Policy briefing: Cataract surgery and independent sector providers

What has been published?

The Sunday Times published an article on 20 April 2025 looking at ‘private’ cataract clinics delivering NHS cataract surgery. Within the piece it was suggested that these clinics faced investigation over artificially inflated costs for the taxpayer and claimed that the providers were performing unnecessary operations and were incentivising High Street optometrists to refer patients to their services.

The Sunday Times suggests that the NHS Counter Fraud Authority has been called in to examine potential billing authorities. The article also refers to a report by the Centre for Health and the Public Interest (CHPI), which criticises the regulation within the NHS and alleges that optometrists are referring patients without oversight by the NHS and doing so in return for being paid for follow up care.

What do we say?

The claims contained within the Sunday Times article are confused and the article draws certain conclusions based upon assumptions.

1. Necessary appointments

Following cataract surgery, it is normal for patients to receive a follow up appointment as part of their aftercare. This check ensures all is well, but also provides an opportunity for the patient to ask questions, raise any concerns that they may have and allows data around the outcome of the surgery to be gathered and submitted to the National Ophthalmic Database which can help patients and the NHS to gauge the quality of the different providers in their area.

Historically, follow-up appointments after cataract surgery have been conducted within the hospital setting, usually by an ophthalmologist. In many instances they still are. However, some providers of cataract surgery, including NHS hospitals, have turned to optometry to provide these follow ups due to the significant pressures that they face in terms of patient numbers, waiting times and capacity challenges within their own workforce. In some cases, these shortages relate directly to the number of NHS ophthalmologists now working in private practice.

Optometry has taken on an important role in providing after-care for cataract patients and that this is helping patients receive timely, specialist eye care closer to home. It is also releasing capacity in hospital eye departments, so that the patients with more complex conditions have access to an ophthalmologist. The significant value of community-based cataract pathways is demonstrated in our jointly commissioned report from PA Consulting Key Interventions to Transform Eye Care & Eye Health. This community based approach is also supported by Healthwatch England in the recent report A strain on sight: waiting for NHS specialist eyecare which calls for greater use of community eye care teams to cut waiting times, and highlights the value patients put on High Street optometry.

The article includes the statistic that ‘only 3-7% of cataract surgery requires a follow up.’ We think this risks confusing two issues, while the risk of sight loss following cataract surgery may be small, for those patients who are concerned, there is little solace in knowing they are at low risk, but there is significant benefit in seeing a qualified professional who can explain, reassure and counsel them about how best to proceed. We therefore maintain that follow up appointments are necessary and should remain as part of the overall healthcare package for cataract patients.

2. Patient choice

The NHS constitution enshrines the importance of patient choice, and the Secretary of State for Health and Social Care has reiterated the government’s support for this principle. Optometry is committed to ensuring that patients are able to make the decision around where they are referred to, whenever it is possible to do so. We strongly oppose any practice among the medical professions which puts political ideology over patient choice.

3. Fees and payment

We do not support fees that might be used to encourage referrals to be made to specific providers, but it is essential that the profession is paid for its time and clinical skills. Our members provide a service for the public and NHS that releases capacity in hospital eye departments.

In the case of cataract, the service broadly comprises two parts: the ‘pre-cataract’ pathway, designed to ensure that patients who are referred are both suitable and willing to undergo surgery, which significantly reduces the number of hospital appointments where patients decline surgical treatment; and the ‘post surgery’ check up, which is an appointment that ensures the patient is seeing well, the surgery is settling well, checks for any signs of complication that the patient may be unaware of, and provides an opportunity to reassure the patient and answer any questions.

4. Referrals discussions and data

Optometrists routinely discuss referral destination with their patients. Our members tell us that the main factor that influences a patient’s choice of provider for their cataract surgery is how quickly they will be seen. Therefore, the quality of data that is accessible to optometrists is a critical factor. Independent providers ensure that the latest waiting list data is available. However, for many NHS hospital sites, this information is not provided, is out of date, or not available. When patients ask where they will be seen the soonest, the only reliable waiting time information available favours the independent sector providers. We accept that in some areas, most referrals go to the independent sector providers who hold contracts for NHS cataract work and this waiting list data is likely a factor. This challenge has been raised by many local optical committees with their local hospitals, with mixed success.

5. Referral letters

The Sunday Times article asserts that patient choice is being stifled by pre-populated referral forms “a High-Street Optometrist in London had their own referral letters pre-printed". To clarify, we recognise that practices use a range of pre-designed templates for referral letters or a PDF form that inserts the name of providers and we see no evidence that this hinders patient choice.

There is also the suggestion that the style of referral letter does not reflect that a choice conversation took place and therefore does not ensure patient choice. This is simply wrong; a referral made by an optometrist, regardless of destination, reflects the outcome of any patient choice discussion, but it does not need to repeat that discussion within the letter. Including such information would distract from and potentially diminish the important clinical information that the referral letter contains.