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Out of hours urgent ophthalmology services

11 September 2014

It has come to the College’s attention that in many areas of the country some ophthalmology departments (‘local’) are closing early in the evening and at weekends, leaving other surrounding departments (‘central’) to cope with urgent ophthalmic referrals that arise during this time. In some instances this action has been taken without sufficient planning and discussion with the central units responsible for taking on the additional work.

The College realises the viability of maintaining an out of hours service in smaller departments has been compromised by the EWTD and the difficulty in recruiting middle grade staff. However, this action compromises safe and effective patient care where:

  1. Local A&E departments and GP out of hours services are not made aware of the new urgent ophthalmology care arrangements
  2. The central unit is not aware of the decision of local units to close until phone calls are made to on call registrars telling them to accept their patients; this is clearly an inappropriate way of effecting change; these arrangements need to be made at higher levels of hospital management
  3. The arrangements for handover of patients back to the local unit for continuing care are not robust and are confusing for patients
  4. The on call staffing arrangements (clerical, nursing and medical) at the central hospital are not reviewed in order to cope with the increased patient numbers in the evening and at weekends
  5. Registrars are effectively running Saturday and Sunday clinics without consultant supervision. The GMC, the College (and patients) will expect such clinics to be consultant supervised in the same manner as they do any other clinic and arrangements will need to be made for this.  This is particularly important where registrars may not be that familiar with the hospital’s systems due to their current placement being with a local unit
  6. Registrars (and consultants) from the local unit are placed into the central unit on call rota without appropriate induction to that department (including IT systems).

Training Programme Directors and Heads of School will have to consider how all registrars are exposed to adequate experience and training in urgent ophthalmic care and how this will be assessed at ARCPs.  Trainees at ‘local’ units may need to be part of the ‘central’ unit on call rota to achieve this.

The College knows that there are other aspects of these arrangements which Trusts will wish to consider such as ‘tariff following patients’ and patients will want to know that transport links have been considered when establishing central units for emergency care.

The College’s concern is for patient care, the training and supervision of registrars and to support members and others who have to make these difficult decisions.  Consultants and Hospital Managers must not abdicate their professional responsibility for patient care and expect that registrars will just cope with the fallout from ill-considered planning.  If members (consultants, registrars and those involved with training) are aware of patient care and/or registrar training being affected by such arrangements would they please let the College know: (Professional Standards) and/or (Training).

Carrie MacEwen, President
Tom Bremridge, Chair Lay Advisory Group
Oliver Bowes,  Chair Ophthalmologists in Training Group
Bernie Chang, Chair Professional Standards Committee
Mike Hayward, Chair Training Committee
Fiona Spencer, Chair Training Committee Designate