A Survey of Local Optical Committees (LOCs) involved in Cataract Pathways within the London Region

Purpose: Cataract enhanced service (direct referral) schemes have been in existence for over 12 years. Such schemes make better use of the primary care practitioner's professional expertise and have the potential to reduce costs and provide an improved patient pathway. Surprisingly little has been published about these schemes, hence there is a lack of evidence to inform local decision making about existing and future services. The aim of this study was to provide more evidence by surveying the Local Optical Committees (LOCs) to obtain their views on their involvement or lack of involvement in cataract enhanced service schemes in the London region. Secondary aims were to compare how schemes operate and determine why schemes do not exist in some areas. Method: A structured survey of London’s 14 LOCs was carried out on two occasions (2007 and 2012). LOCs were contacted via e-mail, telephone or written letter. Some supporting information was obtained from PCTs. All data were analysed qualitatively. Results: In 2007, only two out of the 10 LOCs that had participated in the 2005 Cataract Choose and Book scheme were involved in running a full direct referral scheme. This had risen to six by 2012 with a total of 11 LOCs having participated in a trial/pilot scheme by that date. The remaining three LOCs have never participated in a scheme. Although there are similarities across schemes (e.g. requirement for accreditation, a referral fee etc), marked differences were found in patient booking arrangements, requirements during initial assessment and post-operative assessment. The percentage of LOCs involved in full schemes in the London region (43%) is lower than for the rest of England (69%). Where trial/pilot schemes had run but no full scheme had been implemented the major reasons reported were: lack of central funding; the schemes were only feasibility studies; and the requirement for a Unique Booking Reference Number (UBRN) for the Choose and Book process. Conclusions: Enhanced cataract service schemes do not always develop into full schemes even if the trial/pilot scheme has been deemed successful. Schemes may have a more prominent role in future with requirements on Clinical Commissioning Groups to provide an improved patient experience within tighter financial constraints. The co-ordinating activity across England of the Local Optical Committee Support Unit (LOCSU) and the newly formed Local Professional Networks for Eyecare should help increase uniformity of approach. All established cataract schemes will need to be re-procured during 2013/14 if they are to continue without interruption