Empowering clinicians is key to transforming eye care services | HSJ Partners

ByMartha R. Camara

Aug 1, 2022

The health and care system is entering a new era as integrated care systems and legislative reform create new opportunities for organizations to work together to improve local services.1 These challenges will be familiar to HSJ readers: tackling the elective backlog; dealing with the labor crisis2; and a £9 billion backlog for maintenance of buildings and equipment.3

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The challenges are particularly acute for people with eye conditions, including sight-threatening macular disease which affects nearly 1.5 million people in the UK.4 This figure is expected to rise, with the number of patients with wet age-related macular degeneration expected to increase by 60% between 2015 and 2035.5 With more than three quarters of eye care units in the UK reporting unfilled consultant vacancies,6 demand will continue to exceed capacity.

As a result of these challenges, almost 650,000 patients are waiting to start eye treatment in Englandseven, not to mention those waiting for follow-up appointments. For conditions such as wet AMD, treatment delays can lead to rapid and irreversible deterioration of vision.8 Indeed, across all eye care, up to 22 patients per month lose their sight due to health service-initiated delays.9

Several national initiatives have begun to address the challenge, including the establishment of a national eye care recovery and transformation agendatena Getting It Right First Time work stream and the creation of a new national clinical director for eye care.11 The Macular Society has also mapped out how to bring it all together through the creation of a National Eye Care Strategy.12

While national policy is welcome, at Bayer we know from numerous joint working projects with NHS organizations that the most impactful changes happen at the frontline, with clinical involvement at the forefront. For example, Bayer recently completed a project with the Newcastle Upon Tyne Hospitals Foundation Trust to redesign and transform an existing vacant day room into a virtual hub, enabling rapid access to high-volume imaging.13 We also support clinician-led research on streamlining services, for example using in-home optical coherence tomography monitoring, which benefits both patients and clinicians through reduced clinic visits.

As CSIs are now responsible for organizing the delivery of health services, they need to involve ophthalmologists and others in decision-making about changes in service design, pathways and treatment delivery. Indeed, NHS England guidelines make it clear that CNSs should involve clinical and caring professionals in decision-making “at all levels of their system”.14 This will be necessary, for example, for the deployment of community diagnostic centers, better use of optometry in primary care and the expansion of virtual clinics.15

Clinicians face significant and competing demands on their time. However, active engagement in system-level discussions, for example through system eye care delivery groups where they exist, can help reduce the risk of top-down changes being imposed with unintended consequences. For systems to fulfill their duties to improve the health of populations and reduce health inequalities, the involvement of clinical and caring professionals in the planning of eye care services is non-negotiable.

Work bag number: PP-PF-OPHT-GB-0744

Preparation date: July 2022


1. The Health Foundation, Health and Care Act is passed but leaves unfinished business for the NHS and social services (2022). Available at: https://www.health.org.uk/news-and-comment/news/health-and-care-act-passes-but-leaves-unfinished-business-for-the-nhs-and-social -care. Last access: July 2022

2. The King’s Fund responds to the Health and Social Care Committee report on clearing the backlog (2022). Available at: https://www.kingsfund.org.uk/press/press-releases/kings-fund-responds-health-social-care-committees-report-clearing-backlog. Last access: July 2022

3. The King’s Fund, The latest in the NHS field (2021). Available at: https://www.kingsfund.org.uk/blog/2021/10/latest-nhs-estate. Last access: July 2022

4. Macular Society, nearly 1.5 million people in the UK are affected by macular disease (2018). Available at: https://www.macularsociety.org/about/media/news/nearly-15m-people-uk-are-affected-macular-disease/. Last access: July 2022

5. Royal College of Ophthalmologists, The Way Forward, Options to help meet demand for the current and future care of patients with eye disease (2017). Available at: https://www.rcophth.ac.uk/wp-content/uploads/2021/12/RCophth-The-Way-Forward-AMD-300117.pdf. Last access: July 2022

6. Royal College of Ophthalmologists, Workforce Census 2018 (2020). Available at https://www.rcophth.ac.uk/wp-content/uploads/2020/05/RCophth-Workforce-Census-2018.pdf. Last access: July 2022

7. NHS England, Consultant-led Referral to Treatment Waiting Times Data 2022-23, Waiting Times by Hospital Trust April 2022. https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting- times/rtt-data-2022-23/. Last access: June 2022

8. National Institute for Health and Care Excellence, Serious Eye Disorders (2019). Available at: https://www.nice.org.uk/guidance/qs180. Last access: July 2022

9. Royal College of Ophthalmologists, BOSU report shows patients losing sight due to delays in follow-up appointments (2017). Available at: https://www.rcophth.ac.uk/news-views/bosu-report-losing-sight-delays/?/. Last access: July 2022

10. Local Optical Committee Support Unit, National Eye Care Recovery and Transformation Program (2021). Available at: https://tinyurl.com/2t3h26ys. Last access: July 2022

11. The Macular Society, New NHS role could help transform eye services (2021). Available at: https://www.macularsociety.org/about/media/news/new-nhs-role-could-help-transform-eye-services/. Last access: June 2022

12. NHS Confederation, Eye care services: an urgent call for reform (2022). Available at: https://www.nhsconfed.org/articles/eye-care-services-urgent-call-reformation. Last access: July 2022

13. Bayer, Joint Working Summary (2021). Available at: https://www.bayer.co.uk/sites/bayer_co_uk/files/JW_Executive_Summary_Newcastle_Diagnostic_Hub.V2.pdf. Last access: July 2022

14. NHS England, building strong integrated care systems everywhere: ICS implementation guidance on effective clinical and healthcare professional leadership (2021). Available at: https://www.england.nhs.uk/wp-content/uploads/2021/06/B0664-ics-clinical-and-care-professional-leadership.pdf. Last access: July 2022

15. Busch et al, General Health of Patients with Diabetic Macular Edema – The LIPSIA Study. Available at: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252321. Last access: July 2022