One year on from the National Eye Care Recovery and Transformation Programme: progress and next steps

  • 21 Apr 2022
  • Mel Hingorani, RCOphth Honorary Secretary

Mel Hingorani is RCOphth Honorary Secretary and Joint Clinical Lead of the National Eye Care Recovery and Transformation Programme (NECRTP) and is a consultant ophthalmologist at Moorfields Eye Hospital. In this article, she reflects in her College capacity on what has been achieved by the programme so far and what still needs to happen.

This month marks one year since NHS England and Improvement launched a dedicated recovery programme for eye care. This aimed to improve the experience, safety and quality of care for patients in a sustainable and efficient way, achieving rapid, high impact improvements and longer-term transformation through new, technologically-enabled ways of working.

It has been a difficult year, as the NHS grappled with backlogs and a repeated resurgence of Covid. But the development and implementation of the NECRTP have marked a new and welcome close working relationship between NHS England and Improvement and the Royal College of Ophthalmologists, together with other stakeholders including optometry bodies and patient charities, which has the potential to drive further improvements in inpatient care.

NECRTP is vital because it marks a shift away from short-term thinking and siloed improvement programmes, towards a coordinated, whole pathway approach. It aims to reduce waiting lists while putting ophthalmology services on a truly sustainable footing. The various national programmes for eye care improvement, such as the national outpatient transformation programme (NOTP), GIRFT and digital side were able to come together and work under one governance structure to co-ordinate the national guidance and support offer.

NHS England has asked regional and system teams to set up an Eye Care Delivery Group and an Eye Care Improvement Programme involving a senior responsible officer, multidisciplinary clinical leads, hospital management and commissioners. Each Regional Group can send representatives to the National Eye Care Board.

It is crucial to the aim of the Programme that modern care pathways are designed by experienced clinicians to provide the best quality care tailored for their patients. There is a huge range of practical resources to help on the Eye Care Hub which have been co-produced with regions and systems.

What progress was made in the first year?

Ophthalmology is the highest volume outpatient speciality. We know that almost 10% of the NHS treatment backlog is in eye care, with nearly 600,000 patients on the waiting list for ophthalmology treatment, primarily non-surgical, in England as of January 2022. Many patients continue to undergo worsening quality of life and the profound trauma of sight loss as a result of avoidable delays, with a knock-on financial burden for the wider health and social care system.

To help address this, NECRTP with GIRFT has supported the development of high volume surgical hubs and procedure pathways across England, which can improve productivity and reduce the backlog of cases. The College produced updated guidance this year on high flow cataract surgery and released a joint statement with the College of Optometrists on discharging patients to an optometrist sight test (with outcome data return) after uncomplicated cataract surgery.

As well as cataracts, the implementation of standardised integrated care pathways is also underway across urgent and emergency eye care, medical retina and glaucoma. This should include good quality risk stratification to ensure those with the greatest need are seen first, as well as failsafe processes and recording of the Latest Clinically Appropriate Date (LCAD), renamed from the previous ECAD (Earliest Clinically Appropriate Date), to reduce harm for delayed outpatients. There is room for greater efficiency, with examples across the country showing how this can be done using one-stop preop clinics, enhanced involvement of the multidisciplinary team in outpatient decision making and giving injections, diagnostic centres and technician-led pathways with remote (virtual) clinician review of images and consultations by phone and video. The NECRTP has numerous case studies on the eye care hub and has delivered guidance on efficient injections, patient-initiated follow-up and good discharge, with webinars on all the major pathways and innovations.

Care pathways should also involve optometrists acting as the first point of contact and managing low-risk patients in the community. Primary care optometry is increasingly electronically linked to local hospital ophthalmology teams, sending data and images via electronic eye care referrals (EeRS) for enhanced referrals, filtering and shared care. This is just the beginning of longer-term integrated digital diagnostic and care capabilities, although there are still many roadblocks to digital image sharing.

More information on all these outputs is available by logging into the Eye Care Hub.

In addition, the Programme has been able to gain approval and funding for a new senior leadership role for eye care in NHS England, the first National Clinical Director (NCD) for eye care.

Plans for the next 6 months and beyond

There is big national change now happening, with various bodies (NHSX, NHS Digital and Health Education England) all joining NHS England and Improvement to create a new and hopefully more streamlined and coordinated NHS England. In addition, there is the creation of a new Transformation Directorate with a new Medical Director for Transformation and Secondary Care and the imminent appointment of the NCD (interviews are taking place for this post at the time of writing).

The NCD for eye care will be an important step forward. They will provide a lead point of contact for the profession so that issues and challenges can be escalated quickly within NHS England, as well as being a champion for the importance of eye care within the wider health system.

The future of any eye care transformation programme will be heavily influenced by all these changes and, while things settle, a smaller NECRTP team is continuing to maintain the work, providing support to regions, systems and hospitals to keep driving change and concentrating on national work on these key areas:

  • Detailed work to understand spend and activity across the eye care sector at sub-speciality level
  • The role of the independent sector in NHS eye surgery
  • The eye care workforce
  • Piloting and evaluating a more comprehensive optometry service in early adopter sites
  • Digitally transformed eye care.

What else do we need in ophthalmology?

New ways of managing waiting lists and other efficiencies only get us so far – we cannot ignore the need for proper resources and local prioritisation for the ophthalmology workforce and NHS eye care services. The elective recovery plan, and similar significant national funds made available for pandemic recovery help, have helped some eye units gain funding to invest in surgical hubs and diagnostic centres. These funding streams need to continue to support eye units to clear their backlogs, and the national workforce plan for the NHS that is expected later this year needs to be clear on how our workforce capacity can be expanded to keep up with demand.

And we know that the challenges presented by the growing role played by independent sector providers – including lack of training opportunities, patient access and ultimately the viability of NHS eye care units delivering comprehensive care – have not gone away. The College has worked with NHS England to help develop a service specification for cataract surgery, which is an important step forward in addressing some of these issues. It sets minimum standards which all providers must abide by, including offering training and managing postoperative complications. The key is now to implement this specification, working closely with integrated care systems.

The College has been involved in shaping the NECRTP with NHS England from the start and is determined to see it make a real difference as we emerge from the pandemic. We welcome your involvement and support to make sure it is having the impact it was designed to have on the ground.