Policy briefing: reforming elective care for patients

What has been announced?

The Department of Health and Social Care (DHSC) in conjunction with NHS England has published its plan to reform elective care by March 2029. It includes measures to reorganise a broad range of planned, non-emergency services from tests and scans to outpatient appointments, surgery and cancer treatment.

The NHS has a target that 92% of patients should wait no longer than 18 weeks from the point of referral to treatment, but currently many patients (2/5ths) wait far longer than this. NHS England has committed to meeting the 18 weeks standard for 65% of patients nationally by March 2026 with every trust delivering a five percentage point improvement by March 2026, with further year on year improvements to ensure the 92% target is met by 2029. NHS England are also expecting elective care reform in at least five  specialities – ENT, gastroenterology, respiratory, urology and cardiology.

With the goal of increasing NHS productivity, 17 new and expanded surgical hubs will be provided by June 2025. Community diagnostic centres (CDCs) will also open 12 hours per day seven days a week to deliver faster, widespread access to tests and consultations. Direct referral from primary and community care will be better enabled, with 10 ‘straight to test’ pathways implemented by March 2026. In addition, more contracts with the independent sector will be put in place to help tackle waiting list challenges, and more patients will be given the option of accessible follow-up-care – to include remote consultations, remote monitoring and digital support for patient-initiated follow-up (PIFU). Initiatives to tackle missed appointments are also being proposed, such as overbooking approaches to avoid wasted appointments.

NHS England has also committed to ensuring that both primary and secondary care are funded to deliver Advice and Guidance (A&G). GPs will receive £20 per A&G request to recognise the work required and the importance of their involvement in the process. There will also be quality reward arrangements put in place to reflect activity targets in funding allocations and to incentivise providers who improve the most.

Wider improvements to digital and data include upgrades to the NHS app. The proposed changes will allow patients to self-manage referrals, the use of digital patient engagement portals (PEPs), expanding the federated data platform (FDP) to consolidate systems and developing the NHS e-RS referral platform.

What do we say?

We note that ophthalmology did not feature in the five main specialities that the elective reform plan will seek to tackle, yet it remains one of the busiest outpatient specialities by volume of appointments. Patients with eye problems are often elderly, and poor vision can mean that they are at an increased risk of falls, which in turn potentially adds to the trauma and orthopaedic waiting lists that are in five specialities that have been identified.

We welcome the commitment to fixing the NHS by tackling waiting lists and moving care from hospital to the community. However, while CDCs and surgical hubs may add value for other areas of healthcare, for ophthalmology and optometry it feels like an unnecessary expense and a potential missed opportunity.

We have long argued that within the optometry sector there resides a large, underutilised diagnostic and treatment capacity. OCT scanners can be used to help avoid referrals and to streamline initial diagnosis. Minor and urgent eye care services provide treatment by highly skilled optometrists who can resolve the majority of eye conditions at first point of contact.

Duplicating the existing optometry estate in a diagnostic hub setting is inefficient and a waste of the constrained NHS resource. If the existing optometry estate is utilised and funded correctly, optometrists can make a significant contribution to tackling waiting lists. We recently published research conducted by PA Consulting showing that optometry can help to deliver a 1.9m reduction in NHS appointments in a way that also saves the NHS money.

Looking to A&G, it is reassuring to see that GP colleagues will be funded for the important part that they play in this process, but it is essential that this funding is also made available to the wider primary care professions; optometrists, pharmacists and dentists have a vital role to play in helping to avoid referrals by utilising advice and guidance. The current NHS optometry funding in England is insufficient to deliver any A&G service without additional revenue streams to support it. This is a missed opportunity.

Optometry and ophthalmology are data rich professions, but the proposed improvements to digital and data will be hamstrung if optometry is not included. For example, fully funded access to e-RS for all optometry practices could release widespread efficiencies across primary and secondary care. In recent years, practices have seen many short-term electronic referral systems imposed upon them, but these have rarely been sufficiently funded. A move to a national system is sensible and logical, but optometry practices must not be forgotten.