Agenda item

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 local optometrist will be able to follow the management plan provided by the consultant, which may include referral back to them.

·  In addition, by ensuring that patients are treated in the right place to meet their needs as described above, those patients who do need to see a consultant in secondary care (e.g. macular degeneration, suspected glaucoma) are more likely to be able to access this in a timely manner. Effectively, the new service will increase the local capacity to treat ophthalmic conditions and ensure that patients can access the right service for them more quickly.

·  The CCG is currently receiving bids from potential providers and intends to award the contract at the end of October with the aim of a new service commencing in December, although it is likely that a phased approach will need to be taken to implementation.

·  The RUH is also taking actions to improve ophthalmology waiting times.  They have recruited more consultant locum cover and registrars, who will commence early Autumn and are reviewing their waiting lists. BaNES CCG is further supporting the RUH by reoffering choice to patients who previously selected the RUH for their appointment and may now wish to choose another provider to facilitate being seen more quickly.

The Chair asked what would the regular waiting time now be for a patient that was diagnosed with acute glaucoma to receive an operation.

Catherine Phillips replied that it was likely to be in excess of 18 weeks.

Councillor Robin Moss asked if Optometrists were to be seen as providing a triage service.

Catherine Phillips replied that they would be able to manage many conditions and that it was important to get the message out to the public regarding the change in service. She added that the CCG Board agreed the proposal to commence procurement of a Community Eye Service in July 2018 in order to improve services for patients and develop greater eye service capacity now and in the future.

Councillor Bryan Organ asked how referrals from opticians will be managed.

Catherine Phillips replied that a choice of providers would be offered and that some waiting lists would be longer than others. She added that for example the waiting time could be shorter at a provider that is of further distance away from the patient.

Councillor Lizzie Gladwyn commented that she was unaware of the roll that opticians could play in this process and agreed that it was important to get the message out to the public.

Catherine Phillips replied that work would be undertaken with the bid winners on this and expected literature and posters to be available in GP surgeries and online. She added that she would encourage everyone to have regular eye health checks.

The Select Committee RESOLVED to note the actions that are being taken to improve ophthalmology services locally.