Addressing cataract provision and independent sector challenges: call for input to working groups

  • 27 May 2022
  • Jordan Marshall

As part of the College’s work to address the challenges to long term sustainable patient care created by the growing role of independent sector providers (ISPs), we are convening with NHS England a number of cross-sector task and finish groups.

This follows on from our March 2022 update welcoming NHS England’s cataract service specification as a step in the right direction but emphasising that further work would be needed to ensure implementation.

Get involved in our work

We invite members of the College to contact [email protected] to express an interest in joining either of these below two task and finish groups. When doing so, please briefly explain why you would like to join the group and your experience/knowledge of the area.

  1. Improving the flow and process for referrals and equitable access from optometry into cataract care

This group will explore:

  • Quality and quantity of referrals
  • Communications between main referrers and providers
  • Informed patient choice
  • Tackling unprofessional or unethical incentives to refer preferentially to one provider
  • Referral refusal or inappropriate diversion from ISPs to NHS for complex cases.


  1. Improving the postoperative cataract pathway

This group will explore:

  • Postoperative care and complications
  • Incident reporting and management locally and nationally
  • Unmanaged referrals between providers.

We are also organising two further task and finish groups – on communication and governance barriers, and on addressing the training issues resulting from the increase in ISP activity. Our Training Committee and Ophthalmologists in Training Group will be closely involved in this latter work. Primary care, NHS trust, patient safety and ISP representatives will be involved in these groups to ensure solutions can be found that all key stakeholders endorse.

The College will keep you updated with developments on this in the coming months. This work follows our update in March 2022 on the publication of NHS England’s service specification for cataract surgery. We worked with NHS England to help shape this specification and outlined that it was a step in the right direction in aiming to ensure that all providers of cataract surgery in England met certain standards. These included 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.

We were clear that implementation of the specification would be key. That is the purpose of these task and finish groups – to agree robust mechanisms to ensure obstacles to implementation are overcome.

Current independent sector provision of NHS cataract surgery in England

While independent sector providers (ISPs) have helped to manage cataract backlogs, we have been aware for some time of the challenges created by their growing role – including the delivery of surgical training, equitable patient access and the viability of NHS eye units delivering comprehensive patient care. More detail can be found in our November 2021 position statement Three Steps to sustainable patient care.

According to NHS England data, almost half (45%) of NHS-funded cataract procedures are being delivered by ISPs in England. This has been a dramatic shift – especially since the pandemic – given the figure was just 11% in 2016.

As of October 2021, there are clear regional differences with the North West and Midlands delivering 63% and 56% respectively of its NHS-funded cataracts in the independent sector. London and the South East are at the other end of the scale, with figures of 27% and 34%.

On a smaller geographical level, it is also interesting to note the areas (Greater Manchester, Cheshire & Merseyside, West Yorkshire & Harrogate) which are reliant on the IS in both proportional (over 65%) and volume terms (over 1,000 cataracts by ISPs each month). Where this is the case, the College is keen to understand the local circumstances and we encourage NHS trusts and commissioners to also examine how their cataract services are being delivered.