AMD Services Survey

There is a significant insufficiency of resources to deliver adequate contemporary AMD Services. Only one-quarter of the units surveyed have the very minimum number of specialist clinician staff in place; fewer than a quarter had sufficient nursing support; and some two-thirds did not have the necessary technical resources to cover the need for retinal imaging which is a key component of this service. As a result, the service specification standards for patients with wet AMD to be seen within two weeks of referral and for patients commencing treatment with anti-VEGFs to be reviewed on a monthly cycle are not being met. As such, patients with wet AMD are receiving suboptimal services. Furthermore, the 'Ranibizumab Reimbursement Scheme' does not cover patients who do not receive the three initiation doses at monthly intervals which could have significant cost implications.

Although many reasons have been given for this state of affairs, there are those which have been specifically identified as consequent on a lack of understanding of the importance of this service by hospital Trusts. These include:

• A lack of Trust management support for setting up and delivering these services.

• Failure to consult clinicians in the early planning stages as to the scope of the service in any particular area which appears to have given rise to unrealistic budgets to deliver the service.

• The fact that managers do not appreciate the urgency of processing business cases for AMD services in a timely manner: the feedback we received indicates that the implementation of the new service is being delayed well beyond the period stipulated by NICE.

• An unfortunate impression within Trusts that AMD services, including treatments with anti-VEGFs will become redundant as newer treatments (especially longer acting and less invasive ones) become available, or that neovascular AMD will become less common.

Comments

While a number of clinical trials are seeking ways to reduce the need and frequency of re-treatment, none will formally report their findings for another three years. Furthermore, emerging pilot data indicate that alterations in treatment regimens to extend re-treatment intervals and to reduce the frequency of re-treatment are unlikely to reduce the burden of review significantly. In addition, the current epidemiological evidence clearly points to an increasing prevalence of neovascular AMD as a consequence of the aging population. It is, therefore, the view of the College that the burden of AMD patient follow up will not ease and the current need for the service will continue unabated over the next decade.

Recommendations have been made to the PbR Team at the DH about the funding issues. PCTs and Hospital Trust CEs are to be encouraged to cooperate with clinicians in solving the difficulties associated with AMD service set up and delivery.

Winfried Amoaku
June 2009