Service Improvement and Innovative Practice Award

The initial orthoptic led myasthenia gravis service was set up by Abbie Ewart in October 2022 where she endeavoured to streamline the current ocular myasthenia gravis (MG) pathway for patients at Moorfields Eye Hospital. She identified the scope for extended role orthoptics within this service and created a novel orthoptic-led service which has continued to provide safe, effective care single handed for over 300 patients in the past 2.5 years alone, despite breaking her shoulder and being absent for 6 months. She has developed the innovative clinic over the years to include a wider cohort of patients reviewing those with suspected diagnosis going further than just managing these patients but now diagnosing those without the input from medical staff. Over the years she has managed to identify progression to generalised myasthenia in 3 patients preventing possible myasthenic crisis and allowing them to access the appropriate treatment. 80% of patients with steroid-induced side effects were effectively managed achieving a balance between myasthenia symptoms and effective general health management.

There are no previous local or national guidelines for an Orthoptic led service in MG patients, so Abbie created her own based off the consultant led clinics, in collaboration with the neuro-ophthalmology teams to identify potential risks and how to escalate them including on-the-job training for assessments of generalised myasthenia progression/ testing Bulbar assessments. She took what she had learnt in theory from neuro-ophthalmology master’s modules and the real-life implications are shown in the patients she see’s weekly. This is evident in the patient feedback the clinic receives with patient’s saying “amazing, brilliant, so caring and careful”, “very professional and thorough!” and “the appointment was much quicker, but I never felt rushed”.

Abbie used her experience working in the consultant led clinics, shadowing consultants, having work-place based learning and assessments and her formal MSc education to develop the innovative clinic to where it is today.

She continuously adapts the clinic to go further than the extra mile from her patient feedback and consolidating what works for them. She has shared her progress at BIPOSA in 2023 and spoken at conferences across Europe sharing her knowledge and joy for Orthoptics + extended role. She has plans to publish her innovative service so other organisations can implement their own orthoptic led MG clinics. The research has suggested that the estimates for the number of people diagnosed with a MG is 33.7 per 100,000 of the population in 2019. Based on a current UK population of around 67,817,100 (Worldometers), this would suggest there are currently 22,855 people living with MG in the UK today, up to 80% of which have ocular symptoms!

Abbie’s experience shouldn’t be unique as orthoptists are in a great position to follow in her footsteps and transfer this service to other organisations.

Abbie has used her experience developing this service to contribute to understanding the physiology of myasthenia gravis sharing her research at UKNOS and soon to be published.

Abbie is the epitome of innovative practise!

Anonymous

I am nominating Abbie Ewart for the creation of a novel orthoptic-led Myasthenia Gravis (MG) clinic. This initiative was developed to enhance care and support for patients living with MG, a chronic autoimmune neuromuscular disorder, addressing a critical gap in patient care where individuals often experience long wait times, fragmented care, and inadequate monitoring of ocular symptoms.

MG often presents with symptoms such as ptosis, diplopia, and general muscle weakness, which frequently lead to misdiagnosis or delayed treatment. Recognising this issue, Abbie Ewart, as an orthoptist, identified that many patients with MG were not receiving timely or appropriate care for their ocular symptoms. This resulted in avoidable distress and a decline in vision-related quality of life. The MG clinic was developed specifically to address these ocular symptoms, facilitating early detection and treatment to improve the overall quality of life for patients.

The clinic is unique in its approach, being entirely led by orthoptists with specialist training in neurology. It offers a comprehensive evaluation and treatment plan tailored to the specific needs of MG patients. This service bridges a gap between neurology and ophthalmology, providing patients with an integrated approach to managing their ocular symptoms.

To implement the clinic, Abbie conducted a thorough review of existing services, identifying key areas for improvement. Collaboration with neurologists, ophthalmologists, and fellow orthoptists ensured the development of a multi-disciplinary framework. Additionally, Abbie enhanced their clinical knowledge through further training, focusing on the latest research into MG and its ocular and generalised manifestations.

Operating with a patient-centred model, the clinic includes a comprehensive assessment of ocular symptoms and their impact on daily life. Routine diagnostic examinations such as orbicularis oculi, orbicularis oris, neck flexion and extension, shoulder abduction, hip flexion, and fatiguability of shoulder abduction are conducted alongside assessments of ocular motility and alignment. Regular follow-ups were introduced to monitor disease progression and adjust treatment plans accordingly. This proactive, orthoptic-led approach has allowed for early intervention, addressing the condition before complications arise and providing a more efficient process for managing MG.

