AOP responds to Sunday Times investigation into independent cataract surgery providers

The AOP has highlighted the role of optometrists in the journey of a cataract patient, particularly in the value of aftercare appointments following surgery.

The policy briefing Cataract surgery and independent sector providers was issued following a Sunday Times article on 20 April reporting on concerns regarding independent sector providers delivering NHS cataract surgery.

The Sunday Times reports that clinics face investigation over artificially inflated costs for the taxpayer, claims regarding the performance of unnecessary operations, and that private clinics have incentivised High Street optometrists to refer patients to their services.

In response, the AOP has stated: “The claims contained within the Sunday Times article are confused and the article draws certain conclusions based upon assumptions.”

The AOP has published a summary addressing key points raised in the report regarding the necessity of cataract surgery follow-up appointments, patient choice, fees and payment, the discussions of referral destinations with patients, and referral letters.

Suggesting that a follow-up appointment after cataract surgery forms a normal part of aftercare, the AOP shared that these appointments also enable data regarding the outcome of the surgery to be gathered for the National Ophthalmic Database.

While these appointments were historically conducted in the hospital setting, and in many cases still are, the AOP noted: “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 a key role in providing aftercare for cataract patients, amidst pressure on the NHS and growing waiting lists, ensuring patients receive timely eye care, closer to home, while releasing capacity in hospital eye departments, the AOP suggested.

The association pointed to the value of community-based cataract pathways as outlined in the AOP’s jointly-commissioned report from PA Consulting, and argued that the approach is supported by Healthwatch England’s recent report which calls for greater use of community eye care.

The AOP noted that the Sunday Times article refers to a statistic that suggests ‘only 3-7% of cataract surgery requires a follow-up,’ however, the association has suggested 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,” the AOP shared in its statement.

The AOP shared: “We therefore maintain that follow-up appointments are necessary and should remain as part of the overall healthcare package for cataract patients.”

On the topic of supporting patient choice of provider for cataract surgery, the AOP shared: “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.”

The AOP emphasised its “strong” opposition to “any practice among the medical professions which puts political ideology over patient choice,” and that it does not support fees that may be used to encourage referrals to specific providers.

Outlining the role of optometrists in providing a service for the public and the NHS, the AOP noted: “It is essential that the profession is paid for its time and clinical skills.”

Waiting times are a major factor when it comes to a patient’s decision on referral destination and up-to-date, quality data is key to this. The AOP shared: “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.”

Independent providers ensure that the latest waiting list data is available, the AOP noted, suggesting that for many NHS hospital sites this information is not provided, not available, or can be outdated.

“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,” the AOP shared, adding: "This challenge has been raised by many local optical committees with their local hospitals, with mixed success.”

In response to concerns raised in the Sunday Times article regarding the potential for pre-populated referral forms to restrict patient choice, the AOP recognised that practices use a range of pre-designed templates and stated: “We see no evidence that this hinders patient choice.”

Discussing referral letters, the AOP emphasised: “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.”

The association argued: “Including such information would distract from and potentially diminish the important clinical information that the referral letter contains.”

Find the full briefing on the AOP’s website.