Diagnostic centres need investment if eye care waiting lists are to reduce, Royal College of Ophthalmologists president says

Diagnostic centres will need investment if they are to assist in bringing the eye care waiting lists down, Royal College of Ophthalmologists president Professor Ben Burton told attendees during the Labour Party Conference on 29 September.

There are already well-established and cost-effective models for how eye care can move into the community, including the diagnostic services provided by Moorfields Eye Hospital at Brent Cross Shopping Centre in North London, Burton said.

He also shared his concerns around the number of private providers taking on cataract surgeries, calling the current state of cataract commissioning “a wasteful mess.”

Speaking about eye care moving into the community, Burton said: “If we don’t invest in the NHS to set this up, and instead rely on false patient choice promises, driving privatisation, then we will end up with an unconnected, fragmented community service, duplication of activity and unnecessary work being done, with costs out of control.”

He added: “There will be a prioritisation of care driven by profit margin and not by patient need.”

Burton referenced a Sunday Times investigation into cataract providers, which was carried out earlier this year. The AOP provided a response to the article at the time, as well as publishing a summary addressing key points raised in the report.

The Royal College of Ophthalmologists is calling for differential tariffs for NHS and private providers, Burton said.

The NHS could then “reinvest a fraction of the money saved to set up high-flow diagnostic and monitoring centres across the country, run by the NHS in the community,” he added.

Burton also expressed the need for the creation of an eye care board, “with powers to direct eye care and to get the best outcomes for our patients, as well as make the best use of resources.”

This is how ophthalmology can assist in achieving the Government’s aim of moving care into the community, Burton believes.

Why primary care integration is key to the left shift

Burton was speaking as part of the From Hospital to Community: Transforming the patient experience panel during the conference fringe, alongside representatives from Roche, The King’s Fund, National Voices and Asthma + Lung UK. The event was organised by the Health & Care Forum.

Dr Simon Opher MBE, MP for Stroud and chair of the All-Party Parliamentary Group on Health, was also speaking on the panel.

Opher, a former GP, noted that avoiding the political pressure to focus resources on hospitals is a challenge and a “difficult sell” when trying to get the public on board.

The NHS must invest in “integrating community care with general practice,” Opher believes.

Opher is excited about the prospect of a neighbourhood health service, and about the prospect of getting pharmacy, dentistry and the voluntary sector involved, he said.

Primary care practitioners must share patient care and work as a team, with a neighbourhood health centre at the core, he added.

Kate Rowbotham, UK General Manager at Roche, agreed that a successful shift to care in the community will only come from improving relationships.

“The shift that has been proposed is going to be challenging, and it’s not going to be achieved by one party. It’s going to take partnership,” Rowbotham said.

Roche is committed to partnering with peer organisations, NHS providers, the Government, patient groups, voluntary organisations, and with patients, to help make the shift, she said.

Roche is part of The Eyes Have It, the lobbying group for eye care within the Westminster parliament, of which the AOP and the Royal College of Ophthalmologists are also members.

The role of technology

Burton noted that one of the biggest problems that eye care practitioners encounter is IT integration.

He used the example of optical coherence tomography not working effectively when interoperability between primary and secondary care is so poor.

"When an optometrist sees a patient and does a scan of the retina, and then thinks that they need to come to the hospital, they send us a picture,” Burto explained.

“We might get a photocopy, and it might get printed out in black and white. We don’t have an electronic copy; we’ve seen one slice of the 32 slices [of the retina], and then we’re expect to make a decision about that, and can’t.”

Burton described the lack of connectivity as “a complete, hopeless mess.”

Duplication of work that comes from poor technology is a problem too, Burton explained.

“It may well be something that we saw a month earlier, but because they [the patient] saw a different optometrist, they don’t know that we’ve already seen them,” he said.

He added: “It takes 10 minutes of consultant time to turn the computer on and get the electronic health record to work on, so we can find it.”

Burton emphasised: “There are huge IT problems that are causing massive inefficiencies within the system, and duplication of work.”

Sarah Sleet, chief executive of Asthma + Lung UK, noted that the health sector often fails to look at “the whole person” – and often this is partly the fault of the technology used.

“Unfortunately, the system doesn’t quite organise itself in an integrated way that looks at that person as a whole person,” Sleet said.

“We really need to tackle that, and I think it can only be done in community, because that is where you see the whole person’s life, rather than in hospital, where they tend to come in with a condition that needs to be dealt with by a specialist.”