The outcomes of the clinic have been overwhelmingly positive, with patients reporting a reduction in ocular symptoms and a better understanding of their condition. The service has also led to reduced waiting times for treatment, offering significant benefits to patients who face the uncertainty of a potentially progressive condition like MG.

The sustainability of the clinic has been ensured through its integration into the existing healthcare system, with a model that is adaptable and requires minimal resource allocation. By utilising the skills of trained orthoptists, the clinic has become a cost-effective and essential part of the care pathway for MG patients.

This service model has great potential for transferability across organisations. With the increasing prevalence of autoimmune conditions, the principles of this clinic could be applied to other neuromuscular diseases and even replicated in other specialties that involve extended-role orthoptists. The model holds the potential to be implemented nationally and internationally.

In conclusion, Abbie’s innovative orthoptic-led MG clinic has successfully improved care for MG patients by offering focused, efficient, and compassionate management of ocular symptoms. This initiative demonstrates how innovation within the orthoptic profession can transform patient outcomes and has the potential to benefit healthcare services on a much broader scale and she deserves to be recognised for it.

The Upskilling Project was an innovative workforce development initiative designed to address service backlogs in the Community Eye Service (CES) by upskilling two Band 3 Orthoptic Support Workers (OSWs) to Band 4 roles. This allowed OSWs to lead Child Vision Clinics (CVCs) and support Non-Urgent Vision Clinics (NUVCs), improving patient flow and reducing waiting times.

Developed in response to post-pandemic referral surges, the project streamlined service delivery and created a transferable competency framework that enhanced career progression, job satisfaction, and staff retention.

Project Implementation

The project followed a structured approach:

• Training and Competency Development – A training workbook and competency framework were developed to guide OSWs in leading clinics.
• Clinic Audits and Evaluation – Data from the CES tracked patient waiting times, clinic efficiency, and outcomes.
• Collaboration and Knowledge Sharing – The project aligned with BIOS support workforce initiatives and regional AHP leadership strategies.

Key steps included:

• Recruiting and uplifting two OSWs to Band 4 roles for a 12-month secondment.
• Developing a structured training programme, enabling OSWs to take patient history, assess vision, perform PlusOptix and instil eye drops.
• Implementing audit-driven service improvements, refining workflows for greater efficiency.
• Engaging with trust leadership, BIOS, and NHSE Orthoptic WAG to share findings and promote scalability.

Outcomes and Benefits to Service Users

The impact of the project was substantial, delivering improvements in both patient care and workforce efficiency:

• Reduced Waiting Times: CVC patient wait times decreased from over 2 months to 1 month on average.
• Increased Service Capacity: NUVC clinics doubled patient capacity, allowing 16 patients per day instead of 6–8.
• Enhanced Patient Experience: The shift to OSW-led clinics ensured faster treatment initiation, reducing anxiety for children and families.
• Workforce Development: OSWs gained career progression opportunities, leading to higher job satisfaction and retention.
• Financial Savings: The use of Band 4 OSWs instead of Band 6 Orthoptists resulted in estimated annual cost savings of £13,000.

The project engaged service users by focusing on efficiency, accessibility, and continuity of care. By ensuring prompt referrals and streamlined care, the project improved outcomes for children, particularly those at risk of amblyopia.

Sustainability, Transferability, and Scalability

This model has demonstrated long-term sustainability by embedding competency frameworks within the workforce structure. It has already gained recognition through:

• Winning the AHP Project of the Year award from BLMK ICB.
• Involvement in BIOS national workforce development discussions.
• Creating regional competencies for such clinics.

To expand its impact, the next steps include:

1. Integration into Special Schools: OSW-led vision assessments in special education settings, starting with mainstream schools and the “unable to test” cohort.
2. Embedding Career Progression – Further development of apprenticeships and professional pathways.
3. National Adoption – Collaboration with BIOS to align with NHS workforce strategies.

The Upskilling Project is a scalable, cost-effective model that has set a new benchmark for service improvement in Orthoptics. It demonstrates how targeted workforce development can enhance patient care, improve efficiency, and support professional growth, aligning with national Allied Health workforce priorities.

