The government and NHS England published a joint plan last week setting out how they intend to support the recovery of elective services over the next three years. RCOphth Policy Manager Jordan Marshall summarises the key implications for ophthalmology services.
Prime Minister Boris Johnson recently announced the government’s intention to end all domestic pandemic restrictions in England by the end of February 2022, a month earlier than originally planned.
The challenges that COVID-19 has created for the health system in the form of lengthening backlogs will not be so quick to resolve, however. There were 600,000 patients on the waiting list for ophthalmology treatment in England as of December 2021, 25% higher than 12 months earlier. This equates to 10% of the entire backlog of care.
NHS England and the government responded last week with its elective care recovery plan. There was significant political and media attention on the high-level targets, such as eliminating waits of over 52 weeks by 2025, and ensuring 95% of patients receive a diagnostic test within six weeks by that same date.
Expansion of surgical hubs and community diagnostic centres should help ophthalmology capacity
What may be of most interest for ophthalmologists are plans to expand the use of surgical hubs and community diagnostic centres. The plan specifically references ophthalmology when highlighting the need to increase surgical capacity through surgical hubs ‘that conduct planned, elective procedures only…they might exist within a hospital as a district unit or ringfenced theatre; or on a separate site’. It cites Moorfields Eye Hospital as having used surgical hubs to reduce the time cataract patients spend in the hospital to approximately 90 minutes.
The College has produced guidance on high flow cataract surgery, outlining the steps to developing high flow cataract services within hospitals. In late 2021, we also published guidance on delivering cataract surgery training in high volume settings.
Plans to increase the number of community diagnostic centres (CDC) also have the potential to increase the capacity of ophthalmology services. CDCs have been opened on high streets and in the community, and aim to take patients requiring diagnostic services away from acute areas, removing the risk of the estate being reprioritised for urgent work and creating a simpler more convenient experience for patients.
The Plan uses the example of Finchley Memorial CDC, which provides ophthalmology services as well as blood testing and MRI scanning. The patient journey time through ophthalmology testing averages 40 minutes, shorter than is typical at hospital sites.
£2.3bn has been made available over the next three years to support CDCs, and £1.5bn to support elective recovery and surgical hubs. We believe the elective recovery plan provides a strong steer that these funding pots need to support ophthalmology services to expand their capacity. The College will continue making these points to NHS trusts and commissioners, and we encourage you to make representations within your organisation too.
Short term focus on reducing outpatients will create challenges
Another important focus in the plan is ‘reforming the way we deliver outpatients’. This encompasses a greater emphasis on remote consultations, patient-initiated follow-up (PIFU) appointments, referral refinement, and effective discharge.
This part of the plan should be considered in light of the planning guidance published by NHS England in late 2021, which included a target for systems of reducing outpatient follow-ups by 25% over the 12 months from April 2022.
RCOphth published a briefing document last month to provide more information on this target. This outlined steps ophthalmology departments can take to safely reduce in-person outpatient appointments. It also however emphasised the significant challenges that ophthalmology would face safely reducing outpatient follow-ups in such a short timeframe. The briefing recommended that trusts take a pragmatic approach to implementing this target for ophthalmology, recognising the specific circumstances in their area. It also pointed to the need to expand the capacity of the multidisciplinary eye care workforce and invest in physical and IT infrastructure.
Risks created by the growing role of the independent sector
The elective recovery plan makes numerous references to increasing the use of the independent sector (IS) to boost capacity. As we outlined in our November 2021 position statement on independent sector providers delivering NHS cataract surgery, the growing IS involvement in delivering ophthalmology services has created challenges that must be addressed.
We need to make sure that short term measures to increase capacity do not further hamper efforts to train our future ophthalmologists nor undermine the sustainability of NHS eye units delivering comprehensive care. The College is working closely with NHS England and all stakeholders to raise these challenges and find solutions.
A clearer long term plan for the workforce is needed
Last but by no means least, the plan states the importance of growing and supporting the workforce. While acknowledging the need to ‘narrow supply gaps in priority pathways, specialities and roles across the country to meet the challenges of elective recovery and increase permanent workforce capacity’, there is a lack of firm commitment to the long term actions that are needed to actually do this.
The plan does reference expanding advanced clinical practitioners and increasing the supply for theatre staffing. This could help increase the capacity of the wider eye care workforce needed to deliver procedures and treatments. Support from NHS England to expand the Ophthalmic Practitioner Training Programme would also be a helpful way to increase capacity in the short term.
But what is lacking is a long term plan on how to increase the medical workforce. The demand for ophthalmology will only grow in the coming years as the UK population ages, with the number of people with sight loss expected to rise dramatically to reach 2.8 million by 2030. We need to create more speciality training places for ophthalmology now to be able to meet increased patient needs in future. Across the health and care sector too, there needs to be a greater focus on planning for future demand, and ensuring the data to help make these decisions is in the public domain.