Challenges and misconceptions

Despite the dramatic successes of eyecare provision within the independent sector over the past five years, the sector has come under a significant amount of criticism for perceived negative practices and/or negative impact on the wider health system.

Has the growth in ophthalmology providers increased demand for services?
In reality, demand for both cataract and wider eye care services continues to grow, driven by an ageing population, and the investment in the sector over recent years has meant that backlogs as a result of the Covid pandemic have largely been addressed.

Evidence – Waiting times for ophthalmology were lower in January 2025 than in January 2020, as the pandemic was beginning.

Do independent sector providers only treat lower complexity patients?
Whilst the most complex patients will always need treating in specialist tertiary facilities, the vast majority of patients can be seen in independent sector provider hospitals and clinics. Independent providers deliver consultant-led care in CQC registered facilities with transparent publication of outcomes in their annual quality accounts.

Do independent sector providers follow the same clinical coding standards as the NHS?
All independent providers are subject to clinical coding audit and are required under NHS contracts to report into regular quality meetings with NHS commissioners. Different pathways and approaches to care can also mean coding relativities (the rates of one code versus another when compared between providers) can show different stories.

Some providers deliver risk stratified pathways (often based on GIRFT recommendations) where both routine and complex vitreoretinal (VR) surgical lists are provided. Here, complex high-risk patients are seen by complex VR surgeons. Their additional expertise often means that if there is an issue, it can be addressed in theatre and the surgery doesn’t require the use of additional elements which can increase the resource required to complete the procedure (the HRG code).

How does the use of the independent sector impact system costs?
The impact on system costs needs to be considered across the whole patient pathway. Delayed cataract treatment, glaucoma monitoring or access to retinal care can lead to deterioration in patients’ health and create additional costs for the NHS and social care.

Independent providers are commissioned to add capacity to local systems, with funding following patients for agreed activity. By helping systems to manage elective demand and provide timely treatment, they can reduce pressure on NHS services and enable NHS capacity to focus on urgent and more complex care. Earlier access to treatment can also help prevent avoidable deterioration and the additional health and care costs that can follow.

The National Ophthalmology Database (NOD) audit consistently demonstrates the quality (reduced complications and high outcomes) of cataract surgery performed by the independent sector.

The NOD audit reports that independent providers had a significantly lower adjusted posterior capsule rupture rate (PCR) and adjusted vision loss compared to national benchmarks.

Do independent providers manage aftercare?
Independent providers are contractually responsible for aftercare and complication management, with formal follow-up pathways and governance requirements equivalent to NHS standards. Patients are expected to return to the provider for post-operative care, with only serious emergencies directed to NHS emergency departments, as would occur in any care setting – a similar arrangement is in place for NHS surgical hubs.

Independent providers routinely have an on-call service and emergency phone line managed by clinical teams as well as patient concierge services and 24/7 access to virtual assistants for non-clinical calls. All escalation routes are agreed with local NHS Commissioners at the point of contracting the service and are regulated by the CQC, a process which is no different to that followed for an NHS provider.

Does the independent sector provide training?
The independent sector is increasingly providing opportunities for a wide range of clinical workforce to access training, including community optometrists and access to hospital experience programmes, surgeons undertaking high-volume surgical training, and a range of other apprenticeship and clinical development programmes.