Ava is an Orthoptist based in the West Midlands, and I have had the pleasure of working with her for the past 2 years. During this time, Ava has shown an extraordinary work ethic and has been imperative to the smooth running of the biometry service. She has presented collected data regarding a variety of surgeries, in particular cataract procedures, at our monthly ophthalmology meetings. Moreover, she has driven the use of the Barrett Suite equation as part of IOL calculations with the backing of a corneal consultant in order to improve better cataract surgery outcomes.

She has been a huge inspiration to me and she has been supporting this service in such a selfless and driven manner. She will certainly be an individual to watch as her career continues to flourish.

As an orthoptic profession we already know the value of extended roles for Orthoptists, but this is often extremely difficult to achieve in a paediatric hospital.

In 2022 we began to train two Orthoptists; Giles Pullan and Eve Lynch as Orthoptic First Assistants in Theatre. Giles and Eve have been trained “in house” by our Consultant Ophthalmologists and have co written competencies and guidelines. All training has been underpinned by BIOS professional practice guidelines.

Giles and Eve have both excelled at this role; Consultants have reported that their clinical skills and knowledge in theatre are equivalent to having another doctor in theatre. Having Orthoptists in theatre has improved patient safety as Giles and Eve not only have knowledge of the anatomy of the eye but also understand the effect that surgery will have on the patient’s actual condition. Giles and Eve both feel they act as the surgeons “second pair of eyes and hands”.

Giles and Eve have regular theatre sessions, each session has approximately 3 cases. They not only assist in first strabismus surgery but also assist in complicated re-do strabismus surgeries and cataract extractions in young babies.

Giles and Eve have now extended their roles to provide pre and post op Orthoptic squint clinics. They run pre-op clinics where they assess patients, discuss surgical management plans and consent patients for strabismus surgery. They can then assist theatre and will assess the patient a few weeks later, post operatively. Giles and Eve have developed slit lamp skills and have incorporated this into Post-op assessment.

This service has not only improved patient safety, but it has also reduced waiting times as theatres had previously been cancelled when doctors were not available. Giles and Eve have improved patient satisfaction; parents and patients report they feel safe knowing that Giles and Eve are part of the whole management plan.

Giles and Eve both report this role has improved their job satisfaction. Eve and Giles are working to the top of their licence.

They have been an inspiration to other Orthoptists who are also now keen to train in this role.

Giles presented this new role at British Isles Paediatric Ophthalmology & Strabismus Association (BIPOSA) in 2023 and won the best prize for a non-medic presentation.
I am sure this will have inspired other Orthoptists.

As a paediatric department, we are proud of what Giles and Eve have achieved.

A yellow belt project was undertaken by Iulia titled: Providing timely laser treatment for patients with glaucoma

Proposal:

To improve the quality of care in glaucoma management by potentially
increasing the number of laser clinics by training a non-medical Health Professional (Orthoptist) to perform laser procedures along Doctors.

Iulia trained with a glaucoma Consultant to become proficient in SLT laser and was signed off as competent.

Outcome:

• Iulia was a safe practitioner – less adverse events than a medic
• Clinical capacity –increase to 4 sessions/week vs current 2.5
• SLT pt seen per week increased from 4.5 to 10
• Reduce the waiting time for laser from 7.2 months to ~ 3 months
• Reduce the SLT WL from 113 patient to <80

I would like to nominate Neda for this prestigious award in recognition of her outstanding contributions to service innovation, clinical education, and transformative improvements in ophthalmic care. As a trainee Advanced Clinical Practitioner Orthoptist, Neda has demonstrated an exceptional commitment to professional development and service enhancement that has significantly benefited both patients and colleagues.

Neda has consistently sought to expand her clinical knowledge and skills, undertaking advanced training in areas covered by the senior medical team. Her proactive approach to learning has enabled her to establish and manage clinical services, including an Orthoptist-led glaucoma clinic for the first time at South Tees NHS Trust, which she has set up independently a few years ago. Her ability to overcome multiple hurdles and obstacles from various sides have been overcome by her strong resilience and ability to power through the most challenging times even when no one was on her side. By qualifying in an advanced roles, Neda has reduced patient waiting times for critical assessments and increased outpatient capacity, ensuring timely and appropriate treatment plans can be implemented.

