1

EQA …The Wigan Experience

Salim Natha - Consultant Clinical Lead

Paul Robey - Acting Programme – Ophthalmic Imaging

Manager

Wrightington, Wigan and Leigh NHS Foundation Trust

PROGRAMME START• Launch December 1999

• Size 4,000

• Single Site Co-Located within Ophthalmology

• Bespoke Software

• Clinician facilitated grading sessions

• Hybrid Technician Roles

Wrightington, Wigan and Leigh NHS Foundation Trust

NINE YEARS ON…… NOV 2008

• Programme Size 14,400

• Local Population approx 310,000

• Multiple Sites – Core service remains within Ophthalmology

• Bespoke Software

• Clinician and Technician grading sessions

• Hybrid Technician Roles

Wrightington, Wigan and Leigh NHS Foundation Trust

FAILINGS OF THE PROGRAMME 1999 - 2008

• No continuity of Clinical Leadership

• No continuity of General Management

• No Designated Programme Manager or Failsafe Officer

• No protected time for grading

• No High Level Programme Management Board

• Inadequate grading and admin premises

• Software and network issues

• Funding or Lack Of !!

Wrightington, Wigan and Leigh NHS Foundation Trust

EQA VISIT – 18TH NOVEMBER 2008SERIOUS UNTOWARD INCIDENT DECLARED !

• Serious under grading ( 4 / 21 with missed new vessels)

• Review of R1M1 / R2 screening to treatment timeline revealed new vessels were missed at both grading and Ophthalmology

• Peer reviewers disagreed with almost 50% of referable DR reviewed

Wrightington, Wigan and Leigh NHS Foundation Trust

OTHER CONCERNS• Timeline analysis showed 19 instances of grading

with referable DR downgraded to R0 at secondary or arbitration grading

• R0 timeline revealed high level of rejection by Ophthalmology of R1M0 grades

• Clear evidence of grading being carried out too quickly

• Software not fit for purpose

Wrightington, Wigan and Leigh NHS Foundation Trust

WHAT HAPPENED NEXT ?

• Programme paused

• Retrain of all grading staff

• Look back exercise

• Weekly SUI meetings at executive level

Wrightington, Wigan and Leigh NHS Foundation Trust

FUNDING• Originally funded for 240k pre peer review

• Following peer review an additional 260k was negotiated with the PCT resulting in 500k for 2009/10

• There was further capital investment of 100k from the PCT for new software and hardware

• We chose to remain under block contract for this financial year in order to ensure the programmes QA, failsafe processes and overall sustainability is robust before moving to tariff in 2010

Wrightington, Wigan and Leigh NHS Foundation Trust

WHERE ARE WE NOW ?

• Programme re-launches 1st June 2009

• Quarterly High Level Programme Management Board meetings

• Active Consultant Clinical Leadership

• Protected time for weekly MDT’s and CPD

• EQA on line grading test

• City & Guilds

• New software/ equipment and premises

• New protocols and processes

Wrightington, Wigan and Leigh NHS Foundation Trust

Wigan Screening Timeline DHC.xls

Wrightington, Wigan and Leigh NHS Foundation Trust

HAS IT ALL BEEN WORTH IT??• Retinal screening programmes have been set up to reduce the risk of

STDR. This can only be achieved by ensuring patient safety and maintaining quality of care

• The EQA process has been set up to help us achieve this and despite some bad experiences we must not forget the above goal

• The Wigan programme has made more progress in the last 9 months than we did in the previous 9 years.

• We now have a programme with a good spine, an active PMB, strong clinical leadership and a fully established, motivated and dedicated team

• Relating to the experiences of the Wigan programme my advice to any programme going through or about to go through an EQA visit would be to simply welcome it.

Wrightington, Wigan and Leigh NHS Foundation Trust

THANK YOU