Postcode lottery for cataract training in independent sector

  • 21 Dec 2023
  • Jordan Marshall, Policy Manager

Despite important progress over the last two years, cataract surgery training opportunities in independent sector providers remain limited and in some areas – including the south west of England and London – there is no training at all in the independent sector, insights from our Ophthalmologists in Training Group (OTG) indicate.

The delivery of NHS-funded cataract surgery by independent sector providers (ISPs) has surged over the last five years, with well over half of procedures in England in 2023 being delivered in ISPs. One impact of this shift has been ophthalmologists in training struggling to access opportunities to perform cataract surgery.

We surveyed our 18 OTG members, who each represent a UK deanery area, on the detail of independent sector delivery of cataract training opportunities and validated their findings with education leads from SpaMedica, Newmedica and Optegra.

Key results show:

  • In 14 regions (78%) ISPs are reported to be delivering NHS-funded cataract services
  • In 10 of these 14 regions (71%), cataract training in ISPs is taking place, although in total there are only 44 reported placements.
  • No cataract training is currently reported to be taking place in ISPs in the south west of England, London or Northern Ireland.
  • The standard of cataract training undertaken in the independent sector is reported to be very high, with the quality of supervision particularly valued.
  • There is significant variation between ISPs in the amount of training they are delivering. Both SpaMedica (63%) and Newmedica (60%) are reported to be providing cataract training in most of the deaneries where they are operating. Despite operating across 7 and 3 deaneries respectively, Optegra are currently supporting one trainee while CHEC are not providing any cataract training.

Respondents found that a barrier to cataract training in ISPs is NHS organisations and ISPs agreeing contractual arrangements that enable training. It is vital that the NHS and ISPs work constructively to facilitate these arrangements where they are needed. Commissioning at a local and national level must also ensure that the delivery of training is built into contracts and properly enforced.

Alongside this need to drive better training in, and commissioning of, independent sector providers we will continue to make the case to policymakers for the actions that are needed to enable ophthalmology services to deliver timely care for all our patients and prevent avoidable sight loss. At its heart this means investing in the NHS ophthalmic workforce and infrastructure (both physical and IT) to tackle chronic capacity shortages.

Please contact [email protected] if you have any questions, and read our full summary of the survey for further detail on cataract training in the independent sector including list frequency, procedures per list and case complexity.

We will repeat this survey in the first half of 2024 to assess progress that has been made and further actions that are needed.

Commenting on the findings, chair of our Ophthalmologists in Training Group Adonis El-Salloukh said: “It is encouraging that we are now seeing far more cataract training opportunities available in the independent sector. But that access is still very patchy, especially for more junior trainees. We urgently need to improve this situation so that our trainees gain the relevant experience to progress through the training programme. I am in regular direct contact with the big four of the independent sector to drive further improvements”.