Neda’s initiatives have directly addressed service pressures and improved efficiency. Recognising the growing demand for ophthalmology services, she developed a shared-care glaucoma monitoring protocol that has optimised consultant time, allowing senior specialists to focus on complex cases while ensuring stable patients receive high-quality, streamlined care. She has built on this and now shares the most complex cases with the Consultant. Additionally, her collaboration with community optometrists to improve referrals into the hospital eye service through education and mentorship, we have been able to reduce the number of patients referred into the hospital through Neda’s lectures she delivers in her own time to the LOC.

Neda’s dedication to education has had a far-reaching impact on service improvement. She has designed and delivered annual training programmes for junior doctors preparing for the FRCOphth examinations, significantly improving their clinical knowledge and exam success rates. Her teaching extends beyond medical staff—she has mentored orthoptic students and allied health professionals, equipping them with advanced skills that enhance their knowledge.
Neda’s expertise has been recognised at a national level, where she has delivered lectures and workshops on innovative orthoptic practice and service optimisation. Her presentations on topics such as unique medical retina cases in an ACP clinic have inspired others to pursue further education and extended roles.

Beyond her individual achievements, Neda fosters a culture of innovation and excellence within her team. She encourages colleagues to pursue professional development and actively seeks feedback to refine service delivery. Her ability to identify gaps in care and implement practical solutions has made her an invaluable asset to the department.

Neda’s work exemplifies the requirements of an award for service improvement and innovation combining advanced clinical skills with a passion for service development and improvement. Her initiatives have not only enhanced patient outcomes but also strengthened the capacity and sustainability of ophthalmic services. By recognising Neda’s achievements, we celebrate a professional whose dedication to innovation and education has set a benchmark for excellence in orthoptic and ophthalmology practice.

I believe she is most deserving of this award.
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I am delighted to nominate Neda for the Award for Service Improvement and Innovation in recognition of her exceptional contributions as an Advanced Clinical Practitioner (ACP) Orthoptist. As her Educational Supervisor, I have witnessed Neda’s remarkable growth into a highly skilled, knowledgeable, and innovative clinician who has expanded her expertise far beyond traditional orthoptic practice into wider ophthalmology. Her dedication to research, education, and leadership has not only advanced her own practice but has also transformed service delivery, workforce development, and patient care at both local and national levels.

Neda has consistently sought to push the boundaries of orthoptic practice, developing advanced competencies in areas such as biometry, cataract surgery pathways, and general ophthalmology. Her deep understanding of these specialist fields has allowed her to work at the pinnacle of an ACP role, bridging gaps between orthoptics and ophthalmology. Notably, her expertise in biometry has been recognised nationally—she was awarded Best Presentation at the UKISCRS Conference for her work, a testament to her ability to translate complex clinical concepts into impactful knowledge-sharing by creating a methodical approach to interpreting biometry.

Recognising the capacity challenges within ophthalmology, Neda has championed education as a key driver for workforce upskilling. She has designed and implemented training programmes that empower orthoptists to take on extended roles, improving service efficiency and reducing bottlenecks in patient pathways. Her initiatives have directly addressed staffing pressures while maintaining high clinical standards.

One of her most ground breaking contributions is the development of a novel cataract surgery training model, informed by pedagogical principles from her ACP Master’s Education module. This innovative approach has been so effective that it is now under consideration for national adaptation, potentially reshaping surgical training for junior doctors across the UK. Her ability to merge education theory with clinical innovation exemplifies her forward-thinking leadership.
Neda is not only an outstanding clinician but also a passionate educator and mentor. She has delivered lectures and workshops at national and international conferences, sharing her expertise to elevate the profession. Within her department, she actively supports both orthoptic colleagues and resident doctors, fostering a culture of continuous learning. Her commitment to teaching extends beyond formal training—she leads by example, encouraging others to pursue advanced roles and research opportunities.

Neda’s achievements reflect the very best of what an ACP should be—clinically excellent, research-active, educationally driven, and innovative in service improvement. Her work has had a tangible impact on patient care, workforce resilience, and professional development. She is a role model for orthoptists and allied health professionals aspiring to advanced practice. As a respected colleague in her field, she drives change not just through expertise, but through her unwavering commitment to improving patient outcomes and shaping the future of eye care. Neda’s work exemplifies how advanced clinical practitioners can transform services through knowledge-sharing, technological adoption, and compassionate leadership—qualities that make her truly deserving of this recognition.”

