On 22 September, the new Secretary of State for Health and Social Care, Dr Therese Coffey, set out the Government’s plan to improve patient experience of the NHS in England, outlining a range of measures relating to backlogs, workforce challenges, and digitisation of the NHS. RCOphth Policy Advisor David Murray summarises the key implications for NHS ophthalmology services.
Significant backlogs continue to weigh on ophthalmology services across England, with over 643,000 patients waiting for ophthalmology treatment in England – almost 10% of the entire NHS backlog. Average ophthalmology waiting times are well over 2 months and just 64% of patients are being seen within the 18-week standard. Ophthalmology has led the way in service innovation, including through the development of high flow cataract hubs, helping patients to be treated more quickly. Despite this work, however, a lack of sufficient support or investment in the foundations of ophthalmology services – workforce and infrastructure – has resulted in backlogs continuing to grow.
Last week, Dr Coffey announced a range of measures to tackle the backlogs that are intended to “sit alongside” the NHS Long Term Plan and the upcoming Heath Education England (HEE) and NHS England (NHSE) workforce plans. While the policies outlined in last week’s plan – some new and some reiterated – indicate the Government’s immediate focus is on tackling short-term pressures on the health service, we really need the forthcoming publications from NHS E and HEE to contain long term actions to meet current and future workforce demand.
Tackling the backlog through CDCs, ISPs, and virtual outpatient appointments
In ‘Our plan for patients’ the Government commits to prioritising the rollout of 160 Community Diagnostic Centres (CDCs), including the 92 CDCs already up and running. Ophthalmology is well-suited for inclusion in CDCs, as demonstrated in Taunton where the expansion of imaging assessment clinics helped services in Somerset catch up with the backlog as well as safeguard against future rising demand. An accelerated rollout of CDCs across England has the potential to reduce ophthalmology backlogs, so it is therefore vital that Integrated Care Systems (ICSs) and trusts ensure ophthalmology services are included as standard when planning CDCs.
Dr Coffey also called for the maximisation of the independent sector (IS) to tackle backlogs in the short term. Independent sector providers (ISPs) are already playing a significant role in NHS cataract services in England, where they undertake almost half of NHS funded cataract procedures. While additional capacity to tackle NHS backlogs is welcome, increased reliance on ISPs has created challenges for ophthalmology services, including fewer cataract surgery opportunities being available to ophthalmologists in training. There are also concerns that this shift may hit the future sustainability of comprehensive NHS eye services.
To meet these challenges, RCOphth has convened several cross-sector task and finish groups with NHSE to improve the referral process from optometry, increase training opportunities and address issues in the post-operative management of patients. Alongside this work, the College worked with NHS England to contribute to their cataract service specification, published in March 2022. This specification aims to ensure all providers of cataract surgery in England meet certain standards and requirements. These include the delivery of training, the handling of post-surgical complications, as well the requirement that there is no financial link between the provider and any referring organisation.
Increased use of virtual outpatient appointments – another important aspect of the Government’s plan – will work well for some eye diseases such as for patients with lower risk glaucoma, it is currently not appropriate for other ophthalmic conditions and still relies on undertaking diagnostic tests reviewed remotely by clinicians. Delivering and interpreting the data collected by diagnostic services, for virtual clinics at scale, must be underpinned by an increased focus by trusts on the recruitment of ophthalmic technicians and multi-disciplinary team (MDT) professionals specific to ophthalmic care. The College is best placed to determine the configuration of sub-speciality multi-disciplinary work groups, but ophthalmologists will still need to continue to play a leading role in ensuring proper governance and to facilitate appropriate training and education of the workforce involved.
Delivering a long-term workforce plan
The Government has long promised to design and deliver a long-term workforce plan, but this promise must now be fulfilled. RCOphth continues to emphasise the need to invest in the ophthalmic workforce and the multi-disciplinary eye care team. This means increasing the number of ophthalmologists in training and providing support and funding at a local level for training programmes that provide additional capacity to the ophthalmic workforce. Such programmes include Ophthalmic Local Training and Ophthalmic Practitioner Training, both of which provide additional routes for non-medical eye care professionals such as technicians, nurses, orthoptists and optometrists to upskill and clear career progression for SAS doctors.
The plan announced by Dr Coffey for an extended emergency register will make it easier for ophthalmologists to return to the workforce in the short term. While there were some successes from ophthalmologists returning to the workforce during the COVID-19 pandemic, these successes were limited and do little to ensure future workforce capacity meets demand.
Digitising NHS ophthalmology
The Government’s commitment to supporting trusts to move toward electronic patient records (EPR) by 2025 is welcome, allowing clinical teams to record clinical care in a legible and standardised way while measuring the quality of services. The College has best practice guidance on how to implement secure, high-quality electronic patient records.
It is imperative that any innovation and improvement that creates capacity in managing this demand is prioritised. For example, standardisation of ophthalmic imaging data, in a similar way to that already in place for radiology, will allow a seamless interface with technology for joined up patient care and the use of artificial intelligence that is effective in preventing avoidable sight loss.
Being able to share a patient’s record and diagnostic images digitally across systems, and between eye care centres in primary and secondary care, is absolutely crucial. This would increase the ability to make swift and efficient diagnoses and treatment decisions, while allowing better utilisation of the existing workforce. RCOphth continues to work with manufacturers, optometry, patient organisations and NHS England to promote shared standards throughout eye care pathways.
If you have any questions or comments, please contact [email protected]