Sustainability and transformation plans have real potential to improve the coordination of patient care, says the head of the Local Optical Committee Support Unit, Katrina Venerus, enabling commissioners to finally crack a tricky nut.
The recent appointment of the first esteemed group of sustainability and transformation plan (STP) leaders is a welcome step forward for health reform, adding another piece to the Five Year Forward View (5YFV) toolbox.
The transformation footprints add a new dimension to the commissioning landscape – one that, in my view, CCGs have struggled with so far: enabling provider engagement over a wider footprint.
While the vanguards and new care models have inspired innovation and collaboration, this has tended to be piecemeal. And the jury is still out on whether they can transform wider primary care services at scale.
Surprisingly, very few vanguards are focusing on eye care pathways, despite the fact that ophthalmology accounts for around 10 per cent of the 100 million hospital outpatient appointments in England, and that most acute trusts are facing significant capacity pressures, as highlighted in a recent report by the Royal College of Ophthalmologists.
Beyond the vanguards, it is encouraging that more and more clinical commissioning groups (CCGs) are looking at ophthalmology redesign. However, the commissioning of primary eye care services by individual CCGs is labour intensive and inefficient, and progress occurs at a slow pace. As a result, acute trusts have to cope with different pathways for patients from different CCG areas, and access to eye health services stubbornly remains a postcode lottery for patients.
But on a more positive note, in the last 12 months, the number of primary eye care services being contracted through a regional LOC company – a network of optical practices similar in concept to GP federations – has burgeoned. These commissioned services – primarily minor eye conditions and referral refinement services – operate across two or more neighbouring CCGs. For both commissioner and optical practice, it represents joined-up commissioning of primary eye care services at a more viable scale.
Hard-pressed CCGs understand the benefits of administering one contract with a regional provider while still offering patients a wide choice of practices for eye health services. At the same time, optometrists and opticians are drawn to the efficiency of the approach, as it eases the administrative burden and allows practices of all sizes to participate in pathways.
With an average population of 1.2m, STPs will provide the opportunity for groups of CCGs to work with providers across whole pathways, and over acute trust footprints, to develop truly transformed and sustainable services – and deliver the ambitions of the 5YFV. For eye care services, the regional LOC provider companies are well placed to work with acute trusts and commissioners, and support the plans of the STPs.
STPs look to have genuine potential to improve the coordination of patient care and prevention, and enable commissioners to transform services at scale which has – so far – been a tough nut to crack.
Katrina Venerus is managing director of the Local Optical Committee Support Unit (LOCSU). Follow her and the organisation on Twitter @KatrinaVenerus @LOCSU
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