I wholeheartedly endorse Neda for this prestigious award. Her contributions have set a new standard for orthoptic and ACP practice, and I am confident she will continue to inspire and lead in the years to come.
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I would like to nominate Neda for this prestigious award in recognition of her outstanding contributions to service improvement, innovation, and professional excellence within ophthalmology at South Tees NHS Foundation Trust. Neda has demonstrated exceptional initiative, leadership, and dedication in expanding the scope of orthoptic practice, enhancing patient care, and inspiring her colleagues.

Neda has been a leader in developing extended roles for orthoptists within our Trust which she has established successfully through demonstrating the positive impact that investment in Orthoptists training and education can bring. Recognising the growing demand for ophthalmology services, she proactively designed and implemented an advanced clinical practitioner (ACP) role, integrating orthoptic expertise with broader ophthalmological care. This initiative has significantly improved service efficiency, reduced waiting times, and enhanced patient outcomes as well as improved staff retention. Her work has set a benchmark for orthoptic practice, proving the value of extended roles in meeting the challenges faced in ophthalmology.

Understanding the need for multidisciplinary skills, Neda took the initiative to pursue additional training in general ophthalmology clinics. She sought opportunities to work alongside ophthalmologists, gaining proficiency in diagnosing and managing a wider range of ocular conditions. This self-driven upskilling has allowed her to provide more comprehensive care, bridging gaps in service provision and supporting overstretched medical colleagues. Her proactive approach exemplifies a commitment to lifelong learning and patient-centred innovation.

Neda’s dedication to professional growth is further evidenced by her pursuit of advanced educational qualifications in ophthalmology. She has undertaken rigorous academic training to deepen her clinical expertise and broaden her ability to manage a wide range of ophthalmic conditions. This investment in her knowledge base has not only elevated her practice but also enriched the skill set of an Orthoptist, fostering a culture of excellence and continuous improvement which serves as a positive role model for the orthoptic team.

Neda’s leadership extends beyond her clinical work—she is a mentor and inspiration to her peers and her team. By demonstrating the potential of orthoptists in advanced roles, she has motivated others to pursue professional development and embrace innovation. Her willingness to share knowledge, provide guidance, and advocate for the profession has strengthened team morale and encouraged a forward-thinking mindset among colleagues and management.
Throughout her career, Neda has embodied the highest standards of professionalism. She approaches every patient interaction with empathy, expertise, and integrity, earning the trust of both patients and colleagues. Her ability to navigate complex clinical situations with composure and her unwavering commitment to service improvement make her a deserving candidate for this award.

Neda’s contributions have transformed orthoptic services at South Tees, delivering tangible benefits to patients and the healthcare system. Her vision, initiative, and leadership make her an exceptional nominee for this award.

Paediatric Eye Emergency Team (Rahilah Bukhari, Alan Lok, Silvy John, Sam Tomkins, Amber Preston, Jayna Mistry, Charlotte Calcott, Imran Khan) at University Hospitals Coventry & Warwickshire

Understanding the problem; why the initiative was needed

• Walk- in service of non -prioritised conditions without direct pathways for children
• Adults and children were booked onto the same code
• 88% children assessed by 3+ professionals some without paediatric ophthalmology experience or a lack of interest in children (1)
• 53% of children spent 2 hours + on a single acute eye visit -parents dissatisfied with long waiting times
• 10% of children did not meet <4hr acute waiting target
• 85% of children had no definitive diagnosis resulting in multiple out-patient visits
• Increasing demand on eye casualty and a severe shortage of paediatric Ophthalmologists (2)

References:

1. Eye 33 published 2019.
2. RCOpth & British Emergency eye care – developing emergency eye care commissioning guidance 2020

AIM

To establish and lead a safe, timely, paperless, direct acute eye pathway for children to be assessed & managed appropriately

