New clinical guidance could reduce waiting times for eye care services in England. As part of a wide-ranging list of evidence-based interventions designed to improve the quality of care, the guidance proposes patients get access to more sophisticated diagnostic imaging before they are referred to a consultant.
As well as reducing a patient’s anxiety while waiting for a hospital appointment, it will also ease pressure on ophthalmology services and free up vital clinical time by prioritising those who really need to be seen by a specialist. In addition, by implementing the new way of testing in eye care services, there will be fewer unnecessary referrals, which is better for patients but will also save taxpayers’ money.
Ophthalmology is currently the busiest outpatient speciality in secondary care and makes up almost 10% of the entire waiting list. Improvements will also be made for patients with suspected glaucoma and cataracts, ensuring more accurate testing is available and that patients are more involved in the decisions about which treatment is best for them.
These measures are part of a suite of 10 being introduced by medical experts, clinical commissioners and patients on the evidence-based interventions programme which recommends changes to the way tests, treatments and procedures are carried out based on the latest medical evidence.
Other recommendations include improvements to the way transient ischemic attacks or ‘mini-strokes’ are treated and the circumstances in which breast implants are removed. It also recommends reducing angioplasty for stable angina and expanding the use of MRI scanners in the diagnosis of prostate cancer.
NHS medical director Professor Sir Stephen Powis said: “Medicine and technology is constantly evolving and it is right that the NHS uses the latest clinical evidence to ensure options on the table for patients are as up to date as possible while also maximising efficiencies for the taxpayer.
“We expect these changes will prevent thousands of unnecessary referrals to ophthalmology services – giving back patients and staff alike their valuable time – as well as updating guidance for a range of other services to ensure the most effective and efficient treatment is being used for patients.”
Minister Neil O’Brien said: “Improving access to the latest digital imaging technology will improve the speed and quality of eye care treatment for patients. “Tests such as these are part of the wide range of work being carried out to reduce waiting lists, which is one of this government’s top priorities.”
The NHS continuously reviews the treatments it offers to ensure patients are getting the most up-to-date and best possible care while maximising every penny of taxpayer money.
As many as two in five of suspected new glaucoma cases and half of all suspected diabetic maculopathy cases referred to secondary care via routine optometric tests or diabetic eye screening are false positives, due to the poor sensitivity and specificity in existing tests.
This new guidance will require additional testing at a second appointment – a so-called two-factor authentication – to confirm a diagnosis of glaucoma or with an alternate optometrist specifically trained to undertake a more comprehensive set of tests.
For diabetic retinopathy, screening services are being asked to use an additional tool called Optical Coherence Tomography (OCT), which can take 3D images of the retina instead of 2D, improving accurate diagnosis and referral of patients needing treatment, such as intravitreal injections.
Similarly, as few as 40% (and up to 92%) of referrals for cataract surgery at some services result in the surgery actually taking place, and this intervention aims to ensure primary care staff work with patients to make sure they understand the surgery they are being referred for.
Cataract surgery accounts for 6%, or more than 450,000, of all surgeries completed a year, and was predicted to grow by 25% by 2027 and 50% by 2035 according to the Royal College of Ophthalmologists.
This Evidence Based Intervention (EBI) is the third list of its kind, developed in collaboration with the Academy of Medical Royal Colleges, after the EBI programme started in April 2019. List one and two are estimated to save the NHS around £250 million a year, by reducing as many as half a million unnecessary appointments which the evidence suggests are no longer appropriate in many cases. All money saved is redirected to other clinical interventions which are known to be effective.
The health service is also asking hospitals to make sure they are following guidance set out in lists one and two, which set out updated guidance on a further 48 procedures and services.
Teams are identifying patients on waiting lists for any of treatments that are not cost effective to find out what other options are available as the NHS prioritises the elective recovery – starting with those who have been waiting the longest.
Chair of the Academy of Medical Royal Colleges, Professor Dame Helen Stokes-Lampard, said, “I am delighted that we have been involved in this programme from the start, because it’s important that it is clinically led and is first and foremost about improving the quality of care. I know the team have consulted with medical experts, specialist clinicians, those who commission services and a great number of patient groups every step of the way. Achieving consensus has not always been easy, but it has been worth it. The fact that the programme also reduces unwarranted variation across the country and helps to tackle the backlog as well as freeing valuable clinical time are also huge bonuses.”
