Following representations from the College over many years, we are pleased that NHS England has listened and made a significant change that will incentivise NHS trusts to better prioritise more complex ophthalmology care.
From tomorrow (1 April), changes to the NHS Payment Scheme (which determines what providers are paid in England for delivering different NHS ophthalmology services and treatments) will see prices paid to cataract services providers cut by 20%. Most of the resultant savings will be used to increase payments for more complex ophthalmology care. We hope this will enable NHS organisations to better prioritise treatments for patients who are at risk of irreversible sight loss, including those with conditions such as wet age-related macular degeneration and complex glaucoma.
We would, however, have liked NHS England to introduce differential tariffs for NHS and independent sector providers performing cataract surgery, reflecting the additional costs incurred by the NHS providing a 24/7 emergency eye care service, treating more complex patients, managing post-surgical complications delivering research and education, and cross subsidising loss-making services.
We also believe that NHS England should create an ophthalmology transformation fund to recycle savings, supporting a national rollout of proven local innovations such as the model of high-volume outpatient care pioneered by the One Devon Elective Pilot.
In its impact assessment, NHS England estimates that in 2026/27 independent sector providers will lose £45 million as a result of changes to the NHS Payment Scheme. As we have consistently argued, it is vital that the NHS makes best use of the limited funds available. Comprehensive NHS ophthalmology services focused on preventing avoidable irreversible sight loss need to be resourced with the right staff, space and physical and digital infrastructure.
Commenting on the decision, the College President Professor Ben Burton said: “This is a victory for common sense. Over-incentivising cataract surgery has led to huge resource being diverted to this treatment, particularly in the independent sector, at the expense of more clinically urgent care. This change should reduce profits made by private providers and redirect the money to patient care.
“We hope this sensible decision by NHS England will lead to trusts better resourcing their comprehensive ophthalmology services, so we as ophthalmologists can do more to prevent people permanently losing their sight. I also hope this paves the way towards the government reviewing the commissioning framework that integrated care boards operate in, which can lead to perverse outcomes where commissioners struggle to be allowed to organise the services their patients need.”