Clinician empowerment is the key to transforming eye care services

The health and care system is entering a new era as integrated care systems and legislative reform create new opportunities for collaboration between organisations to improve local services.¹ These challenges will be familiar to HSJ readers: tackling the elective backlog; addressing the workforce crisis²; and a £9 billion backlog of building and equipment maintenance.³

The challenges are particularly acute for people with eye conditions, including sight-threatening macular diseases which affect nearly 1.5 million people in the UK.⁴ This figure is set to rise, with wet age-related macular degeneration patient numbers expected to increase by 60 per cent between 2015 and 2035.⁵ With more than three quarters of UK eye care units reporting unfilled consultant posts,⁶ demand will continue to outstrip capacity.

As a result of these challenges, nearly 650,000 patients are waiting to start ophthalmology treatment in England⁷, not including those waiting for follow-up appointments. For conditions like wet AMD, delays to treatment can cause rapid and irreversible deterioration of vision.⁸ Indeed, across eye care, up to 22 patients per month lose vision because of health service-initiated delays.⁹

Several national initiatives have started to address the challenge, including the establishment of a National Eye Care Recovery & Transformation Programme¹⁰, a Getting It Right First Time workstream, and the creation of a new National Clinical Director for Eye Care.¹¹ The Macular Society has also set out how to bring this all together through the creation of a national eye care strategy.¹²

Whilst national policy is welcome, at Bayer we know from numerous joint-working projects with NHS organisations that the most impactful changes come at the frontline, with clinical involvement front and centre. For example, Bayer has recently completed a project with Newcastle Upon Tyne Hospitals Foundation Trust to redesign and repurpose an existing vacant day ward into a virtual hub, enabling fast access to high-volume imaging.¹³ We are also supporting clinician-led research into streamlining services, for example using home optical coherence tomography monitoring, which benefits both patients and clinicians through reduced clinic visits.

With ICSs now responsible for arranging the provision of health services, they must involve ophthalmologists and others in decision-making about changes to service design, pathways and treatment provision. Indeed, NHS England guidance makes clear ICSs should involve clinical and care professionals in decision-making “at every level of their system”.¹⁴ This will be needed, for example, in the roll out of community diagnostic hubs, better use of primary care optometry, and the expansion of virtual clinics.¹⁵

Clinicians face significant and competing demands on their time. However, active engagement in system-level discussions, for example through system Eye Care Delivery Groups where they exist, can help reduce the risk of top-down changes being pushed through with unintended consequences. If systems are to meet their duties to improve population health and reduce health inequalities, involving clinical and care professionals in the planning of eye care services is non-negotiable.