Ahead of Integrated Care Systems becoming mandatory bodies in England in July 2022, Lawrence Gnanaraj, consultant ophthalmologist and Chair of the North East and North Cumbria (NENC) Eye Care Alliance, shares his experience of the move towards integrating care and how ophthalmologists can get involved in developing services for their region
How did you become involved in integrated care?
I trained in the North East, started as a consultant in 2005 and eventually became a clinical director at Sunderland Eye Infirmary. I took up the role of Chair of the NENC Eye Care Alliance in December 2020 as I wanted to try and make a difference to help improve eye care in the region and reduce health inequalities.
The key thing was getting the right people around the table. It was clear that the Alliance needed to be clinically led, but that we also needed people involved like community optometrists and commissioners who are important in designing pathways.
The NENC Eye Care Alliance has five secondary care providers and four Integrated Care Partnerships (ICPs). We, therefore, have a core group of four commissioners, four Local Optical Committee Chairs representing each ICP, five clinical leads from provider organisations and two project leads from NHS England. We also have a reference group to ensure the views of GPs, the voluntary sector and patient groups are heard.
Since then we’ve been getting to work to try to address system variation, particularly in relation to referral guidelines and standardising pathways through primary and secondary care.
What progress have you made in the last year?
We are looking at the four areas in The Way Forward document to try to reduce variation – glaucoma, AMD, cataracts and emergency care. For example, in our glaucoma task and finish group, we have two aims – to make sure all units can risk stratifying in the same way and to standardise pathways in the region.
For this work to be effective, it was essential that it was clinically led and we, therefore, had the glaucoma clinical leads from the five providers and optometrist leads in the four ICPs involved in the group. We also ensured commissioners were involved from the start.
Each of the four task and finish groups have very clear terms of reference and timelines, so we will be able to evaluate the progress we have made soon.
Have there been any lessons from this work that you can share?
The shift in mindset from competition to collaboration has genuinely been a revelation. Traditionally I think that secondary care and community optometrists have often seen themselves as competitors. But demand is so great now that we have to be collaborators. I think that we as clinicians need to get better at working with community optometrists, learning from the challenges they face and offering support where it is needed.
Making sure integration and system change is clinically led is vital too. Ultimately it will be ophthalmologists and other eye care professionals who will be responsible for delivering care, so they must be involved in shaping what it looks like. If not, we risk integrated care being a top-down project and ineffective.
Another lesson is that you don’t need to reinvent the wheel when trying to create more joined-up care in your area. For example, when developing plans for our Eye Care Alliance, we made sure to tap into the expertise of the GIRFT team, and the clinical and optometrist lead in the National Eye Care Recovery and Transformation Programme. You can also learn from those integrated care systems (ICSs) that are more advanced – what worked in their area and what didn’t.
Is there any other advice you would give to ophthalmologists looking to shape eye care services in their area?
System change is already happening across the country, and it is vital that ophthalmologists are part of that change so they can help ensure more patient-centred services. ICSs will have statutory commissioning roles so the voice of ophthalmologists needs to be heard when these important decisions are being made.
A practical first step would be to have a conversation with those already involved in this work to see how you can help – your clinical lead would be a good link.
Becoming involved in an ICS can sometimes be frustrating, but ultimately it is incredibly rewarding as you know your contribution can lead to long term improvements in services for ophthalmology patients.
Further information
The way that eye care services are designed and commissioned is changing in England. From July 2022, clinical commissioning groups will be abolished and their powers will be transferred to integrated care systems (ICSs).
Over the coming months, RCOphth will share further information and advice to help ophthalmologists become involved in integrated care in their region. If you have any comments or questions, please contact [email protected]