The independent sector responds

As part of efforts to tackle the backlog following the pandemic, there has been a surge in the number of NHS-funded operations that are performed by private ophthalmology providers.

At present, close to 60% of NHS cataract operations are performed in the independent sector. 

In April, then-shadow health secretary, Wes Streeting, announced an intention to use capacity within the independent sector to address waiting lists.

While independent providers have been an effective force in addressing waiting times for cataract surgery, the shift in how care is offered has not been without controversy.

A workforce census by the Royal College of Ophthalmologists in March 2023 found that 58% of hospital eye units believed the independent sector was having a negative effect on patient care and ophthalmology services in their area.

Professor Bernie Chang, who was RCOphth president at the time, told HSJ that the independent sector was focusing on routine cataract operations and leaving more complex surgeries to the NHS.

Concerns have also been expressed about the workforce pressures created by NHS staff leaving to work in the private sector.

OT took the opportunity to speak with a range of eye care experts at 100% Optical for their views on the role that the independent sector can play in ensuring that patients can receive timely care.

What is your perspective on the relationship between community ophthalmology and High Street optometry?

Jose Bailey (JB), chief commercial officer at CHEC: What we’ve seen, and what has become more clear since the pandemic, is the absolute importance of optometrists on High Street, delivering high-quality primary care, in tandem with ophthalmology. There has been a lot of talk recently, rom the Kings Fund and others, around community and primary care evolving, and one of the things I’ve really picked up has been around community optometry offering enhanced services.

I think the community element is an important direction of travel. One thing that’s become very clear is the speed at which patients are able to access services from primary optometry in their communities, affording swift referrals where required. I think that there should be consideration of what more optometrists can do to support community and tertiary referral refinement.     

How can community ophthalmology services address the issue of long waiting times for treatment?

JB: The waiting list is clearly a concern for many. I think that there should be more consideration of how the waiting list is reduced. As a community provider, we aren’t just doing routine surgery, such as cataracts and YAG laser, through patient choice. We see around 500,000 glaucoma patients a year. From an optometrist perspective, these are the types of conditions you want your patients to be well-managed and seen quickly for. It’s not always just the surgical element – it may be that you have multiple conditions that need to be managed at once, and that’s our primary concern.

Amir Hamid (AH), consultant ophthalmic surgeon and medical director at Optegra Eye Health Care: We’ve been very successful in addressing the backlog. Certainly, in cataract surgery, that has been a huge success story. Ophthalmics is the only speciality in the NHS where waiting lists have been considerably reduced since the pandemic.  More and more, we're looking at other ways to help support the NHS – not just cataract surgery, but glaucoma care and macular degeneration. We are enabling care to be delivered close to where patients live, with short wait times and excellent outcomes. I think the whole independent sector is looking for ways to help the NHS.

By investing in resources to help with cataracts, independent providers are helping the NHS devote its resources to other priority areas.

With some private providers, there has been criticism of taking on the straightforward work – for example, quick cataract operations – while leaving more complex cases to the NHS. What would you say to that kind of criticism?

JB: From our perspective, our data is indicative of the fact that we are seeing complex patients. We consistently monitor the complexity of patients we are seeing through our Clinical Governance Steering Groups. These are patients with multiple comorbidities, whom we treat irrespective of those circumstances. On the rare occasion CHEC is unable to treat a patient, it is generally because of general anaesthesia requirements, where it is wholly appropriate to be carried out in an acute setting.

AH: When contracts are awarded to the independent sector, we are not allowed to be selective about cases. In terms of complex cataracts, it is a very small minority of patients where we say ‘It is not suitable for you to have surgery with Optegra.’ Most of the time, when that is the case, it is because we are an isolated site and we don’t have general anaesthesia.

There doesn’t have to be this adversarial relationship between the independent sector and the NHS. To the patient, it doesn’t really matter to them who provides treatment – whether it is a public institution or independent provider. The NHS has served us very well, but things change. We can’t have the same health service that we had 50 years ago. We have to think about different ways of delivering care. We believe that if we deliver the best results for our patients, everything else will follow. If the patient gets a great result, they’re happy and it’s done in a way that is cost effective for the nation – I can’t see why that would be a problem.

Workforce problems within ophthalmology are a key issue at the moment, including ophthalmologists being drawn into private providers from the NHS. How would you respond to those concerns?

JB: Invariably, there is crossover, with ophthalmologists working across both the independent sector and the NHS, and that's been the norm for quite a considerable length of time. I don’t think it is generally in the wake of workforce pressures.

From our perspective, we offer speciality and surgical training. Everything we do is with consideration for not taking workforce from our partners in the NHS. You will get a crossover of consultants, but we employ multiple doctors and surgeons across our portfolio to avoid taking needed resources from the NHS. It is important to note though that clinicians’ and professionals’ movement is generally a result of opportunities and better conditions – and that is not just secular to ophthalmology.

AH: Our data shows that only 5% of our staff come directly from the NHS. At Optegra, we train our own healthcare technicians, run a junior doctor training initiative to support colleagues in the NHS and have also started a fellowship training system for people who want to do high-volume cataract surgeries as a specialty.