Issue - meetings

The paper describes the pressure on the ophthalmology service at the Royal United Hospitals Bath Foundation Trust as a result of increasing demand and a national shortage of consultant ophthalmologists. 

Catherine Phillips, Senior Commissioning Manager for Acute Care, BaNES CCG introduced the report to the Select Committee. She explained that there is pressure on the ophthalmology service at the Royal United Hospitals Bath Foundation Trust as a result of increasing demand and a national shortage of consultant ophthalmologists.  She added that this has resulted in long waiting times to be seen and potential patient risk, for eye care pathways in B&NES.

She informed them that the main provider to the population of B&NES for planned (elective) and urgent (non-elective) Ophthalmology activity is the RUH, managing approximately 78% of total B&NES activity.

She stated that the RUH Ophthalmology service has not achieved the 92% Referral to Treatment (RTT) target of 18 weeks since July 2017, although the service had achieved the target in previous years. She said that this has resulted in current waiting times of 36 weeks for a General Ophthalmology appointment. She added that the number of follow up appointments that have been delayed has also increased within this period.

She highlighted some of the actions the Clinical Commissioning Group and Royal United Hospitals are taking to improve quality and safety, and provide a more effective and efficient service through the procurement of new community based pathways.

·  BaNES CCG is in the process of commissioning a Community Eye Service which will particularly benefit a range of patients. Clinically, the model includes pathways for Minor Eye Conditions, Intraocular Pressure (IOP) Referral Refinement, Ocular Hypertension (OHT) & Stable/Suspect Glaucoma monitoring Cataract Referral Refinement and Cataract follow up.

·  Firstly, patients who have recently identified that they have an eye condition, such as a scratch, foreign body, lumps and bumps in the eye, blurred vision, watery eyes, flashes and floaters. These patients will be able to visit an optometrist in the community to be seen within 2 working days, usually on the same day. For the majority of patients, these eye conditions will be resolved in the community but referral routes will be in place for patients to be sent to the RUH for further urgent treatment if required.

·  Secondly, patients with suspected cataracts or glaucoma will receive a second and more detailed assessment and discussion in the community in order to ensure the right patients are referred to secondary care. There are benefits to the health system of ensuring only patients that need and want further treatment are referred, but also to patients who will be able to speak to someone more rapidly (within 4 weeks) about their potential condition and their options.

·  Thirdly, patients who have received a procedure in secondary care (e.g. cataract removal) or who have a condition that the consultant ophthalmologist considers is stable (e.g. stable glaucoma) will be able to see a local optometrist for their follow up appointment instead of returning to their secondary care provider. This will be more convenient and is more likely to meet the appropriate follow up timescales, e.g. annual follow up for glaucoma. Should the patient’s condition change, the  ...  view the full minutes text for item 42