OBJECTIVES

• Establish a booked standalone direct acute pathway for children with access to child focused workforce
• Achieve a definitive diagnosis with all investigations completed at first visit allowing identification of true ‘acute’ requiring escalation and directing non acute into appropriate pathways
• Reduce waiting time and footfall for child and improve patient/parent satisfaction
• Improve wider departmental integration by challenging existing departmental boundaries
• Up skilling existing workforce whilst utilising existing core skills to deliver service
• Cost effective service- repurpose existing equipment/ environment

METHOD AND APPROACH TO IMPLEMENTATION

• Patient time mapping and satisfaction survey identified inefficiencies and dissatisfaction
• Partnership working with relevant medical colleagues, orthoptists; administrators ; management in developing service process map
• Brainstorming sessions and discussion at regular intervals with all stakeholders
• Streamlining processes supported integration & helped reduce duplication
• Specific ‘phased’ training sessions for workforce, development of training package/peer reflection and 1:1 to supplement learning
• Scope of practice and competencies maintaining governance

RESULTS AND EVALUATION

• Moved to a quality driven, booked paperless service with timely access for Orthoptic-led examination, diagnostics and clinical decision making supported by the senior casualty doctor.
• 100% safely assessed within 30 minutes of arrival. Immediate medical care delivered to reduce the risk of sight threatening conditions- in line with acute waiting target
• 96% see a maximum of 2 professionals during acute visit
• 97% deflected away from main eye casualty delivered by the right staff with appropriate skills in the right place
• 56% discharged at first visit.
• 100% patients/carers rated service as good /very good
• Paediatric trained workforce motivated & enriched & continually audited
• Improved collegiate working with wider medical & administrative colleagues

LESSONS LEARNED

• Buy in from all stakeholders essential – everyone understands the goal
• Communication is key and that it is continuous
• Dealing with individual working relationships – different methods of approach
• Accept and tailor learning package to suit different needs and experience level
• Overcoming negativity from wider team –by providing supporting evidence of improvements achieved
• This service model demonstrates strong potential as a scaleable framework for broader implementation in other Eye Casualty departments.

Paediatric Ophthalmology Diagnostic Team (Claire Critchley, Bridie Bukorovic and Rida Khalid) at Lancashire Teaching Hospitals

I am nominating our Paediatric Ophthalmology Diagnostic Team in recognition of their exceptional creativity and innovation through the development and implementation of a Paediatric Diagnostic Clinic (PDVC) led by Orthoptists. This initiative, coupled with a comprehensive revalidation of the waiting list, has significantly enhanced patient care and service delivery within our specialty. It has increased clinic capacity, reduced consultant workload, heightened overall patient satisfaction, and notably reduced waiting times for paediatric ophthalmology appointments.

The impetus behind this innovation arose from the critical need to address prolonged waiting times for consultant appointments in paediatric ophthalmology. Children previously faced waiting periods of 12-18 months, significantly impacting timely diagnoses and treatments. Recognising the profound effect on patient care, the team endeavoured to create a more efficient system to expedite diagnostics, aligning with our commitment to patient-centric care.

The Paediatric Diagnostic Clinic is an original initiative that redefines traditional paediatric ophthalmology care. Key elements include:

• Orthoptist-Led Clinics: Orthoptists now lead the diagnostic process, performing comprehensive assessments that encompass OCT and Optos imaging and visual fields, supported by an internally developed proforma. This innovative approach extends job roles, empowering team members to diversify within the broader field of ophthalmology. The team optimises workforce capabilities and promotes collaborative efforts. This strategy underscores the team’s trust in orthoptists’ expertise, promoting cost-effective care delivery while maintaining high standards.
• Triage System: Patient triage by team clinicians ensures inclusion in the streamlined diagnostic process, emphasising resource optimisation and commitment to efficient service delivery without compromising patient outcomes.
• Remote Consultant Review: Following assessments, notes undergo remote review by paediatric consultants within one week, who determine appropriate follow-up, whether a face-to-face consultation is necessary or if management can be handled remotely by the orthoptist via the PDVC clinic. This integrated approach leverages technology to enhance patient experience and underscores our dedication to innovation.
• Revalidation and Redistribution: Implementation of the diagnostic clinic included meticulous revalidation of all patients on the PTL waiting list, ensuring appropriate appointment triaging. This ensures only necessary consultant appointments are scheduled, redirecting all others to PDVC or orthoptic clinic, promoting equitable and efficient healthcare delivery.
• Team Education: Comprehensive training for the orthoptic team equips them to proficiently conduct imaging and tests across various conditions. This investment in continuous learning encourages professional growth and ensures the highest standards of patient care. Knowledge dissemination among the orthoptic team empowers them to advocate for the benefits of diagnostic clinics, thereby maximising their utilisation and promoting patient/parent understanding.
• Expansion Across Sites: Initially piloted at Royal Preston Hospital with a 50% reduction in face-to-face consultant appointments, the clinic now operates at both Chorley and Preston Hospital sites. This expansion enhances accessibility for patients from diverse areas and those referred from neighbouring hospitals, addressing current gaps in ophthalmology consultant availability.

