‘Getting it Right First Time’ in ophthalmic surgery

Posted: 22/04/2022

Ophthalmology is the busiest NHS specialty in England. Before the pandemic, there were around 7.5 million outpatient appointments and 500,000 operations every year. The impact of the pandemic on health services has inevitably led to a large increase. With an ageing population, the volume of patients needing ophthalmic care is set to increase further and the Royal National Institute of Blind People estimates a 35% increase in the number of people with sight loss by 2030.

Working with ‘Getting it Right First Time’, an NHS programme to improve patient safety and outcomes, the Royal College of Ophthalmologists (RCOphth) investigated standards in eye care to try to mitigate risks of sight loss. Just before the pandemic, they published a report that made a total of 22 recommendations to deliver better care across the NHS. These include:

• enabling high street optometrists to provide patients with follow-up care after cataract surgery, making it closer to home and consequently more accessible for many;
• prioritising ophthalmology patients according to risk factors;
• improving procedures and protocols to ensure those needing consultant appointments are seen more quickly and safely, avoiding appointments that are unnecessary;
• improved training so that staff involved in eye care can help deliver more treatments, for example, training non-medical staff to perform injections for age-related macular degeneration, in turn also freeing up consultant time; and
• offering more routine monitoring and treatment in the community.

These high-level recommendations led in turn to various initiatives to improve specific aspects of eye care. Among these was a review of cataract surgery, one of the most common ophthalmic procedures. To try and manage demand, the NHS has long referred patients to the independent sector for treatment and almost half of NHS-funded procedures are now delivered in the independent sector. By January 2022, demand for cataract surgery was so high that the RCOphth reported that waiting lists exceeded 600,000 patients.

According to NHS Networks, if NHS trusts performed all routine cataract surgery in 30 minutes or less, more patients would have their vision restored and the NHS could save £64 million. This ‘high flow’ approach to treating large volumes of patients depends on having in place clear, streamlined processes for managing care efficiently in cases of low complexity, freeing up time elsewhere in the NHS for treating more complex cases. The growing pressure on resources, however, is leading to more complex cases being increasingly managed in independent settings. Some private providers, for example, now exclude only those patients who need a general anaesthetic, hoisting, or have a defibrillating pacemaker fitted.

Andrew Clayton leads a team of specialist solicitors advising on ophthalmic claims and comments: “The growth in patient demand quite properly means the NHS is looking at the allocation of resources and how best to optimise delivery of ophthalmic services. The principle of ‘Getting it Right First Time’ should, by definition, mean that the well-known and recognised risks and complications of surgery are avoided, saving the costs of corrective treatment and follow-on care when things go wrong. Crucially, this depends on an effective risk assessment in every case to determine complexity and allocate resources accordingly.

“The current volume of patients and pressure to reduce waiting lists must not compromise proper risk assessment in every case. Only by getting it right – first time – can the potential savings of streamlined care be realised. There must be proper and effective mechanisms to recognise those patients whose management is not straightforward, notwithstanding the costs and time they may need.”

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