Working with training programme directors, NHS England, ophthalmologists in training and independent sector providers, The Royal College of Ophthalmologists (RCOphth) has published a blueprint to help providers and trainers enable appropriate and safe cataract training within the independent sector (IS), where these training opportunities are needed.
Blueprint for cataract training in IS summary
Key points from ‘Blueprint for cataract training in the independent sector’ include:
Within every NHS setting that delivers a cataract service, training opportunities must be maximised.
- Every independent sector provider (ISP) delivering NHS-funded cataract surgery must be able to train NHS ophthalmic trainees on at least 11% of whole cases within two years in every region – in line with NHS England’s March 2022 cataract service specification and supporting guidance (both accessible via the Eye Care Hub).
- Commissioners, including through the Integrated Care Body (ICB) structure, must ensure that within contractual arrangements all ISPs delivering NHS-funded cataract surgery demonstrate they are able to train NHS ophthalmology trainees on 11% of all NHS cataracts within two years, in each region that they operate in.
- All pre-placement and intra-placement documentation must be available to both NHS and ISP training partners during all placements.
- To enable training to take place successfully in ISPs where it is needed and appropriate, it is essential that ISPs and NHS trusts work together to proactively plan how the placement will be delivered. These discussions should begin at least one month prior to the training beginning within the ISP.
The blueprint covers practical information on how to determine whether trainees need training opportunities in ISPs, which areas trusts and ISPs should plan collaboratively one month prior to placements (including a timetabled list, trainer accreditation and indemnity cover), and what information ISPs, training programme directors and trainees should provide prior to placement. The blueprint also outlines a template timeline for the different milestones and steps that should be taken during a placement in an ISP.
Analysis of cataract training delivery in England
To sit alongside this blueprint, RCOphth has published an analysis of how cataract training is currently being delivered in England.
Collating data from the General Medical Council’s 2022 National Training Survey, RCOphth’s Training Committee and Ophthalmologists in Training Group, Analysis of cataract training provision in England highlights that:
- Over a third (35%) of trainees had not completed more than 50 complete cataract operations by the end of ST2 training. This was up significantly from 22% in 2021 and 12% in 2019.
- By the end of ST2 training, 37% had completed more than 90 cataract operations. This had never fallen below 56% before 2021. Across all grades, 59% said they were on course to undertake the expected number of operative/practical procedures needed for their stage of training.
- 25% of ophthalmology trainees said they did not need to access training opportunities in ISPs for operative procedures. Of the 75% who did, 86% disagreed (65% strongly disagreeing) with the statement that they were easily able to access these opportunities, while just 6% agreed.
- Of those who had been able to access training in ISPs, a large majority (75%) found the experience to be positive – with excellent teaching quality and clinical supervision reported.
- In those deaneries where limited training in ISPs was available, frustration was expressed at a number of obstacles including administrative issues, a lack of willing trainers in ISPs, equipment not always being available and a lack of investment in NHS eye units.
Reaction to the blueprint and data
Commenting on the blueprint and data on cataract training provision, Chair of RCOphth’s Training Committee Sarah Maling said:
“By drawing together information on when cataract training opportunities are needed in the independent sector and best practices on how that training should be delivered, this blueprint will help ensure we effectively train the next generation of ophthalmologists. The College will continue to work will all partners so that ophthalmology services integrate high-quality training with delivering excellent patient care.”
Sunil Mamtora, chair of RCOPhth’s Ophthalmologists in Training Group said:
“In the aftermath of the pandemic, more ophthalmologists in training are struggling to progress with many finding it difficult to undertake the required number of cataract procedures. A big part of this challenge in England is that there has been a huge increase in the proportion of NHS cataract procedures delivered in the independent sector, without the accompanying increase in training opportunities. We hope the blueprint plays an important role in tackling this situation.”
This blueprint represents part of the College’s work to address the challenges to sustainable patient care created by the growing role of independent sector providers. Following joint task and finish groups with NHS England, we will also shortly be providing more information on a cataract commissioning guidance document that NHS England will publish.
Earlier this year, RCOphth published a summary of cataract surgery trends in England and an explanation of NHS England’s cataract service specification, which followed our 2021 position statement on the delivery of NHS cataract surgery in the independent sector.
For any questions or comments on these publications, please contact [email protected]