Use of private providers damaging NHS eye care, survey reveals

The independent sector should be commissioned to provide more NHS outpatient appointments, rather than just be focused on cutting cataract waiting lists, the president of the Royal College of Ophthalmologists has said.

A “workforce census” survey carried out by the college and shared with HSJ found almost 60 per cent of respondents believed independent providers were having a “negative impact” on care and ophthalmology services in their area.

Speaking about its findings to HSJ, RCOphth president Bernie Chang said covid had exacerbated problems caused by use of independent sector providers. These problems included cases being passed back to the NHS when IS care failed, and the NHS being left with a greater concentration of more serious, and costly, cases as the IS focussed on routine cataract operations.

The loss of income from cataract procedures made it more difficult for NHS providers to fund the complex and emergency care which only they could carry out.

Professor Chang said the situation could be improved by better planning and commissioning. This should include asking IS providers to see more outpatient appointments, rather than focusing only on surgery, primarily for cataracts. 

It should also mean commissioning capacity – including in the NHS – in regions where it was most needed, rather than where there is existing supply.

Professor Chang said positive change would require “joined up collaboration between the two sectors, backed up by investment in comprehensive NHS services”.

He added: “We’ve lacked investment in ophthalmology for so many years, and this is why the independent sector in ophthalmology has thrived. In terms of infrastructure like theatre space and technology as well as staff. They [NHS units] often struggle to deliver high volume surgery or diagnostic services.”

The specialty has long had more IS provision for NHS patients than most. Despite that high starting point, it has also seen significant expansion in the use of the IS in the past two years as a result of efforts to address the covid backlog, which has now reached 630,000 pathways, with almost 30,000 patients waiting more than a year. Professor Chang said that “at one stage, the IS did over 50 per cent of all NHS cataracts in England”.

The Independent Healthcare Provider Network stressed the move towards centralising high volume low complexity work – as ophthalmology has done with cataracts – was consistent with the approach seen in other specialties.

Its chief executive David Hare said the independent sector “very clearly had a positive impact on the capacity and volumes of ophthalmology patients being seen and treated in a timely way, particularly when it comes to cataract operations”.