Lack of timely monitoring of patients with glaucoma

The RCOphth has been actively working with partners to deliver on the two recommendations requested from us to improve glaucoma care for patient. We believe the second recommendation should be completed over approximately the next couple of weeks, The first recommendation is progressing well but will come to conclusion under the National Outpatient Transformation joint work on eye care services.

We do however have concerns about the two recommendations below, which are not directed at the RCOphth, which we believe are not progressing at the required pace for protection of patients. These actions are potentially straightforward to enact and would make an enormous impact on patient safety both for glaucoma and for other chronic eye conditions. However, despite efforts to liaise and regular pressure to progress the actions, these two require further action from NHSE and NHSD and any help to further progress this would be very welcome. Resolution of these are vital to efforts to streamline pathways, improve patient care and validate the results of the changes that national programmes and local initiatives are expected to produce. This will be benchmarking for trusts but ideally this should also be followed up with support for improvement projects to bring trusts back to compliance. They will also identify individual patients at risk for whom failsafe processes can be put into place to protect them from avoidable loss of sight.

• It is recommended that NHS England/Improvement commission NHS Digital to publish reports of hospital eye services’ compliance with the follow-up appointments performance standard included in the Portfolio of Indicators for Eye Health and Care.
• It is recommended that NHS Digital include provision for identifying, prioritising and monitoring patients at risk of developing sight loss within the next version of the national Commissioning Data Set. Provision should include the ability to record a risk rating and the recommended follow-up date for each patient, meaning these are mandated data items for collection by hospital eye services. This should be carried out in consultation with key stakeholders such as the Royal College of Ophthalmologists and patient administration system suppliers.

We were planning to undertake this as the next phase for our Ophthalmic Workforce Group but instead this will now be delivered with as in partnership with other stakeholders including GIRFT and the College of Optometirsts as part of the National Outpatient Transformation Programme's Eye Care group, in conjunction with NHSE's Kate Branchett.

We have already started the work on glaucoma pathways and this is planned to be supported by implementation tools and assessments of success. As part of the COVID lockdown and recover phase response, the RCOphth has already, and is continuing to, put out regular guidance on glaucoma provision that will help recovery of services but also lead to future transformation of glaucoma services. We are also working actively with NHS Trusts and Health Boards via the RCOphth clinical leads forum, as well as with optometrist and commissioners to ensure patients who need to be seen are seen during pandemic through improved and more optimal service reconfigurations which involve the whole eye care pathway. TIMELINE: TBC by NOPT.