When talking could be good for your sight

22 December 2016

Mercy Jeyasingsham

The recent round table event that VISION 2020 UK held with NHS Providers on ophthalmology services attracted the interest of senior managers across a range of tertiary providers and district general hospitals. Not surprising really given that most hospitals are struggling with an increasing drugs budget, large increases in patient numbers and a decreasing number of staff, with the vacancy rates for specialist staff set to increase. New treatments such as Anti-VEGFs have made once untreatable conditions such as Wet Aged Related Macular Degeneration treatable. Other breakthrough treatments are waiting in the wings. As one consultant ophthalmologist observed “At the moment there isn't a treatment for dry AMD which is 90% of macular degeneration. When there is, and I'm sure there will be, this is going to be a potential burden because we know how much service is required to treat patients with neurovascular AMD. There's going to be a 22% increase over the next 10 years, 44% over 20 years.” The aging population and co-morbidities will see cataract surgery growing at a similar rate. If it takes 14 years to train a consultant ophthalmologist do we have the trainees out there? The answer is no. The Royal College of Ophthalmologists have pointed out, whilst discussing their recent workforce survey, that there is the appetite to increase the number of ophthalmology trainees is not keeping pace with demand or the the fact that the posts are over-subscribed at least four to one. Funding is just not available for these trainees despite there being capacity across the country to train them.

If it takes 14 years to train a consultant ophthalmologist do we have the trainees out there? The answer is no.

 

These issues are not limited to ophthalmology and might seem a familiar story to many specialisms –growing demand, decreasing capacity and comorbidities. Both in children and older people it is more common to have vision impairment along with other disabilities and conditions. So why is sight so important? 80% of our information on the world comes through our sight and not surprisingly one of the greatest fears people have is the loss of sight. Being able to function independently in everyday life is much more difficult with vision impairment. Unfortunately sight loss is becoming more, not less, common despite medical breakthroughs.

VISION 2020 UK, part of the WHO initiative to eliminate avoidable blindness, is the umbrella organisation for the eye health and sight loss sector. It encompasses charities such as RNIB and Guide Dogs and professional organisations covering ophthalmologists, optometrists, orthoptists, nurses and rehabilitation officers for the vision impaired. It is important to engage the whole system in our endeavours to share information and develop solutions. We know key links should be between primary and secondary care as well as secondary and social care. Hence our work with NHS Providers to explore whether having hospitals talk to each other –and us- would be useful. It didn’t take long before participants were raising the issues mentioned already. There were also frustrations with competition between hospitals instead of cooperation, tariffs that incentivised the wrong thing and the 18 week wait that did not reflect clinical need. Helping out with spare capacity from one hospital to another highlighted the competition trusts often feel within the NHS and between the NHS and private hospitals who often deal with a more selective casemix.

It was good to share models of care that really worked – for instance telemedicine - as long as you had good connectivity; and working with optometrists - if you could work out the funding barriers and the correct training. Just sharing good practice and together raising the profile of ophthalmology was almost reason enough to form a network. Practical outputs included a combined need to respond to the recent tariff consultations which incentivised getting new patients to the disadvantage of follow up patients –where the majority of sight was being saved! Certainly in future minor eye care schemes and pre and post-operative cataract assessments could be done through primary care – if the right schemes were available. However, as our New Year briefing to MPs will highlight, these schemes are not always in place. The Clinical Council on Eye Health Commissioning had produced frameworks for commissioners on community ophthalmology and primary care. These frameworks listed issues such as having multidisciplinary teams with appropriate competencies and a clear lead on clinical governance without being prescriptive on what local models could look like.

Participants of the round table event agreed that meeting was useful and next time having primary and secondary care clinicians would help.

 

Mercy Jeyasingham is chief executive for VISION 2020 UK. The NHS Providers ophthalmology roundtable was held on 25th November 2016.