Back in August I joined more than 300 NHS professionals – including clinicians, commissioners, pharmacists, and service managers – at a national webinar hosted by NHS England to support the implementation of the newly published Medical Retinal Treatment Pathway for Wet Age-related Macular Degeneration (AMD).
The session was aimed at providing essential context and practical guidance about the pathway, and also gave participants a platform for discussion around clinical, operational, and commissioning aspects of the pathway.
There were a number of key themes, which I’ve outlined here:
Data-driven implementation
- The pathway promotes a treat-and-extend regimen using aflibercept 2mg biosimilar and ranibizumab biosimilar as first-line treatments.
- The use of National Ophthalmology Database (NOD) AMD audit data https://nodaudit.org.uk/ was central to discussions, highlighting current variation in service capacity and patient outcomes.
Reinvestment to expand capacity
- Attendees were encouraged to adopt the full pathway to realise system-wide savings.
- These savings should be reinvested into ophthalmology services to increase capacity and reduce waiting lists.
Clinical choice and switching
- While agents are not interchangeable, clinician preference remains important.
- The pathway recommends early switching to longer acting agents as second line for patients who do not respond optimally, ensuring better outcomes and efficient use of resources.
National alignment and governance
NICE and MHRA engagement
- NHS England is liaising with NICE to review AMD-related guidance and technology appraisals.
- NICE is exploring mechanisms within its methodology tools to align with the pathway.
- The College supports this request for clarification.
Consent and EMR integration
- The webinar featured extensive discussion on the consent process.
- The current recommendation is to use the College’s consent guidance.
- NHS England is working with MHRA to clarify whether consent should be by brand name or biosimilar agent.
- There was a request for NHS England to liaise with electronic medical record (EMR) providers to ensure drug names are clearly recorded.
- At the College, we will consider reviewing the AMD dataset and coordinating with EMR systems.
Implementation support
Key enablers for successful rollout include:
- Strong clinical leadership and local champions.
- Multidisciplinary switch teams.
- Use of standardised consent and patient communication materials.
- Specialist pharmacy service checklists.
NHS England has published a set of FAQs – now live on the NHS Futures Forum biosimilar workspace – which will support ongoing implementation.
I would encourage College members to review the full pathway guidance and visit the NHS Futures Forum workspace.