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• Re:The Primary Eyecare Acute Referral Scheme, PEARS was introduced in Wales in in 2003. We welcome the paper by Sheen et al since this presents an opportunity for the scheme to be appraised and costed.
  Nicholas JL Sheen
  Published on: 5 April 2010
• The Primary Eyecare Acute Referral Scheme, PEARS was introduced in Wales in in 2003. We welcome the paper by Sheen et al since this presents an opportunity for the scheme to be appraised and costed.
  Simon Longstaff
  Published on: 15 March 2010

• Published on: 5 April 2010

  Re:The Primary Eyecare Acute Referral Scheme, PEARS was introduced in Wales in in 2003. We welcome the paper by Sheen et al since this presents an opportunity for the scheme to be appraised and costed.

  • Nicholas JL Sheen, Optometrist
  • Other Contributors:
    • David Fone, Ceri J Phillips, John M Sparrow, Jonathan S Pointer, and John M Wild

  Authors response

  Dear Sir,

  One concept of the PEARS/ WEHE schemes was to increase equity of access to eye care services across Wales. Any successful scheme which achieves an increase in access will increase cost, at least in the short- term, but can prove to be more cost-effective since more expensive downstream-treatments are avoided as a result of earlier intervention and patient outcomes are likely...

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  Authors response

  Dear Sir,

  One concept of the PEARS/ WEHE schemes was to increase equity of access to eye care services across Wales. Any successful scheme which achieves an increase in access will increase cost, at least in the short- term, but can prove to be more cost-effective since more expensive downstream-treatments are avoided as a result of earlier intervention and patient outcomes are likely to be enhanced.

  Purchasers must judge whether improved access for patients justifies the small additional cost per case (c. £12-15) and improved access results in more patients being seen in secondary care. In the evaluation, 66% of patients were managed entirely by optometrists without referral to the Hospital Eye Service (HES): previously, these patients may have contributed to unnecessary referrals. Other benefits for patients include convenience, reduced travel time, reduced anxiety and fewer mis-diagnoses.

  The change in total cost of primary and secondary eye care following the introduction of these schemes was not quantified. This would have required a randomised protocol comparing costs between intervention and control groups and incorporating a before and after design to capture detailed patient-level data.

  Optometrists registered on the schemes at the time of the evaluation had completed seven distance learning modules, four case history scenarios and a clinical-skills assessment. We utilised the results of the evaluation to determine the nature of the re-accreditation training. Optometrists were required to complete six distance learning modules and pass OSCE assessments based on communication, clinical examination and referral. Tutorials were held for those optometrists, identified in the evaluation, who had made inappropriate patient-management decisions. The current cost of training for accreditation is approximately £200 per optometrist. The impact of this one-off cost is minimal given the number of patients seen under the scheme and was therefore not included in the model.

  We hope these comments have further clarified patient-centred benefits of the schemes.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 15 March 2010

  The Primary Eyecare Acute Referral Scheme, PEARS was introduced in Wales in in 2003. We welcome the paper by Sheen et al since this presents an opportunity for the scheme to be appraised and costed.

  • Simon Longstaff, Chairman

  Sir,

  The Primary Eyecare Acute Referral Scheme, PEARS was introduced in Wales in in 2003. We welcome the paper by Sheen et al since this presents an opportunity for the scheme to be appraised and costed.

  The authors are open about the weaknesses of their study, such as the poor response rate to letters sent to GPs. However, there are still considerable uncertainties about the accuracy of the costings....

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  Sir,

  The Primary Eyecare Acute Referral Scheme, PEARS was introduced in Wales in in 2003. We welcome the paper by Sheen et al since this presents an opportunity for the scheme to be appraised and costed.

  The authors are open about the weaknesses of their study, such as the poor response rate to letters sent to GPs. However, there are still considerable uncertainties about the accuracy of the costings. It is likely that the provision of this service will have generated an increase in the number of patients seen in ophthalmic primary care and a consequent increase in the number of referrals to the HES thereby increasing costs. No data is presented in this respect although this could have been sought from GP or hospital databases.

  The authors conclude that the net cost of the scheme is between 10GBP and 15GBP per patient. What is not made sufficiently clear is that this is ADDITIONAL cost to the purchaser. PCTs should be discouraged from implementing this service without first identifying extra funding. It should not be expected that this service can be paid for from savings made in the budgets of ophthalmic units.

  No mention is made of the training required before optometrists can embark upon this scheme. It would have been helpful for those considering such a scheme to have some idea of the nature of and the costs of such training.

  Yours faithfully,

  Simon Longstaff Chairman Ophthalmic Group Committee

  Conflict of Interest:

  I am the chairman of the Ophthalmic Group Committee

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  Conflict of Interest:
  None declared.

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