Challenges of private provision in the NHS

Citations Over TimeTop 13% of 2005 papers

Abstract

Editor—Timmins questions whether the benefits of using independent providers for health care outweighs the risks.1 He notes the tendency for treatment centres to take on simpler cases, leaving the NHS to deal with complex surgery, but he brushes over the devastating effect that this is having on surgical training.1 Cataract surgery is the most common operation performed by treatment centres. It takes intensive training to become a good cataract surgeon. It is usually possible to predict which cataract operations are going to be difficult or high risk when the patient is seen before the procedure.2 In our department, these complex cases are listed as “consultant to do.” The remainder are listed as “any surgeon to do,” and it is these patients who may be suitable for training.​training. Figure 1 Credit: PASCAL GOETGHELUCK/SPL Since Netcare, a mobile treatment unit, and the Shepton Mallet treatment centre started operating in Somerset, we have noticed a dramatic reduction in training opportunities for cataract surgery. The number of “any surgeon to do” patients on each consultant list has halved from three patients per operating list in 2003 to 1.5 patients per list in 2005. Trainees are often unable to operate because of a lack of suitable cases. This will affect all ophthalmic training grades, but particularly senior house officers. Fielder and Watson, noting that Action on Cataracts had failed to consider surgical training, made some excellent suggestions about how training could be improved.3 Their ideas of high volume service and low volume training surgical lists, with blocks of intensive surgical training seem eminently sensible. The demand for surgery was apparently overestimated when planning treatment centres.1 Could the NHS now use this excess capacity in the form of low volume surgical training lists? It seems very “short sighted” that, although the number of cataract operations performed in the UK is increasing, the future of cataract surgery training is under threat.

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