High Flow Cataract Surgery

  • 02 Feb 2022
  • RCOPhth and GIRFT

In March 2021, the RCOphth and GIRFT released joint guidance on cataract hubs, based on work in London to establish high volume low complexity (HVLC)/ high flow low complexity (HFLC) sites in several surgical specialties, led by GIRFT with the regional NHSEI team. The cataract hubs which emerged in London (1-2 per system) were not new buildings but existing units willing to work some or all of the time to the standardised high flow processes agreed by the regional stakeholders.

Since that time, further learning has emerged from other UK areas and evolution of the London hubs. The high flow process was originally envisaged as only suitable for low complexity patients. The high flow hubs were envisaged as a shared facility in a system or region, with large numbers of low complexity patients and/or surgical teams travelling to them, using rigorously consistent processes across different sites. This would free up capacity for more complex patients to have surgery in their local trust. However, the backlog from the COVID-19 pandemic has resulted in many more cases that do not qualify as “low complexity” –a combination of longer waits and higher proportions undertaken by the independent sector (IS) [at April 2021, 45% of NHS cataract surgery is being undertaken in the IS, NHS England data].

This document highlights the necessary steps, using real world examples, to develop high flow cataract services within hospitals. The key components that underpin high flow operating, whether in complex or lower complexity cases and whether in hospitals or standalone units, are described in this updated guidance.