Recommendations

The independent eyecare sector is committed to working with the NHS to deliver a sustainable, safe and effective eyecare service. To make best use of capacity across the whole system, we recommend four priorities for action:

• Consistently implement patient choice: ensuring patients can choose from the full range of qualified NHS-funded providers and removing local policies or pathways that unnecessarily restrict that choice.
• Introduce transparent demand-and-capacity planning: giving commissioners and providers a shared view of current and future demand, and the capacity available across NHS and independent services.
• Provide stable contracting arrangements: moving away from short-term or stop-start commissioning so providers can plan and maintain safe workforce and clinical capacity.
• Establish common standards for data, audit and digital interoperability: ensuring all providers contribute to national outcomes reporting and can share the information needed to deliver joined-up patient care.

Independent ophthalmology providers are already working with NHS England and the Department of Health and Social Care through the National Partnership Agreement, collaborating with GIRFT on best-practice guidance for glaucoma, and working with the Royal College of Ophthalmologists to expand training opportunities and improve access to electronic patient records. The next stage should be to turn this partnership into consistent action across local NHS systems.

What good looks like
A high-performing ophthalmology system should make the best use of capacity across NHS and independent providers, delivering high-quality, high-volume and patient-centred care. Patients should have timely access to any qualified provider, based on informed choice, quality and value.

All providers should be held to consistent expectations on clinical quality, governance and transparency, including participation in national audit and outcomes reporting, such as the National Ophthalmology Database, and CQC regulatory oversight.

Providers should also contribute to the wider health system through workforce development and clinical training, alongside investment in pathway innovation, digital technology and new clinical techniques that improve productivity, patient experience and outcomes.

Actions for providers
Providers should:

• Use available capacity to help meet demand and reduce waits for conditions including cataract, glaucoma and age-related macular degeneration, helping to prevent avoidable deterioration.
• Participate fully in national audit, outcomes reporting and regulatory requirements, including the National Ophthalmology Database.
• Invest in workforce development and clinical training, supporting the sustainability of the wider ophthalmology workforce.
• Improve productivity and patient experience through pathway redesign, digital tools and appropriate adoption of new technology.
• Demonstrate strong governance, transparent outcomes, robust incident learning and constructive collaboration with local systems.

Actions for NHS England and ICBs
NHS England should provide clear national leadership on implementing the Partnership Agreement, backed by an operational plan that sets expectations for how ICBs identify and use available independent sector capacity. ICBs should undertake transparent demand-and-capacity planning across all providers, enabling activity to flow to services with capacity and supporting earlier intervention for patients.

Patient choice should be consistently implemented and enforced. Patients should be able to access the full range of qualified NHS-funded providers, and local commissioning arrangements, referral pathways or minimum waiting-time policies should not unnecessarily restrict choice or leave available capacity unused. Commissioners should provide greater contractual stability, reducing reliance on short-term and stop-start arrangements that make it harder for providers to maintain workforce and clinical capacity.

Finally, NHS England should establish common expectations for data, audit and digital interoperability across all providers, alongside tariff and payment arrangements that support efficient pathways, high-quality outcomes and participation in national reporting.