As service providers to the Birmingham & Midland Eye Center (BMEC) we are very aware of the increasing waiting lists and have planned for the last 12 months for the expected surge in demand related to COVID-19. However, the resurgence of COVID-19 due to the highly transmissible Omicron variant has placed our services under significant pressure since early 2022, with sickness-related absenteeism across our departments being the highest we have experienced since the beginning of the pandemic.
Unfortunately, the illness-related absence of COVID-19 has led and continues to lead to patient appointment cancellations, and we continue to work hard to reschedule appointments and minimize disruption to our patients. The change in self-isolation guidelines does not appear to have eased the pressure we are facing, particularly on our pediatric and contact lens services.
To address the above challenges, we are very fortunate that our trust backs our services with world-class clinics that give our experienced colleagues the opportunity to work evenings and weekends. The impact on the pediatric waitlist has been very positive and this delivery model is expanding to other aspects of the service.
As we continue to focus on treating our waiting lists and more complex patients who need to be seen in the Hospital Eye Service (HES), we rely on the support of our community optometrists to manage less complex cases and pre-referral refine referral to the HES
Adapt and Respond
The National Eye Care Recovery and Transformation Program outlines steps towards recovery plans while recognizing that ophthalmology accounts for the largest volume of outpatient specialties, with around 10% of the NHS treatment backlog in ophthalmology.
In accordance with the GIRFT (Getting it right first time) guideline, the BMEC is setting up a diagnostic center to provide personnel, equipment and an environment that enables high volume, high quality and comprehensive diagnostics, in line with the need to to change focus from face to face to virtual review.
Optometrists, orthoptists, nurses and vision scientists have the opportunity to further develop their skills to assist medical colleagues in managing these backlogs while meeting the growing demand in the major subfields of glaucoma, medical retina and corneal services. Although the initial capital investment is high, this is offset by much greater efficiencies in reducing diagnostic test wait times and providing the infrastructure for longer-term recovery.
As ophthalmology has changed dramatically in recent years, advances in diagnostic imaging have led to a much higher level of diagnostic accuracy and timely intervention. Those of us who work in the field of ophthalmology, whether in primary or acute care, have welcomed the change as the benefits to patient care have been immense.
Unfortunately, the loss of staff due to COVID-19 related sick leave has resulted in and continues to result in patient cancellations
The BMEC is a national reference center for highly specialized services such as pediatric and adult electrophysiology and rare services such as ultrabiomicroscopy. While financial support is provided to diagnostic centers and the focus remains on reducing wait times for busy clinics, it is critical that financial support is also provided for services that meet the needs of a minority of patients with rare and complex diseases will.
Our optometry and ophthalmology colleagues who regularly work in emergency clinics and emergency clinics advise that a significant proportion of patients present directly to the eye clinic for conditions related to red eyes, foreign bodies and flashes and floaters. It appears that patients are not fully utilizing the local mild eye disease service or the urgent COVID-19 eye care service as a first port of call. As we continue to focus on treating our waiting lists and more complex patients who need to be seen in the Hospital Eye Service (HES), we rely on the support of our community optometrists to manage less complex cases and pre-referral refine referral to the HES.
In summary, the effects of the COVID-19 crisis are having a massive impact on the ophthalmological backlog in the BMEC. As service leaders, we have had to develop strategies to deal with reduced staff and the increasing backlog, and we have made many changes to the way we deliver services. The business continuity plans we have today are unrecognizable compared to those of 2019.
About the authors
dr Waheeda Illahi is Consultant Optometrist and Head of Optometry Services at BMEC, Rosie Auld CBE is Head of Orthotics Services at BMEC, Dr. Emma Berrow is a consultant eye electrophysiologist and director of visual function at BMEC, and Dr. Peter Good is a consultant neurophysiologist and director of visual function at BMEC.
