Understanding people’s needs

Six per cent of Dorset’s population, which exceeds 700,000, lives with diabetes and that number is expected to double by 2040. We took over delivery of the county’s eye screening programme in April 2022 after being awarded the contract by NHS England.

Screening programmes must reach as many people as possible, yet this can be tricky in rural areas or in places with poor transport links. So, in the early weeks of our contract, as well as working hard to build up our team, we looked ahead to understand how we could encourage as many people as possible to attend their appointment, as missing this can result in sight threatening retinopathy.

As part of our research, we considered the number of clinics available, how accessible the buildings were and whether they were well-served by local buses. We used our OptoMize software’s Health Equity Audit tool to understand attendance rates in areas of deprivation. We also looked at the information available both to patients and healthcare professionals to see where improvements might be made.

Armed with all this data, we set out to deliver a first-class service and to match every resource we had to our patients’ needs and preferences.

Innovating with our partners

Parts of rural Dorset are very poorly serviced with insufficient transport links. One area we identified had several people overdue on their screening appointments. To resolve this, we arranged two Saturday clinics at the closest GP practice and enjoyed a very high attendance rate close to 100%. In addition to this, the Diabetes Specialist GP in the practice was able to see the same patients to carry out all their other diabetes tests. This was a huge success and resulted in our first collaborative, ‘one-stop’ clinic. Our patient feedback survey showed 100% satisfaction as they benefited from having all the tests in one appointment. This has now become a regular clinic for this remote area.

The results were excellent. Of the 50 patients invited to the first clinic, 46 attended. These included younger people who would not have normally been able to come to the clinic due to work, as well as elderly people who are often restricted due to poor transport links. The 4 patients that didn’t attend, cancelled and rebooked. There were no DNAs.

For a different area of high deprivation, which often means lower rate of car ownership, the closest clinic was three buses away and could take an hour and a half each way to reach the screening venue. We trialled a new clinic in the local community hospital to bring our service closer to the people that need it.  The results of this clinic were fantastic, Out of the 25 patients invited, only 2 didn’t attend. This resulted in a 92% attendance rate.

Improving attendance requires good education processes too. For example explaining the importance of eye screening to patients and ensuring that healthcare professionals understand the service we’re delivering. In addition to reaching out to GP practices and patient support groups across the county, we’ve developed close links with the Diabetic Endocrine Centre at Bournemouth Hospital, delivering talks at MDTs and Newly Diagnosed, Patient Education sessions. We’re now an integral part of their ongoing education programme and are building a great communication channel and partnership together.

Maximising uptake

As well as reaching all the people within the area, regular communication and the monitoring of participants response and attendance is an integral part of increasing uptake.

Calls are made to remind participants to attend their appointments which are then followed up with reminder SMSs. These communications, and whether those who have been contacted have responded or not, is logged onto the database so that the team are able to closely monitor who is aware of their appointments and increase the numbers that will attend.

We’ve also worked on increasing our capacity in clinics so that we could screen more participants over the year. We did this by calculating the clinic capacity based on how many more participants we could add week on week, whilst prioritising safety.

We are delighted with the results. Attendance rates have been improving month on month, so by the end of the year, the number of those attending screening appointments has exceeded what was predicted. At the start of the programme, in April 2022, we were projected to screen 36,656 people. Our actual numbers at the end of March 2023 have been over 1,000 more. Our efforts to increase uptake have also led to 87% of the slots being filled that have been available.

Focusing on continual improvement

But we’re not stopping there. We’re inviting clinicians to our Multi-Disciplinary Team meetings to educate our team in other areas of Diabetes care and so they will encourage participants to attend screening clinics.

We’ve moved our HQ to a building with a lower carbon footprint and we’re making sure our dedicated team have what they need to provide a great service right across Dorset. Our new offices are located more centrally in Bournemouth, within a venue we have been using for many years as a screening clinic.  We screen here every day and we have regular Slit Lamp clinics running every week. This has become our first dedicated screening hub in Dorset.