To Solve Ophthalmology Backlogs, we Must Look Closer at Primary Care

The extensive waiting lists for NHS services are no secret. But ophthalmology is an area where the delays are amongst the worst in the country – with as many as 628,502 people on waiting lists for treatment. 551 patients were reported to have lost their eyesight since 2019 as a result of the extensive backlog, as waiting times cause delays to vital treatments. Tackling the backlog is a crucial  priority – and we must start at the root of the problem. Broken referral systems between different eyecare services are making patient triage slow, complex and leading many to join waiting lists for care they don’t end up needing. To solve the problem in emergency eye care, we must therefore start by turning our attention elsewhere, to the first point of contact for many patients: their GP or optometrist.

Clunky communication and information silos between different healthcare organisations mean that many patients referred by their GP or optometrist for specialist treatment end up waiting for care they don’t really need. This exacerbates existing wait times and leaves patients either facing delays for urgent treatment or being bounced around different services unnecessarily.  Many patients’ conditions will worsen in the time it takes for them to be seen, often forcing them to seek out urgent care in the meantime and potentially causing irreversible damage to their eyesight in the process. This places extra pressure on urgent care services, which are already struggling under increasing patient demand. Referral and treatment pathways must urgently be streamlined to improve patient triage, whilst reducing the ophthalmology backlog.

This starts with handing clinicians the tools to communicate more easily between primary, secondary and community care services. By making it easier for these different services to work together, and make faster shared referral decisions, we can facilitate more joined-up care and help direct patients to the most appropriate form of treatment sooner. Most importantly, we can ensure those in need of specialist care are able to access it before their condition worsens.

Teleophthalmology has a key role to play in enabling this. Arming clinicians with digital tools which open up new channels of communication can help build more direct, collaborative networks between primary care, optometrists and ophthalmologists. Replacing time-intensive paper-based systems with these more streamlined digital channels will enable specialist advice and information to be shared much more quickly, and for more timely, informed shared referral decisions to be made. This will help clinicians to cut down the number of unnecessary referrals, and collaborate on the best next steps for a patient regarding onward treatment.

Digitally-supported joined-up care across different services can not only help reduce wait times for patients, but can also save time and resources for clinicians, freeing up capacity to meet rising demand by reducing pressure on individual services, as well as decreasing the amount of manual admin for clinicians to complete.

The use of teleophthalmology is already proving highly effective in the regions of the UK where it has been implemented. Through my work with Cinapsis, I’ve seen the impact this can have when implemented collaboratively. In Cambridgeshire, for example, the introduction of a digital advice and guidance system has enabled optometrists to quickly connect with secondary care colleagues during or after a patient consultation. Use of the platform is enabling clinicians to directly share high-resolution images, documents, complete OCT scans and videos with local specialists, leading to faster, informed shared referrals. This is helping direct patients to the most appropriate form of care and reducing pressure on urgent eye care services in the region.

Until we fix the way patients are triaged from the very offset, eyesight threatening delays will continue to put patients at risk. To truly tackle the backlog, we need to re-imagine the way primary and secondary care services communicate with each other and fix the broken referral system. Teleophthalmology can help us to achieve this by supporting clinicians to collaborate more easily, and on a much larger scale. A solution to the eyecare backlog is in sight, and it starts in primary care.

By Dr Owain Rhys Hughes

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