This guidance has been developed by The Royal College of Ophthalmologists, supported by NHS England Elective Care Transformation Programme and High Impact Intervention Programme/EyesWise, GIRFT Ophthalmology and the HSIB and with advice from NHS Digital.
Ophthalmology is now the busiest outpatient specialty and demand is outstripping capacity. Patients are experiencing delays across the UK and this is leading to recurrent episodes of harm, particularly for glaucoma patients2-4. National professional organisations and NHS transformation programmes recommend the use of:
- models of care incorporating referral refinement or ongoing care in the community
- the full range of multidisciplinary ophthalmic team, virtual (telemedicine) and consultant led care deliver
- IT and data systems to ensure up to date understanding of the level and details of any delays
- failsafe processes to protect patients from being harmed by delays.
All of these are recommended to be based on understanding and acting upon measurements of delay, particularly for follow-up patients, and to incorporate clinical risk stratification, particularly the risk of permanent visual loss. There is a recommended method for measuring follow-up delays in ophthalmology originally published in 2018 jointly by the RCOphth and NHS Digital. However, currently there is no nationally agreed system for how to undertake this risk stratification consistently. In addition, for outpatients, there is no mandatory diagnostic coding beyond ophthalmology and paediatric ophthalmology. Units without electronic patient records or very strict division of patients into subspecialty non-mixed clinics cannot easily identify which patients have high risk conditions such as glaucoma and retinal conditions.
This document describes the recommended method for ophthalmology providers to measure delays to follow-up care using a patient administration system (PAS) field which can submit data to NHS Digital to assess national performance, provide data for managing individual patients and services, and allow reporting to commissioners and trust executive teams. This allows the calculation of the Portfolio of Eye Health & Care follow up indicator of % of hospital outpatient appointments that occur within 25% of their intended follow up period, including rescheduling or hospital initiated cancellations14. In order to ensure consistency across providers on derived metrics, it is essential that data collected from any PAS has been recorded in a consistent and equitable manner. Trusts and commissioners need to use this metric to help ensure that Hospital Eye Services (HES) develop and/or review local pathways, guidelines, policies and procedures to ensure that patients receive follow up review and treatment from the right person, in the right place, within 25% of their individual intended schedule for follow up.
The document also presents a new risk stratification coding framework to support local and national systems to develop consistent risk based reporting. The risk framework in combination with the 25% follow up indicator will help to ensure delayed patients at high