Title : Complex realities: Navigating the tougher road into NHS cataract services
Abstract:
Introduction: NHS cataract service delivery has been increasingly challenged by rising demand, resources constraints, the pandemic, and the expansion of independent sector providers (ISPs). This study aims to assess whether there has been a shift towards managing more non-routine cataract cases within our service.
Method: A retrospective evaluation of cataract surgery waiting list forms completed at Northern General Eye Centre for February to April 2023 and 2024 was conducted to assess differences between the two years in the main surgery categories: “complex” (e.g., white cataract), “special” (e.g., ISBCS), and “GALA” (post-pandemic initiative, converting surgeries from GA to LA).
Results: Over the same three-month period, a total of 668 cataract surgeries were listed in 2023, compared to 955 in 2024. In 2023, 212 cases (31.7%) were classified as "complex," while in 2024, 358 cases (37.5%) were classified as "complex" (p=0.02). Thirty-six cases (5.4%) and 70 cases (7.3%) were classified as “special” in 2023 and 2024, respectively (p=0.15). Five cases (0.7%) and 9 cases (0.9%) were classified as “GALA” in 2023 and 2024, respectively (p=0.89). ISBCS cases more than doubled from 23 to 49 the next year.
Conclusion: There is an obvious increasing trend in the number of “complex” cases encountered within our service. The increasing trend of complex cataract cases offers valuable experience for senior trainees but limits junior trainees' exposure to routine cases. To optimise training, partnerships with ISPs are recommended. This trend also hinders the running of high-volume, low-complexity lists but may support the development of high-complexity, low-volume lists.
