http://www.drfosterhealth.co.uk/ Find a specialist doctor - UK NHS and private practice. Hot site. You will see your doctor's various clinics at different NHS hospitals and catch him/her in private practice at different venues. You can seach on condition combos eg 'thyroid eye'. Maybe fast-track into private practice for same-week diagnosis while waiting for NHS 'first appointment within 18wk' target, or doctor-shop first to make best use of your GP NHS referral to the right consultant.
NHS is planning 'centres of excellence'. This means we chase the team expertise.
- Your local optometrist or GP (primary care) is unlikely to be this knowledgeable about who's available and may refer locally to general ophthalmology service, or to independent triage business servicing NHS, so check the local hospital website to find the right consultant, eg anterior segment, surface disease, inflammation, so you can ask to be referred to them rather than general.
- Local hospital ophthalmologist (secondary care) will treat as best they can with resources available, and not refer on unless it's uncertain diagnosis, unresponsive. Maybe look for 'second opinion' with specialist, private or NHS, if treatment's not working/don't seem to know what it is/what they're doing? GP is happier referring 'round' local ophth service if you have a diagnosis letter from specialist. May get access this way to NHS tertiary referral teaching hospital, anterior segment team.
- Regional teaching hospitals with eye clinics and research centres also serve their local community with normal access. No restriction on going out of county for treatment. Overloaded, high-volume, but working on efficiency, funded, current on treatment, full-on consultants, 24/7 emergency cover.
We know about NHS Choices http://www.nhs.uk/Pages/HomePage.aspx but what about a second opinion in the NHS?http://www.nhs.uk/chq/pages/910.aspx...categoryid=156
Most GPs are well out of their depth on commissioning in hospital specialisms - but at least they are opening up to the idea, and more creative NHS and private referrals, unless yours is a dinosaur. Chronic red eye is a GP diagnosis nightmare, could be so many scary things: 'Are you sure - this could be so many things, couldn't it?' is the question to get referred on.
Inform your choices even further by searching on your local 'NHS referral pathway eye' for referral criteria, eg here's ours http://www.oxfordradcliffe.nhs.uk/fo...guidelines.pdf (same-day referral for moderate-severe pain). Hmm, that explains a lot. Not always blepharitis though, is it - see further referral critieria including pain, inflammation unresponsive to antibacterials. See how they are being pressed to try to treat chronic eye conditions 'in the community', without expertise. A wise GP does not get the ophthalmoscope out, but refers on to eye doctors. According to clinical guidelines on eye steroids, no one must prescribe eg FML or dexamethosone without being certain it's not viral or fungal, regular monitoring of intraocular pressure. http://www.cks.nhs.uk/clinical_topic...specialty/eyes We had progress asking for monitoring by calling the chronic inflammation 'glaucoma' for which there are targets, protocols and budget. http://guidance.nice.org.uk/CG85 All optometrists are obliged by regulation to refer to hospital or referral service on finding any 'ocular pathology' or raised eye pressure, great shopping tool. http://www.aop.org.uk
Regional hospital eye emergency clinics Check criteria for access, includes pain, inflammation (eyedrop reaction, intraocular pressure out of hours, start records with patient ref number). Try to go in quiet times, only senior staff authorise follow-up. Less likely to get a referral out of local emergency eye clinic, just treatment. Watch out for unsupervised less experienced staff, doing their best, if consultant's not around; ask what they can see, what they're checking for, what they think - they are working on their doctor-patient skills - 'are you sure?...' for referral.
Access to diagnosis/treatment - the power of consultant's secretary, hospital optometrists, Patient Liaison, GP admin, to refer straight to the top, or have a quick word, should not be underestimated for existing patients with a case. Consultant's secretary can ask the consultant what they want to do and book appointments (even required to attempt triage over the 'phone, dear god...). If still getting nowhere, consider an email or letter to a specialist consultant asking for advice, describe case, suggest still undiagnosed/untreated. If obstructive/ignorant non-clinical staff, say 'shouldn't we ask someone medical?...' If obstructive clinical staff, say 'shouldn't we ask an ophthalmologist/the consultant to have a quick look?...' A diplomatic suggestion that the system has failed and you should be seeing Dr X sometimes meets with sympathy and may obtain a consultation, especially if in clinic that day.
Clinical need priority problems start with general ophthalmologist clinics when there is nothing to see in the slit-lamp but surface pain is chronically bad. Keep going until you find a dry eye ophthalmologist who's current. Trust your gut feelings on their available services/expertise. This is when you may need to pay a specialist from the regional hospital in private practice for diagnosis if you can't get NHS referral, due to priorities and targets. Keep a diary of impact on life to make the case for referral to regional anterior segment team in the NHS. Also ask for NHS pain management service. The goal is a regular ophthalmologist team who work with you to adjust treatment towards a 'spiral of improvement', available when needed.
Opticians - many faking knowledge on dry eye now to flog drops, especially unqualifed staff. But there's a lot of qualified optometrists better informed on dry eye than some hospital ophthalmologists.
Private specialist appointment costs are aligned to private health insurance standard rates, eg £120-180, unless it's inflated for Harley Street. Docs grouping in dedicated clinics is a sign of peer-group respect. Private practice is not just about freedom (professional indemnity premiums for ophth are huge) and cars, it's about access. The NHS practice is overloaded and restricted by 'clinical need' and hospital policy (consultants v hospital managers, ongoing) - they are giving us this opportunity, even if it's a one-off diagnosis or reassurance, if we need them. Money wasted if they're not current on what you've got. If anyone has managed to get eg BUPA to cover for chronic disease monitoring, please let me know...
Paediatric eye inflammation management for under-16s is excluded/overlooked in all of the above NHS local provision, triage guidelines, budget. Best treated by paediatric ophthalmologists in children's eye clinic in specialist tertiary referral hospital. We were refused NHS tertiary referral from primary and secondary sectors, misdiagnosed, no advice, serial discharge/re-presenting. Private paediatric surface disease ophthalmologist - cornea vascularising, punctate keratopathy - gave us access. Untreated child blepharokeratoconjunctivitis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1772603/ If anyone wants to talk about this, paediatric, welcome to PM me.
Be nice to them in the NHS, though, make the best of the opportunities, and show a bit of support. BMA opposes NHS Reform Bill until amendment: '4.Will continue to oppose any Bill which seeks to break down the NHS family and treat healthcare as a commodity to be bought and sold in a commercial market'. Respect, guys. http://www.bma.org.uk/healthcare_pol...mstatement.jsp