Guidance on high volume cataract lists and hubs aims to improve patient care post-COVID

The Royal College of Ophthalmologists (RCOphth) and Getting It Right First Time (GIRFT) have jointly produced a new document offering guidance and recommendations for setting up cataract hubs and high volume cataract lists, to improve help patient care post-COVID.

Ophthalmology is the highest volume outpatient specialty in England, providing over 7.5 million outpatient appointments a year. The specialty also carries out more than half a million surgical procedures every year, including the most common operation offered on the NHS, cataract surgery. 

The new RCOphth and GIRFT guidance, which can be found here, builds on advice in the August 2020 collaboration Restarting and Redesigning of Cataract Pathways in response to the COVID 19 pandemic, and aims to support the efficient use of resources for high-flow surgery, resulting in excellent patient care.

Alison Davis, co-author of the report and GIRFT’s joint clinical lead for ophthalmology, said: “This development of the high flow low complexity (HFLC) cataract pathway and hubs has been a clinically-led workstream and is part of a wider project including five other surgical specialties.

“We are very grateful to everyone involved for sharing their expertise and time. We have worked together to develop solutions to ensure the pathway improves patient outcomes and experience while supporting everyone who cares for patients requiring cataract surgery.

“Further opportunities for innovation will undoubtedly arise, but as we face the challenges of resetting and restarting our services following the second wave of COVID-19 we hope this guidance document will be a useful resource for all providers and commissioners.”

Alison Davis, GIRFT joint clinical lead for ophthalmology

Melanie Hingorani, co-author of the guidance, Chair of professional standards at RCOphth and Chair of the UK Ophthalmology Alliance, added: “Modern cataract surgery is a mini miracle – a 10 to 20-minute procedure which changes lives, restores sight and protects independent living in older people.

“By providing surgery much more efficiently for suitable people in high volume hubs, we can increase the surgical capacity for everyone. This means we can catch up on backlogs due to COVID-19 and ensure all patients who will benefit can receive surgery on time in a way that is suitable for them and their individual needs.”

The document was based on work carried out in London led by Steve Harsum, a consultant ophthalmologist and ophthalmology coordinator at Epsom and St Helier University Hospitals NHS Trust and the cataract lead for London, who also co-authored the report.

He said: “We are being asked as leaders to increasingly balance performance and resources without sacrificing quality and patient experience, and at the same time to consider the wellbeing and job satisfaction of staff. In my experience I can honestly say that high volume low complexity hubs deliver on all of these objectives.

“In implementing this pathway all staff learned new skills. We were able to put more patients through clinic and theatre than we have ever done before, and with reduced stress levels for staff and improved satisfaction for patients. 

Steve Harsum, consultant ophthalmologist and ophthalmology coordinator, Epsom and St Helier University Hospitals NHS Trust

“Equally, I have seen mutual aid and collaboration between acute trusts, for the benefit of patients, which I believe is a model for the future of healthcare.”

The document is available to download from both the GIRFT website and the RCOphth website.

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