Project name: Joint Working

Project Summary:

Bradford hospitals NHS Foundation Trust (the “Trust”) deliver their ophthalmology diagnostic and treatment service into the community through the Bradford Macular Centre (“BMC”). However, increased demand for medical retina (“MR”) services and significant capacity issues across the Trust have resulted in delays to follow-up and access to treatment across all MR indications. This has led to an increase in unnecessary activity; additional burden to patients and carers; impacted on the time to diagnosis, treatment, management; and further exacerbated pressures on an already at capacity service.
Critically, with BMC’s current activity at capacity, the Trust is unable to make the necessary re-configurations to their current service provision and are limited in their capacity to utilise new models of care such as virtual clinics and triage. The BMC is currently being used for Intravitreal injections, but requires an updated diagnostic pathway, enabling a simultaneous one-stop service for patients in the active phase of treatment and a review and triage pathway for new patients and those in the monitoring phase of treatment.
The aims of the project are, therefore, to:

  • Support the BMC in overcoming the challenges associated with implementing their post Covid-19 recovery plans.
  • Increase the service capacity, efficiency and patient throughput by improved utilisation of space and resource by establishing a third diagnostic lane and empowering the wider workforce to better manage patient flow.
  • Reduce the number of new clinic spaces occupied by patients with a false positive diagnosis and triage new patient referrals via the third diagnostic lane for suspected wet aged-related macular degeneration (“wAMD”) cases.
  • Create a virtual clinic enabling patients to be reviewed and assessed and embed a system of triage for new patients thus aligning ophthalmology services to the strategic priorities set out in the NHS LTP and GIRFT agenda.
  • Provide additional capacity across the ICS for patients requiring access to diagnostics and imaging technology for various disease areas such as multiple sclerosis (“MS”).
  • Expand and improve access to care at the BMC for patients with wAMD and other MR conditions.
  • Improve the management of wAMD through enhanced system architecture and purchase of additional equipment in order to flatten the demand for ophthalmology services, thus ensuring new patients are seen and medically optimised earlier, resulting in improved patient outcomes and adherence to quality standards.
  • Facilitate the use of novel treatments and National Institute of Health and Care Excellence (“NICE”) guideline directed therapy for patients with wAMD.

Covid-19 and the reduction in outpatient appointments have encouraged ophthalmology services to look at innovative ways to address the growing capacity issues, improve patient flow through the system and remove bottlenecks across patient pathway’s to increase service efficiency.

Planned Milestones

bradford teaching hospitals nhs foundation trust table

Expected Benefits

Anticipated Benefit for patients

  • Reduction in waiting times for new patients to receive a confirmed diagnosis of wAMD therefore accelerating time to treatment and reducing risk of avoidable sight loss.
  • Reduction in waiting time for existing patients to receive specialist input and access ophthalmology service’s for follow-up, review and medicines optimisation.
  • Reduction in the number of outpatient attendances for treatment and review by re-establishing the one-stop service thus reducing the burden on patients and carers.
  • Increased speed and efficiency through outpatient clinics and enabled through virtual capabilities.
  • Rapid, efficient access to wAMD services across the clinical pathway.
  • Improvement in patient reported outcomes and satisfaction scores through quality audit from baseline.
  • Improved access to innovative novel therapies for the treatment of wAMD.

Anticipated Benefits for the NHS

  • Increase in total capacity to deliver MR service across all indications delivered through a one-stop, one site service.
  • Increase in the proportion of new patients (from baseline) to receive a confirmed diagnosis of wAMD seen in the new patient clinic.
  • Increase the number of existing patients to receive specialist input and access ophthalmology services for follow-up, review and medicines optimisation from baseline.
  • Reduction in the number of outpatient attendances for treatment and review by re-establishing the one-stop service thus improving staff utilisation efficiencies (HCPs and clerking staff) and preventing the duplication of work.
  • Rapid, efficient access to wAMD services across the clinical pathway.
  • Improvement in patient adherence to individual treatment intervals in order to prevent loss in visual acuity measured through audit and improvement from baseline.
  • Improved access to innovative novel therapies for the treatment of wAMD.
  • Improvement in patient reported outcomes and satisfaction scores through quality audit / questionnaire from baseline.

Start Date & Duration November 2021 – October 2023

UK2111150603