Scaling up video consultation capabilities in ophthalmology services: The experience at Moorfields

8 September 2020

By Peter Thomas, David Probert and Hugh McCaughey

The NHS Long Term Plan set out NHS England and NHS Improvement’s ambition to transform outpatient appointments. With the onset of the Covid-19 outbreak, these efforts were accelerated with all NHS trusts and foundation trusts supported to roll out video consultations to their patients. The technology is now being used in new and innovative ways across the country, in a range of services, including in ophthalmology with hugely positive results.

Not only are video consultations an important tool as we seek to reduce physical attendances at our hospital sites during the course of the pandemic, they have very real and tangible benefits that should, and must endure as we consider what ophthalmology care looks like in the post-COVID world.

Video consultations reduce the time and costs associated with travelling to appointments at NHS sites, as well as the environmental impacts. Video consultations also reduce disruption to a patient’s day and mean patients can access the care and advice they need in a place that is convenient to them. For clinicians, it means less travel between sites and more time to spend with patients who have higher support needs.

In ophthalmology specifically, video consultations do not allow clinicians to conduct complete patient examinations but in some cases, such as in oculoplastic and strabismus, some elements of an examination can be remotely conducted. Supporting technologies can further increase the clinical capabilities, this could include:

· data collection portals allowing patients to upload structured symptomatology and history

· high quality smartphone photographs submitted by patient’s allowing a better view of any abnormalities

· home vision testing apps and devices that help to monitor progress.

At Moorfields, we have been conducting video consultations since March this year as part of NHS England and NHS Improvement’s national pilot trialling video consultations for outpatient appointments. Access to the video consultation platform, Attend Anywhere, was offered as part of this pilot. NHS England and NHS Improvement are now offering fully funded access to Attend Anywhere to all NHS trusts and foundation trusts in England for 12 months as part of their national response to COVID-19.

Our experience to date has been really positive. Our patients have welcomed the offer of a video consultation, reducing the challenges they face accessing expert care from distance whilst our clinicians have described the platform as incredibly easy to use. This usability was key to gaining support to deliver video consultation across our 30-site network model of care.

Initially our focus was on livestreaming slit lamp examinations from one professional to another but with the onset of the COVID-19 challenge, we sought rapidly to scale up the use of video across our other services, and are now using video in both planned and unplanned care. Drop in consultations were quickly launched by our A&E department, and we now see over 100 patients per day in this service. The results are impressive, with almost 80% of callers spared a visit into hospital (reducing the risk of viral transmission), and many managed definitively at home with advice, remote prescription, or in collaboration with a GP or optometrist. Scheduled, invitation only consultations were made available across a range of our services including Adnexal, Rapid Access clinics, paediatrics, strabismus, neuro-ophthalmology, pharmacy, and counselling. In many cases, video consultations replaced a face-to-face visit, at least in the short term. Within the first two weeks of the UK lockdown, we were able to avoid more than 540 face to face appointments. This success has continued to grow throughout the course of the pandemic.

Whilst there are ophthalmology settings in which video may not be appropriate for patients, there are many areas in which it is applicable and can be used successfully. We identified a range of areas where patients could be managed remotely and discovered that even with standard devices some degree of examination was possible in some sub-specialties. We’re encouraging our colleagues to consider the art of the possible and have been amazed at the ingenuity and enthusiasm they have displayed since we made the option of video available. As our services re-open, we are hopeful that clinics that previously relied on some form of in-person visit might be able to make more use of video consultations, helping to keep patient visits short and efficient and supporting social distancing guidelines by reducing the stress on our waiting areas. We expect this would work well for example with the results of an investigation-only visit.

The ability to use video has been hugely valuable as we work to mitigate the impact of COVID-19 on our services and provide expert support to our patients. The outbreak challenged us to deliver digital solutions faster, and with more agility. We must now consider how we best embed this practice going forward and are working closely with colleagues within NHS England and NHS Improvement as well as those working across our services at Moorfields to support the transition to using video consultations as business as usual going forward.

To read more about our experiences of using video in eye care services, click here: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/C0639-Moorfields-case-study.pdf

Peter Thomas is Director of Digital Innovation and Consultation Paediatric Ophthalmologist at Moorfields Eye Hospital NHS Foundation Trust. David Probert is Chief Executive of Moorfields Eye Hospital NHS Foundation Trust, and lead of an NHS taskforce supporting acute providers rapidly scale up their remote consultation capabilities. Hugh McCaughey is Director for Improvement at NHS England and NHS Improvement, overseeing the rapid roll out of video consultations across secondary care.