Safety recommendation
It is recommended that NHS England and NHS Improvement require commissioners to agree, under their service contracts, the action that providers will take to ensure compliance with the Portfolio of Indicators for Eye Health and Care follow-up performance standard. Where the standard has not been met, there should be a requirement for providers to demonstrate that they have reviewed individual pathways and taken action to mitigate risk, as well as to understand the causes of any unnecessary delays to inform improvement.
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 England/Improvement review the payment for the ongoing management of patients with glaucoma, regardless of setting. Pricing should reflect the complexity and costs of follow-up appointments and encourage new ways of working.
Response:
We have made it a requirement, under the 2020/21 NHS Standard Contract, that every Clinical Commissioning Group (CCG) in England must agree an action plan on this recommendation with each of its local hospitals. The action plan will describe what the hospital will do, during 2020/21, to ensure that it complies fully with the Portfolio of Indicators for Eye Health and Care follow-up standard. The action plan, known technically as a “Service Development and Improvement Plan”, must be included as part of the local contract between the CCG and the hospital. The hospital must implement the actions set out in the plan during 2020/21, and the CCG will monitor implementation and ensure that improvements are made if progress is off track.
Responding to the Covid-19 emergency is currently the top priority for the NHS at present, of course, but we will expect CCGs and hospitals to take forward the necessary actions on this recommendation as soon as possible.
ACTION: NHS England / Improvement have included in the 2020/21 NHS Standard Contract a requirement for every Clinical Commissioning Group (CCG) to agree an action plan with each local provider of ophthalmology services, setting out what steps the provider will take during 2020/21 to ensure that it complies with the Portfolio of Indicators for Eye Health and Care follow- up performance standard. These plans (known as “Service Development and Improvement Plans” or SDIPs) will be included in each local contract. The provider must implement the actions set out in the SDIP during 2020/21, and the CCG will monitor implementation and ensure that improvements are made if progress is off track.
Under the SDIP, the provider will be required to demonstrate that it is routinely:
- risk rating patients;
- recording a recommended follow-up date (by completing the Earliest Clinically Appropriate Date field in relevant outpatient datasets) NHS Digital and NECT guidance on PAS;
- reporting compliance with the Portfolio of Indicators for Eye Health and Care follow-up performance standard (95% of hospital appointments to be within no more than an additional 25% of their intended follow up period, including rescheduling of hospital initiated cancellations); and
- addressing full implementation of failsafe prioritisation processes for follow-up patients, as described in Elective Care High Impact Interventions: ophthalmology.
Responding to the Covid-19 emergency is currently the top priority for the NHS at present, of course. During this period, contractual requirements on providers are being relaxed, and this will slow the progress on implementation of SDIPs. But we will expect CCGs and hospitals to take forward the necessary actions on this recommendation as soon as possible. TIMELINE: For inclusion in local contracts with effect from 1 April 2020 and for local implementation during 2020/21.
Response received on 27 April 2020.