Evidence of the Impact/Result of This Change on Service Provision, Patients, or Colleagues:

• Reduced Waiting Times: Significant reductions from 12-18 months to 1-2 weeks for appointments have ensured timely diagnoses and treatments, reinforcing our commitment to patient-centred care and operational efficiency.
• Increased Efficiency: Streamlined processes and empowered orthoptists have optimised resource utilisation, reduced consultant burden while maintaining high standards of care, reflecting our dedication to operational excellence.
• Enhanced Patient Satisfaction: Positive feedback from parents underscores appreciation for quicker appointments and streamlined visits, enhancing overall patient experience compared to traditional consultations.
• Emergency Slot Reservation: Reserved slots for emergencies prioritise urgent cases, demonstrating responsiveness to patient needs and reinforcing our commitment to patient safety.
• Consultant Efficiency: Virtual reviews by consultants expedite patient management, accommodating urgent cases without disrupting scheduled clinics, displaying adaptive and efficient healthcare practices.
• Revalidation Data: Out of 66 new referrals, only 6 patients (9%) required a doctor’s face-to-face appointment, with more than half (>50%) suitable for the PDVC and 15 for orthoptic-only review, significantly reducing wait times and enhancing patient-centred care.
• Reduction of Face-to-Face Appointments: A 50% reduction in initial face-to-face consultations optimises consultant time for cases requiring specialised expertise, ensuring effective healthcare delivery and patient outcomes.

This model serves as an exemplary illustration of utilising workforce capabilities, promoting collaborative working environments, and developing individual team strengths. Its success demonstrates a forward-thinking approach to service delivery and a commitment to embracing change effectively and safely within our organisation. Their initiative has not only transformed service delivery within the department but also serves as a benchmark for enhancing efficiency and patient satisfaction across other healthcare specialities.

Project Summary and Significance

Rebecca’s (Becky’s) project aims to enhance stroke patient care by introducing systematic visual screening during inpatient stays. By identifying visual deficits early, the initiative ensures timely intervention, improving rehabilitation outcomes and overall patient experience. This innovative approach seeks to address a longstanding issue of delayed diagnosis, ensuring visual impairments are considered in stroke recovery planning.

Implementation and Methods

Recognising the need for structured visual assessments for stroke patients, Becky successfully secured funding for a part-time Band 7 post dedicated to conducting ward-based screenings twice a week. This addition to the stroke team allows for proactive identification of visual issues that may affect recovery, and evidence indicates that early visual screening can enhance rehabilitation outcomes, minimising delays in treatment.
Screening sessions were carefully integrated into existing stroke care pathways to ensure efficiency and effectiveness. Becky has also collaborated closely with multidisciplinary teams (MDTs), fostering cross-specialty engagement to enhance patient care.

Outcomes and Benefits to Service Users

While the project is ongoing, data collection through patient questionnaires and audits is actively assessing its effectiveness. Early results indicate that inpatient visual screening may contribute to faster diagnosis, enabling prompt intervention and potentially reducing the need for outpatient follow-up appointments.

Patient engagement has been central to the initiative, ensuring that the screening process aligns with their rehabilitation needs. As the project progresses, Becky continues to assess patient feedback to refine and optimise the service.

Additionally, the project has strengthened the visibility of the Orthoptic profession within hospital settings, demonstrating its integral role in stroke rehabilitation and promoting further MDT collaboration.

Sustainability, Transferability, and Scalability

If results confirm the project’s effectiveness in accelerating treatment and improving rehabilitation outcomes, Becky plans to present a business case for permanent funding. By demonstrating the efficiency of inpatient screening in reducing outpatient demand, the initiative has strong potential for long-term integration within stroke care services.

