Expanding capacity and patient choice: the new NHS agreement with the independent sector

The NHS has formed a new agreement with the independent sector to expand capacity and widen patient choice.

The agreement was published alongside the government and NHS’s elective reform plan last week.

The NHS and independent sector partnership agreement sets out how independent sector capacity could be used to address waiting lists.

Some of the specialisms with the longest waiting lists, such as gynaecology and orthopaedics, are key focuses.

The partnership forms part of the government’s ambition to meet the NHS constitutional standard that 92% of patients in England wait no longer than 18 weeks from referral to treatment.

The commitment will include work to align NHS and independent sector digital systems around a national set of standards.

The partnership also encourages longer-term contractual relationships to enable further independent sector investment in NHS capacity, and to work together to grow and develop the elective workforce.

Prime Minister Keir Starmer suggested this would ensure “working people get greater choice over when and where they receive their treatment, and provide more support to the areas in greatest need.”

Delivering more services to a wider range of patients

SpaMedica welcomed the new agreement, with Tom Fellows, head of policy and value proposition, calling it a “significant step forward in creating a more accessible, efficient and patient-centric ophthalmology service.”

He added: “It means that we can continue to build on our partnership with the NHS to deliver more services to a wider range of patients.”

Independent service providers (ISPs) can provide capacity to tackle waiting lists, Fellows said, particularly for high-demand procedures such as cataract surgery.

Describing the “positive effects in action” of partnership between the NHS and ISPs, he pointed out that cataract patients with SpaMedica typically wait four to eight weeks for treatment, compared to a national benchmark of 18 weeks. All patients with age-related macular degeneration are contacted by SpaMedica within 14 days of referral.

A dedicated 24/7 helpline is available to any patients who experience post-operative complications, Fellows added, through which SpaMedica can provide support.

“With almost 600,000 patients still on the NHS waiting list for ophthalmology, we believe this partnership agreement will encourage commissioners to fully utilise the capacity and capabilities that exist within the independent sector,” Fellows commented.

For SpaMedica, this means commissioning more services to support increasing access for a wider range of patients suffering from a wider range of conditions.

Meeting the growing demand for eye care

Imran Rahman, consultant ophthalmologist and chief executive officer of CHEC, told OT that the new agreement is “one we’ve been hoping would come to fruition for some time.”

CHEC has been a partner to the NHS for more than 12 years, providing treatment for ophthalmology services within four weeks of referral, Rahman shared.

“There is extraordinarily high – and continually growing – demand for quality eye care in the UK, and the NHS may currently not be in a position to cater for it alone knowing that increasing demands will be coming through an ageing population,” he said.

An integrated model, working with independent ophthalmology providers, offers alternative routes to care and provides additional capacity and resource, he suggested, alleviating pressure on NHS services and increasing equity of access to care.

Collaboration between sectors presents an opportunity to improve knowledge-sharing and skill building, supporting an overall higher standard of care, Rahman said.

“With the official partnership agreement in place, the true value of collaboration between the NHS and the independent sector can be realised, and we can work together to improve the quality of life of all patients requiring ophthalmology,” he said.

More can be done to ensure a long-term sustainable model in this area of healthcare, Rahman suggested.

He proposed: “Not only can independent providers help by offering more common services including cataract and glaucoma surgeries, but many – like CHEC – offer more specialist solutions for complex issues, such as vitreoretinal surgery and minimally invasive glaucoma surgery.”

With the official partnership agreement in place, the true value of collaboration between the NHS and the independent sector can be realised

Enabling patient choice

Alastair Stuart, medical director at Optegra, said: “The new agreement will allow patients more choice as to how and where they access their eye care, and Optegra is committed to ensuring patients can be seen and treated swiftly, at a location convenient to them.”

Optegra has seen its services grow from carrying out 3000 NHS cataract operations before the pandemic, to more than 50,000 in 2024.

“The increased involvement of the ISP in eye care has made a huge impact on waiting lists within ophthalmology in this time,” Stuart said.

He added: “However in certain areas of the UK, waiting lists for cataract surgery are still unacceptably long. We hope that the agreement will allow more patients in eye healthcare deprived areas to access care promptly and safely.”

Stuart told OT that, with eye care needs of patients differing across the UK: “We hope that this agreement will allow commissioners to make decisions to target these differing needs and involve both the ISP and the NHS providers in making these decisions.”

A springboard for addressing preventable sight loss

Newmedica managing director, Rebecca Lythe, explained that the provider would be signing up to the agreement, describing it as “good news for patients and the health service.”

