Lack of timely follow-up for glaucoma patients is a recognised national issue across the NHS. Research suggests that around 22 patients a month suffer severe or permanent sight loss as a result of the delays.
The patient in the reference event is a 34-year old woman who lost sight as a result of delayed follow-up appointments. She saw seven different ophthalmologists, and the time between her initial referral to hospital eye services (HES) and laser eye surgery was 11 months. By this time her sight had deteriorated so badly, she was registered as severely sight impaired.
Our investigation identified that there is inadequate HES capacity to meet demand for glaucoma services, and that better, smarter ways of working should be implemented to maximise the current capacity.
The investigation makes recommendations for the management and prioritisation of follow-up appointments for glaucoma patients. The findings and conclusions of this investigation are also likely to be applicable to follow-up of patients with other eye conditions, or conditions that fall within other specialties.
The report highlights that there are innovative measures implemented by some NHS trusts that have reduced the risk, but this good practice is yet to be implemented more widely.
We’ve made seven safety recommendations to the Royal College of Ophthalmologists, NHS England/Improvement, NHS Digital and the International Glaucoma Association as a result of this investigation.
We expect them to respond to their safety recommendation within 90 days of the publication of the investigation report. Their responses will be shared here when they’re available.
Royal College of Ophthalmologists
It is recommended that the Royal College of Ophthalmologists, working with relevant stakeholders, develop models and review workforce required for the optimal delivery of glaucoma care. The models should be tested and evaluated.
It is recommended that the Royal College of Ophthalmologists agree criteria for the risk stratification of patients with glaucoma so that practice can be standardised across NHS hospital eye services.
It is recommended that NHS England/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.
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.
International Glaucoma Association
It is recommended that the International Glaucoma Association facilitate the funding of research into the development and evaluation of an automated, predictive risk stratification tool.