The model is highly transferable across hospitals and stroke units, offering a scalable framework for embedding structured visual assessments into routine inpatient care. With further validation, Becky’s initiative could inspire widespread adoption within NHS stroke services, reinforcing the importance of orthoptic-led early intervention in multidisciplinary rehabilitation strategies and ensuring these interventions are consistently available to stroke patients nationwide.

Conclusion

Becky’s innovative approach to stroke patient care exemplifies service improvement through proactive screening and interdisciplinary collaboration. Her dedication to securing funding, integrating screening sessions, and promoting orthoptic visibility demonstrates her commitment to enhancing patient outcomes. With the potential to transform stroke care pathways, this initiative is a strong candidate for the Service Improvement and Innovative Service Award.

Pamela Anketell and Ciara McAtamney, Strabismus Team at Belfast Health and Social Care Trust

Ophthalmology is facing a significant national capacity challenge, and the 2022 RCOphth census highlighted paediatric ophthalmology was no exception with the additional pressing workforce issues. Our initial project aim was to release capacity within paediatric ophthalmology by using advanced orthoptists. Two advanced orthoptists underwent training for squint surgery consenting and theatre assistant roles using BIOS competencies.

Describe your project implementation and methods and relevant background work

The quality improvement aim was to release/increase paediatric ophthalmology capacity by three appointments per week using orthoptic-led squint pre-assessment clinics (PAC) including independent consenting. The two advanced orthoptists completed an informed clinical consent course, and underwent in-house training alongside completion of BIOS competencies for consenting and surgical first assistant under the guidance of two Consultant Paediatric Ophthalmologists. Initial investment of Ophthalmologists’ time required for training and generating availability of advanced orthoptist for surgery sessions with new workload of consenting/boarding for squint surgery in clinic time.

What are the outcomes and benefits to service users, and did you involve them?

From May 2024 to January 2025 (35 weeks) there was an increase in paediatric ophthalmology capacity, 44 of the 126 (35%) patients attending a squint PAC were seen independently by an orthoptist. 27 of the 44 (61%) were consented and boarded for squint surgery by a trained orthoptist, with the remaining having informed discussions led by the orthoptist with regards to unsuitability for squint surgery. There was a 100% agreement with the orthoptic-led decision with the Consultant Paediatric Ophthalmologist

Figure 1 demonstrates a shift after the orthoptic consent training completed. It shows 4 runs crossing the median, this gives a statistically significant impact of the introduction of the new model.

Since commencing this pilot the urgent paediatric squint surgery waiting list was cleared as no theatre was cancelled with trained orthoptist assisting in theatre when a resident doctor was unavailable. For the period of June 2024 to December 2024 the surgical waiting list has reduced from 1 year to no cases waiting for urgent and from 4 years to 107 weeks for routine cases. There was no negative impact on resident doctor training.

How could it be sustained and what is the potential for transferability and scalability across organisations or services?

After our initial primary aim was achieved, the spread and scale potential for this model was explored. The pilot commenced with two Consultant paediatric Ophthalmologists this is now expanding to the regional Paediatric Ophthalmology service and two adult motility consultants. The scale would involve upskilling additional orthoptists to build service resilience, and further improve capacity with the orthoptist as first assistant role in squint surgery to maintain theatre lists with absence of resident doctor.

We have identified a cohort of patients suitable for orthoptic-led PAC to minimise ophthalmology input needed to maintain the released capacity e.g. primary childhood squints, consecutive exotropias. Therefore providing additional capacity within ophthalmology clinics. The additional development of orthoptic-led post-operative squint reviews including slit lamp examinations would allow for additional release of ophthalmology resources.

Entrants:

Ciara McAtamney Lead Paediatric Orthoptist, Pamela Anketell Orthoptic Service Manager on behalf of the of the strabismus team (Eibhlin McLoone, paediatric ophthalmologist, Kate Shirley, paediatric ophthalmologist, Orla McNally paediatric and adult oculo-motility ophthalmolgist, Monica Hrabovsky neuro-motility ophthalmologist, Sonia Geore Paediatric Ophthalmologist, Edward Pritchard, Paediatric Ophthalmologist, Kelly Harpur lead for adult orthoptics )