The agreement could also act as a “springboard” to working on preventable sight loss and chronic disease management, she suggested.

Newmedica provides a breadth of NHS ophthalmology services and is trialling the reduction of clinical exclusion criteria.

“We strive to see more patients and ensure no-one is left behind,” Lythe said.

Training forms a key part of the agreement, and Newmedica suggests this is a focus for the provider.

Bespoke in-house and external programmes support clinicians, managers, and support colleagues, Lythe said, while continuing professional development opportunities are offered to healthcare professionals not employed by Newmedica.

In addition, the provider has a growing training programme for resident doctors, nurses, optometrists, consultants and technicians in theatre and clinic.

Unintended consequences a concern

The Royal College of Ophthalmologists described it as “right” that the government is refocusing efforts on tackling backlogs for planned care but emphasised that the approach “must prioritise those waiting for follow-up appointments, not just first appointments with a consultant.”

More than 600,000 patients in England are waiting to see an ophthalmologist, with more than a third waiting beyond the 18-week target.

Ben Burton, president of The Royal College of Ophthalmologists, shared: “This figure is dwarfed, however, by the number who are waiting for follow-up appointments for sight threatening conditions – estimated at 10,000 per NHS trust, the most of any specialty.”

Burton suggested that previous programmes have overly incentivised a focus on clinical volume, which has seen a “huge uptick in cataract surgeries,” with ISPs performing more than half of these.

The additional capacity has helped to bring down cataract waits, but Burton described concerns about “unintended consequences.”

He shared: “Investing so much scarce resource into treating cataracts – a reversible, relatively low-risk condition – in the independent sector has led to funding, workforce, and infrastructure being diverted here at the expense of resourcing for conditions such as glaucoma that, while being more complicated to treat, can cause irreversible sight loss if not treated swiftly.”

The agreement provides clarity on how NHS England plans to work with the independent sector, the professional body suggested, but shared: “We feel an investigation of how independent sector capacity can best be commissioned and an evaluation of how tariff structures can better incentivise the prioritisation of follow-up pathways are urgently needed.”

The body suggested that England should follow the example of Wales by requiring trusts to report on risk rating.

Burton welcomed NHS England’s commitment to working with ISPs to ensure training opportunities are available where needed.

Cost-effective interventions, increased services, and a commitment to training

Reflecting on these concerns, the independent providers of ophthalmology services highlighted the impact of cataract surgery, for the NHS and for patients.

SpaMedica’s Tom Fellows, commented: “Cataract surgery remains one of the most cost-effective interventions in the NHS.”

Patients with cataracts are at higher risk of falls and other accidents in the home and can become reliant on others and isolated, he said.

“Cataract surgery can drastically improve patients’ quality of life at a low cost to the NHS, especially compared to other common interventions such as hip and knee replacements, which cost many thousands for each procedure,” he added.

SpaMedica is reducing exclusions to its services, increasing the types of patients the provider can accept and therefore widening access.

In addition, Fellows said: “We are also investing in other ophthalmology services to expand our offer – something the NHS England IS Partnership Agreement explicitly asks for providers to do.”

Cataract surgery can drastically improve patients’ quality of life at a low cost to the NHS

Alastair Stuart at Optegra also highlighted that the provider is not solely focused on providing cataract surgery.

He shared: “We provide 10,000 NHS AMD treatments a year and have just rolled out our first glaucoma service in our Manchester hospital that will help to reduce the waiting list for routine glaucoma follow up appointments in the UK.”

Acknowledging the need for ISPs to be involved in training, Stuart noted that this is also his priority as the new medical director for Optegra.

The provider currently has six junior doctor placements and plans to increase this number in 2025.

CHEC’s Imran Rahman reflected: “Ultimately, we want to achieve a successful partnership approach that ensures quality of access and short referral to treatment times for all ophthalmology services.”

Timely treatment reduces the potential for complications or complexities of eye conditions, as well as related trips and falls and the potential mental health effects patients might experience.

Ultimately, we want to achieve a successful partnership approach that ensures quality of access and short referral to treatment times for all ophthalmology services

“At CHEC we are curating the workforce, hospital estate and agility in our operations to respond to the NHS’ long-term plans to help minimise this risk,” he said.

Talking to OT, Rahman shared: “Moving forward, we would want to see continued prioritisation of all acute and chronic conditions, such as glaucoma, a condition where we know that if we can ensure early treatment to slow the progression of the disease, we can prevent vision loss.

“The system has to change to a solution fit for the future of healthcare. The partnership agreement is a big step in shaping an improved integrated healthcare system.”

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