_Morgan@moh.govt.nz R el ea se d un de rt he O ffi ci al In fo ************************************************************************ **** Statement of confidentiality: This e-mail message and any accompanying attachments may contain information that is IN-CONFIDENCE and subject to legal privilege. If you are not the intended recipient, do not read, use, disseminate, distribute or copy this message or attachments. If you have received this message in error, please notify the sender immediately and delete this message. ************************************************************************ **** This e-mail message has been scanned for Viruses and Content and cleared by the Ministry of Health's Content and Virus Filtering Gateway Document Profile io n Ac t 19 82 Elective Services Filing Status: Final Drawer: Service Improvement Date: 20/12/2018 Folder: Ophthalmology\Communications Title: upswing in referrals File Location: Unit: Ministry of Health Author: Sue Morgan DHB Performance Support and Document Type: Email Infrastructure Summary: DHB Performance and Knowledge Content: Med Support\Electives and National Services\Electives Service Improvement Maintainer(s): Sue Morgan Hi Jess rm at Specsavers advised (in request to Minister prior to meeting) In fo In the first year alone, Specsavers expects to perform more than 485,000 OCT diagnostic scans  across New Zealand which have the potential to detect an additional 100 cases of eye diseases  each week, based on 2017 and 2018 findings in Specsavers’ Australian stores.   O ffi ci al ADHB report an anecdotal increase of about 100% in in referrals  between October 2017 and Ctober  2018, with a steep increase since May 2018 when OCT was beginnign roll out at Specsavers.  They are  doing further analysis to dtermeine where their referrlas are coming from and how much is attributable  to population change. R el ea se d un de rt he Sue Morgan Portfolio Manager, Service Improvement, Electives & National Services, DHB Performance and Support DHB Performance, Support and Infrastructure, Ministry of Health, P O Box 5013, Wellington 6145, NZ DDI: 04 816 2543, Mobile: s 9(2)(a)  http://www.moh.govt.nz mailto:sue_morgan@moh.govt.nz Security classification: In-Confidence Memorandum: Meeting with Specsavers Optometrists Report No: File Number: 20181477 98 2 Date: 18 July 2018 Contact for Telephone Discussion (if required) In s 9(2)(a) fo Manager, Electives & National Services, Service Commissioning Team Leader, Service Improvement, Electives & National Services, Service Commissioning Ac Contact Order 1st Contact 2nd Contact O ffi Simon Duff Telephone s 9(2)(a) al Jess Smaling Position ci Name n Minister Clark Deadline 30 July 2018 rm at io Action Sought Note t1 Action Sought he Actions for the Minister’s Office Staff un R el ea se d Note any feedback on the quality of the report de rt Return the signed report to Ministry of Health Page 1 of 3 Database number: 20181477 Security classification: In-Confidence Quill record number: H201804936 To: 19 82 Meeting with Specsavers Optometrists Hon Dr David Clark, Minister of Health Ac t Purpose This briefing provides you with information for a meeting requested by Specsavers Optometrists, on Monday 30 July 2018, 4.30pm to 5.00pm in your office. This meeting has been requested by Specsavers Optometrists to discuss their pending launch of Optical Coherence Tomography (OCT) technology into all Specsavers Optometrists practices 2. They also wish to discuss how Specsavers Optometrists can best work with the Government to help improve New Zealanders’ eye health. rm at io n 1. fo Background Specsavers Optometrists are a commercial company based in the United Kingdom. 4. They entered the New Zealand market in 2006 and work in a partnership framework comprising 52 optometry and dispensing practices. 5. Their New Zealand revenue in the 2017/18 year was approximately $37 million. 6. Specsavers Optometrists is introducing Optical Coherence Tomography (OCT) technology into all Specsavers Optometrists practices in a roll out that will be complete by the end of September 2018. 7. OCT is a non-invasive diagnostic imaging technology that enables clinicians to obtain detailed information about the structures of the eye, allowing for more accurate detection of potential eye diseases including glaucoma, macular degeneration and diabetic eye disease. 8. Images obtained from OCT can be used as part of a referral to district health board (DHB) ophthalmology services where appropriate. OCT may also be used as part of the ongoing monitoring of patients with chronic eye disease. 9. OCT scanning is available at many optometry practices in New Zealand. 10. Specsavers Optometrists propose to scan all patients as part of the pre-test screening routine, and expect this to detect an additional 100 cases of eye disease per week. 11. OCT scanning as proposed by Specsavers Optometrists is not ‘screening’ but opportunistic testing. 12. There is concern that this will lead to an increase in patients being referred to DHBs for unexpected findings, or for interpretation of findings of uncertain clinical significance. R el ea se d un de rt he O ffi ci al In 3. Contacts: Jess Smaling, Manager, Electives & National Services, Service Commissioning s 9(2)(a) Simon Duff, Team Leader, Service Improvement, Electives & National Services, Service Commissioning s 9(2)(a) Page 2 of 3 Database number: 20181477 Talking points 19 82 13. While OCT is a non-invasive test, procedures to ensure the appropriate use of clinical testing, informed consent about the possible risks and benefits, and the management of any findings are essential. Ac t 14. The Ministry has been working in partnership with the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) with a multidisciplinary service improvement expert advisory group. The group is now progressing the implementation of national guidelines for the two chronic eye conditions, the management of age-related macular degeneration, and glaucoma referral. io n 15. The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) have made a statement as part of the Choosing Wisely campaign. “In the absence of relevant history, symptoms and signs, ‘routine’ automated visual fields and optical coherence tomography are not indicated’. rm at 16. All parts of the eye health workforce need to be involved, including those working in both public and private practice, in providing the best eye health care for New Zealanders. fo 17. Officials are available to attend this meeting at your request. R el ea se d un de rt he O ffi ci al In END. Page 3 of 3