Ophthalmology Service in UK “Failing”, Says Report

When the UK’s Royal College of Ophthalmologists (RCO) receives a complaint about an ophthalmology practice, they investigate. Now the College has distilled what it has learned from a decade’s worth of investigations into a particularly candid document (1) that also provides recommendations for avoiding such problems in the future.

The issue most frequently raised in complaints was “a chronic mismatch between capacity and demand within the service.” There have not been enough ophthalmologists around to meet patient demand for a long time – a fact acknowledged by hospitals and primary care administrators. But the College criticizes previous reactions to the shortages, noting that they are “…often reactive and sporadic rather than forward-looking and concerted.” It also bemoans “simplistic solutions [that are] frequently offered,” among them, the suggestion that practicing ophthalmologists “just need to discharge more patients to the community.” Furthermore, the report implies a growing disquiet: “under these circumstances, clinicians, managers and commissioners may start to blame each other for being inefficient or inflexible or failing to understand the true situation.” The report’s authors acknowledge that “some ophthalmology services are at an inherent disadvantage when compared with others, for reasons of difficult geography, crumbling estate or a legacy of poor organizational planning,” but are realistic about the extent of what needs to be done to improve matters: “There may not  be quick or easy solutions to all of these problems.” The College offers recommendations of its own for remedying the problems. They note that, since both geographic and demographic factors influence needs for ophthalmology clinics, a full understanding of both factors is necessary for planning service provision. Also, the sooner a struggling practice realizes that it is struggling the better; to this end, the College has produced a self-assessment questionnaire as an early-warning system.  The biggest headache is understaffing: “sustainability of an ophthalmology service depends on having both the right numbers of health care professionals and the right mix of skills to meet the needs of the population”. Currently, according to the authors, the departure of a single staff member can throw a practice “into crisis”; succession planning also needs to be improved. The report also champions the delegation of roles and tasks previously undertaken by ophthalmologists to support staff, making more efficient use of ophthalmologists’ time. However, the greatest emphasis is on training, which is often the first thing to be neglected by a practice in crisis. “The training and supervision of ophthalmologists,” the report concludes, “requires dedicated time which must be factored into workforce planning.”

If you work in the NHS, do you feel that the RCO report presents a fair and accurate picture? How is your day-to-day workload? How could your working conditions be improved? Have your say in the comments below.