Policy briefing: Patient choice in elective eye care

What has been published

IPSOS and Policy Partners have published research that looks at patient choice and how it is delivered in the NHS and associated areas of care.

The work, Patient choice in elective eye care, was funded through NHS England and commissioned by North Central London’s Single Point of Access (SPoA) service, hosted at Moorfields Eye Hospital NHS Foundation Trust.

NHS choice is a legal right enshrined within the NHS Constitution. This research looks at patient views on what is important when patients make a choice. The approach taken by the research partners was one of “deliberative engagement”, where representatives of the wider population were engaged with over an extended period to understand public views.

The AOP was a member of the oversight group for this work, but was not involved in the data gathering, appraisal or conclusions that were set out in the research findings.

‘Quality of care’ is cited as a common patient driver of choice in the research. This includes ‘waiting times’, ‘ease of aftercare’, ‘convenience/flexibility of appointments’, and ‘location/travel.’ Less common, but still valued, drivers of choice cited in the research are ‘information on outcomes,’ ‘CQC ratings’ and the ‘type of provider (eg NHS or independent provider).’

In the report, the research partners set out 15 ‘expectations’ from healthcare providers to facilitate choice in decision making in elective eye care. These include:

• “Patients must always be informed that they have a choice, if available, and be able to express a preference, including the choice not to choose. Triage should be explained, and options may change after triage.” 
• “Patients must always be given the pros and cons of each provider.”
• “There is a role for automated support tools (including AI driven tools) to deliver information to patients, but these should never be used to deliver clinical guidance or without appropriate testing. There should always be an option to speak to a human when using such tools.”
• “Those patients who want it should be given a shortlist of up to five providers based on their preferences (prompted by a list) and what is in their best interest.”
• “Information (i.e. about waiting times and outcomes) must be accurate and up-to date.”
• “The decision should never be made for a patient without involving the patient, unless the patient explicitly states that they do not want to be involved, or they don’t have capacity to decide, or it’s an emergency.”
• “Money should never be the driving factor behind the provider a patient is referred to (i.e. an optometrist referring to a specific provider because they get a fee or are affiliated). Fees associated with referrals should be reported and monitored/regulated.”

The authors of the report conclude that when it comes to patient choice, “one size does not fit all.” They highlight the importance of clear communication, including updates to ensure that patients understand what is happening to them and what the next steps look like. The report also says that patients need time and information to make informed choices; support should be prioritised for those in most need and that information should be widely accessible.

What do we say

We welcome this report and the insights that it brings. Patient choice in the NHS is a subject where views can vary widely, and at times these views are heavily based on anecdotal evidence rather than research and analysis. This report provides qualitative data, based on in-person workshops with 65 members of the public, that shows the importance of patient choice and outlines ‘15 expectations’ for healthcare providers.

The points raised about the need for “fairness, equity and support for patients”, alongside the need for clear information, are important. They highlight the value of the work of optometrists to reassure and explain procedures to patients and help them decide about where their care can be best delivered.

Additionally, the report provides valuable clarity for optometrists about the public’s view on waiting for an appointment and the weight they place on ‘certainty’ that the appointment will take place. In other words, patients are, at times, content to wait longer for an appointment if they have certainty that the appointment won’t be cancelled or rearranged at the last minute. This is closely linked to the duration of wait and the impact this has; for example, waiting a couple of weeks after a cancellation can reasonably be expected to affect a patient differently to a wait of six months. The research confirms what our members have told us for some time; that waiting time and the reassurance that patients will be seen promptly are key factors and they explain the referral patterns, in particular for cataract appointments, that we are seeing.

Looking more widely, the report highlights several key factors that demonstrate why optometry practices are the right choice for moving eye care services out of a secondary care setting. Not only are waiting lists rare in optometry settings, but location, flexibility and travel time are also key drivers of choice for patients. Optometry practices, located on the High Street, are far more accessible than hospitals. It should be noted that this research focussed on 65 patients in London: a high-density urban area with the most comprehensive public transport system within the UK. As the report notes, “one size does not fit all”, and what works in London will be different from what works in rural parts of the country.

It is disappointing that this report raises the recent issue around fees paid to optometrists who provide post-surgical aftercare on behalf of the NHS. This argument conflates key issues and is not underpinned by the evidence; indeed, we go further and say it risks damaging public confidence in optometrists. In our view, the research could have provided some clarification in this area and dispelled, rather than embed, this myth.

It is clear from this report that optometrists do and should continue to play a critical role in the referral process. Optometry adds much needed and much valued face-to-face interaction with the public. Optometry can also help the NHS to deliver what patients clearly value: accessible, timely, expert care.