NHS planning guidance aims for 25% cut in outpatient follow ups alongside increase in elective activity

  • 03 Jan 2022
  • Policy Manager

Annual planning guidance published by NHS England has set out priorities for increases in elective and diagnostic activity, as well as the ambition to reduce outpatient follow-ups by a quarter over the next year. RCOphth Policy Manager Jordan Marshall summarises the key targets, implications for ophthalmology and what steps you can take.

Ahead of each financial year (April to April), NHS England publishes guidance setting out its priorities for the NHS and what support it will offer to help deliver them. The 2022/23 guidance contains a number of targets which are particularly relevant to ophthalmology, including:

  • Delivering 30% more elective activity by 2024/25 than before the pandemic, and over 10% by 2022/23
  • Reducing outpatient follow-ups by a minimum of 25% against 2019/20 activity levels by March 2023.
  • Expanding the uptake of Patient Initiated Follow Up (PIFU) to all major outpatient specialties, moving or discharging 5% of outpatient attendances to PIFU pathways by March 2023.
  • Increasing diagnostic activity to a minimum of 120% of pre-pandemic levels across 2022/23. Community diagnostic centres (CDCs) are expected to play a key role in meeting this, while £21m is being made available to support digital pathology and imaging networks.

NHS England is clear that these ambitions are dependent on COVID-19 returning to a low level, and will be kept under review as the pandemic evolves. Nonetheless, they will have significant implications for ophthalmology and careful planning will be needed.

Accelerating elective recovery

There are now almost 600,000 patients waiting for an ophthalmology procedure – 10% of the entire waiting list in England. We therefore agree that recovering elective activity is important, though the targets of a 10% increase over the next year and a 30% rise over three years will be challenging with infection prevention and control (IPC) measures in place, but most importantly the continuing workforce shortages – a huge challenge for ophthalmology and many other specialties across the NHS.

The guidance states that independent sector (IS) capacity should be ‘incorporated as a core element to…reduce waiting times sustainably’. As we outlined in our statement on the IS in November, the IS is already playing a very prominent role in delivering NHS cataract procedures. This has helped to increase capacity but has also created challenges that must be addressed, including access to training opportunities and the financing of NHS eye care units. RCOphth will continue to make clear that IS capacity cannot be a long-term substitute for properly funding and resourcing NHS ophthalmology units.

We agree with NHS England that community diagnostic centres (CDC) have an important role to play in helping to tackle these backlogs. We will continue to make the case to NHS England that they need to provide a stronger steer to commissioners on the importance of prioritising ophthalmology as part of the rollout of CDCs. Successfully implementing CDCs will also require greater capacity to rapidly capture and analyse diagnostic data. We are working with NHS England to collate information on how best to train technicians, but funding from trusts and NHS England to support training would be helpful.

Support for new surgical hubs is also being made available, as part of £1.5bn capital funding. This could boost elective recovery for ophthalmology – more detail has been promised in additional guidance.

Reducing outpatient follow ups

Alongside increasing elective activity, the guidance sets out the ambition to reduce outpatient follow-ups by at least a quarter (25%) by March 2023. NHS England wants to see a greater uptake of Patient Initiated Follow Up (PIFU) appointments, with 5% of outpatient attendances moved to PIFU pathways by 2023.

RCOphth can see the merit in greater use of PIFU in certain contexts, especially for patients with less complex conditions. We do have some worries though about the impact this goal could have if implemented in a blanket way. The average wating time for ophthalmology outpatients already tracks above the average for other specialties, so cutting the number of outpatient follow ups in a way that does not harm patient care could be challenging.

When implementing this policy, NHS trusts will need to pay careful attention to the caveat given by NHS England that ‘the opportunity to reduce outpatient follow-ups will differ by trust and specialty and local planning should inform how the ambition will be delivered across the system’.

Move to integrated care systems delayed

Due to Parliamentary timings around the Health and Care Bill, the move to Integrated Care Systems (ICSs) has been delayed from April to July 2022. RCOphth supports ICSs as having the potential to enable greater joined up working in eye care between primary and secondary care. Under the changes, clinical commissioning groups will be abolished and the powers they exercise will be transferred to ICSs.

Planning guidance for 2021/22 included information on how ICSs should go about supporting eye care transformation, including through the setting up of Eye Care Delivery Groups. We would encourage clinicians to become involved in these groups to ensure joined-up eye care services are designed well in your region. We will be publishing case studies in the coming months to show how integrated eye care is successfully being delivered.

What happens next?

NHS England has asked systems to rapidly draw up delivery plans by March to meet the objectives set out in this guidance. RCOphth would encourage you to speak to your clinical leads now to discuss the delivery of these targets. If you would like the College to be aware of any challenges that we can seek to address or raise with other stakeholders, please contact your regional representative or email me directly on [email protected].

Separately, NHS England’s National Eye Care Recovery and Transformation Programme has set out six priority areas for the year ahead, which it believes can be delivered without large scale commissioning change. These include reducing unnecessary follow up, enabling high flow diagnostics and high flow intravitreal injections being delivered by the wider workforce. You can visit the Eye Care Hub or email NHS England at [email protected] for more information.