Safety recommendation
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 agree that the way payment for ophthalmology appointments is made can adversely impact patients with glaucoma. To address this we are making both shorter- and longer-term improvements. In the short term, we intend to introduce a fixed payment for all outpatient attendances that will allow clinicians to make decisions about prioritising the patients that they see. As part of the NHS’s response to Covid-19, a set of extraordinary payment arrangements is currently in place instead of the usual payment system, the national tariff. So this fixed payment will be introduced in April 2021 in the next national tariff.
We are also working closely with the Royal College of Ophthalmology and NHS colleagues to support their longer-term work reforming ophthalmology. Among other improvements, this work will improve data collection to support better payment design. Better-designed payments will allow the money to follow the patient across the boundary between primary and secondary care. In turn this will support Integrated Care Systems to better design ophthalmology services.
We are planning to pilot this work in the next national tariff in April 2021 and scale it up nationally in subsequent years.
ACTION: We will move ophthalmology outpatients onto a fixed payment to reduce the incentive to delay follow ups.
TIMELINE: Planned for April 2020 but delayed because of the suspension of the 2020/21 national tariff as the NHS responds to covid-19. Will implement in April 2021.
ACTION: Develop and pilot ‘pathway’ and ‘year of care’ payment models for ophthalmology.
TIMELINE: Pilot from April 2021. Scale up nationally from April 2022.
ACTION: Implement ‘year of care’ payment models for glaucoma.
TIMELINE: April 2023.
Response received on 24 July 2020.