As heads of service at the Birmingham & Midland Eye Centre (BMEC), we are acutely aware of the increasing waiting lists and have been planning for the anticipated surge in COVID-19 related demand over the last 12 months. However, the resurgence of COVID-19 due to the highly transmissible omicron variant has placed our services under considerable pressure since the beginning of 2022, with the levels of absence due to sickness in our departments being the highest we have experienced since the start of the pandemic.
Regrettably, COVID-19 related sickness absence has resulted in, and continues to result in, patient appointment cancellations, and we continue to work hard to reschedule appointments and minimise disruption to our patients. The change in self-isolation guidance does not appear to have alleviated the pressure that we face, in particular on our paediatric and contact lens services.
In order to address the above challenges, we are extremely fortunate that our trust is supporting our services with premium rate clinics, giving our experienced colleagues the opportunity to work evenings and weekends. The impact on the paediatric waiting list has been very positive and this model of delivery will be extended to other aspects of the service.
While we focus on continuing to address our waiting lists and more complex patients who need to be seen in the hospital eye service (HES), we are reliant on the support of our community optometrists to manage less complex cases and to undertake referral refinement prior to referral to the HES
Adapting and responding
The National Eye Care Recovery and Transformation Programme outlines steps towards recovery plans, whilst also recognising that ophthalmology accounts for the highest volume of outpatient specialty, with approximately 10% of the NHS treatment backlog being in eye care.
In line with Getting it right first time (GIRFT) guidance, the BMEC is establishing a diagnostic hub to provide staff, equipment and an environment that facilitates high volume, high quality, and comprehensive diagnostics, in line with the need to change the emphasis from face-to-face to virtual review.
There is an opportunity for optometrists, orthoptists, nurses and vision scientists to develop their skills in order to support medical colleagues to manage these backlogs, while dealing with growing demand in the big sub-specialties of glaucoma, medical retina and corneal services. Although the initial capital investment is high, this is offset against much greater efficiency as the waiting times for diagnostic tests are reduced and infrastructure is provided for the longer-term recovery.
As ophthalmology has transformed dramatically in the last few years, advances in diagnostic imaging have led to a much higher level of diagnostic accuracy and timely intervention. Those of us working in the field of ophthalmology, whether that be primary or acute care, have embraced change as the benefits to patient care have been immense.
Loss of staff due to COVID-19 related sickness absence has regrettably resulted in, and continues to result in, patient appointment cancellations
The BMEC is a supra-regional referral centre for highly specialised services such as paediatric and adult electrophysiology, and rare services such as ultrabiomicroscopy. Whilst funding support is being made available for diagnostic hubs and the focus remains on reducing waiting times for high volume clinics, it is essential that financial support is also provided for services that cater for the needs of the minority of patients with rare and complex disorders.
Our optometry and ophthalmology colleagues who work in A&E and urgent care clinics on a regular basis indicate that a significant proportion of patients are presenting directly to the eye hospital for red eye-related conditions, foreign bodies and flashes and floaters. It appears that patients are not fully utilising the local Minor Eye Conditions Service or the COVID-19 Urgent Eye Care Service as a first port of call. While we focus on continuing to address our waiting lists and more complex patients who need to be seen in the hospital eye service (HES), we are reliant on the support of our community optometrists to manage less complex cases and to undertake referral refinement prior to referral to the HES.
In summary, the effect of the COVID-19 crisis has had massive consequences on ophthalmology service backlogs at the BMEC. As heads of service, we have had to develop strategies for managing with reduced staff and the increasing backlogs, and we have made many changes to how we deliver services. The business continuity plans that we have today are unrecognisable in relation to those used in 2019.
About the authors
Dr Waheeda Illahi is a consultant optometrist and head of optometry services at BMEC, Rosie Auld CBE is head of orthoptic services at BMEC, Dr Emma Berrow is consultant ophthalmic electrophysiologist and head of visual function at BMEC, and Dr Peter Good is a consultant neurophysiologist and head of visual function at BMEC.
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