Policy responses and statements
- Name of organisation:
- Scottish Uveitis National Managed Clinical Network
- Name of policy document:
- Draft Clinical Standards for Uveitis
- Deadline for response:
- 3 December 2010 (extended to 7 December 2010)
Background: Uveitis (inflammatory eye disease)
is a significant, but largely unrecognised cause of visual impairment
in the United Kingdom. In the Western world, current incidences of
uveitis vary between 38 and 200 per 100,000. These reports however,
do not differentiate sight-threatening uveitis from non-sight-threatening
uveitis.
The Uveitis National Managed Clinical Network was commissioned by
National Services Division, NHS National Services Scotland in 2008.
Its vision and aim, through collaboration and multidisciplinary working,
is that there will be a significant improvement in the outcome of people
with sight threatening uveitis and people will receive equitable access
to care across Scotland.
To enable this vision to be realised the Uveitis NMCN has produced
a set of consultation documents; Clinical Standards for Uveitis, Information
Leaflets for Patients, Uveitis NMCN Evaluation Tool and the Uveitis
Treatment Guidelines. These documents have been developed in partnership
with the Scottish Association for Paediatric and Adolescent Rheumatology,
the Royal National Institute for the Blind, the Uveitis Information
Group as well as representatives from each Health Board area in Scotland
to ensure a complete process is realised.
The Uveitis NMCN hopes the College will take the opportunity offered
by this consultation to provide feedback on the documents. We have
to make sure that services in this area meet people’s needs,
and that we learn from people’s experience of existing services
to make sure any gaps are plugged, as part of a process of continuous
improvement.
The Uveitis NMCN would like to see contributions from people who have
any form of uveitis, their families and carers, the voluntary sector
organisations which act as the advocates of people with uveitis, and
those who have a personal or professional interest in any of the issues
covered by the consultation document.
There is to be an open meeting to discuss the documents at Heriot-Watt
University in Edinburgh, on Wednesday, 15th December. We hope as many
of the Stakeholders as possible can attend this meeting. The meeting
will commence at 9 am and finish at 4 pm.
COMMENTS ON
Scottish Uveitis National Managed Clinical
Network
Draft Clinical Standards for Uveitis
The Royal College of Physicians of Edinburgh is pleased to respond
to the Scottish Uveitis National Managed Clinical Network on its Draft
Clinical Standards for Uveitis.
Strengths:
- These are a comprehensive series of documents aimed at patients/parents
and clinicians managing a relatively rare condition with potentially
serious effects on sight.
- The documents for parents/patients are important and well structured.
- MCN for uveitis in paediatrics is an excellent development.
The Draft Clinical Standards make appropriate emphasis on training,
education and Board responsibilities. The document on Board responsibilities
for managing and complying with optimal management is useful to focus
attention on uveitis and ensure an appropriate Board service.
There is need for a simple document for GPs, some medical sub-specialists
(gastro/respiratory/renal) and opticians to alert them to the possibility
of uveitis versus much commoner eye conditions and with a referral
pathway.
Concerns:
- Drug management pathway drug funding issues
Adults with uveitis requiring greater than 7.5mg a day of prednisolone
long-term in addition to, or are intolerant of systemic immunosuppression,
have access to biologics within 10 working days.
This timescale is felt to be ambitious.
- Who will fund the Uveitis nurse?
This nurse should also cover the transition service and continue to
support JIA patients into the young adult clinic rheumatology service
While there are increasing voices in the adult international rheumatology
community arguing that rheumatologists should transfer their skills
and knowledge of immunosuppressive therapy to inflammatory eye disease
and take primary control for prescribing in this condition, the majority
are reluctant due to the lack of ability to monitor response themselves
and the difficulty of keeping up-to-date with the latest treatment
recommendations in inflammatory eye disease.
The main concern in adult transition and adult services is funding
and the difficulty of monitoring/managing potentially non-arthritic/rheumatic
associated inflammatory eye disease.
There is considerable overlap in the long section on therapies with
existing documents on the use of these drugs in other inflammatory
conditions and the College does not feel that this section will be
used often – those without experience of the drugs will not wish
to be responsible for managing them, and experts will have more up
to date or experiential information to guide their use. Patients
requiring treatment beyond oral steroids should probably be managed
in conjunction with regional uveitis experts (electronic or visiting
clinics).
The production of parallel documents by the many Scottish Boards will
be onerous, and for small mainland and island Boards this will involve
a lot of work for a small number of patients. A national spine
which can locally be adopted would be welcomed.
Similarly, not all small Boards will be able to sustain specialist
nurses for uveitis and innovative ways of managing the small cohort
of patients in these Boards is necessary.
Clinicians appreciate a regional expert to discuss complex cases,
and the mechanism of formalising this ‘MCN’ needs to be
clear to all participants
The relationship between paediatric rheumatology and ophthalmology
is critical and agreed policies for clinical leadership and communication
are pivotal with attention to the problems of patients distant from
regional centres.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[6 December 2010]
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