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CHESTER , England – Depending on who owns one, a so-called "Diagnostic and Treatment Centre" represents the pinnacle of medical efficiency or a threat to the health services, say UK ophthalmologists. The Diagnostic and Treatment Centre – "DTC" for short – represents a new model for care in Britain . For ophthalmologists in such centres, their workload will be devoted to performing as many cataract operations as possible in a bid to reduce the country's waiting lists. The UK government has engendered controversy among UK ophthalmologists because it is not only setting up its own centres within the existing publicly funded National Health Service; it is also preparing to contract with independent, privately owned centres to do cataract surgery. According to the UK government, such independent DTCs should not only offer additional capacity (surgeons, nurses, operating theatres) but also introduce a degree of competition and patient choice into the health service. Despite such high-minded ideas, ophthalmologists worry that privately run centres could actually harm patient care.For instance, ophthalmologists say they worry about how the government will monitor quality in the private centres. "We know how the NHS DTC programme will run," says Helen Seward, FRCOphth, a consultant ophthalmologist at the Croydon Eye Unit in London and former president of UKISCRS. "We need to make sure the Independent sector DTC programme will run to the same standard." In addition, ophthalmologists also worry that private centres will steal patients from local NHS services and deprive NHS hospitals of cataract surgery funding that often offsets the cost of more expensive and complicated eye procedures. Ophthalmologists at Oxford Eye Hospital learned in September that 25 per cent of its cataract workload–will go to the private DTC planned for the area. Consultants accuse the government of robbing Peter to pay Paul. This represents £750,000 of our funding, and we will lose staff from the service as a result, making it difficult to provide a comprehensive service," said Paul Rosen, FRCOphth, a consultant at the hospital. " We already have overcapacity in this area, and we will have our cataract waiting list to below three months by early next year,." Currently there are 1,300 patients on the hospital's cataract surgery list; with six consultant ophthalmologists on staff plus 10 other trainee surgeons. The service will easily reduce that waiting list to 500 (or one months work) by next year, Dr. Rosen predicts. In response to the plans, consultants at the hospital have contacted health authorities to alert them to the ramifications of the private DTC. According to Dr. Rosen, the plan to establish the private centre contradicts promises by the UK Department of Health not to undermine existing services, and to deploy private DTCs only to deal with excess demand; there is no excess demand at Oxford Eye Hospital although there are in some areas. The difficulty has arisen in Oxford because of an error made and acknowledged by the Health Authorities and the Department of Health, in which a large number of cataract operations were transferred from the Oxford Eye Hospital to the private DTC. To correct the "mistake" would allegedly have compromised the Ophthalmology DTC programme. This will compromise training and reduce the outpatient capacity by 10,000 appointments a year in Oxford . Despite such criticism, the Department of Health is determined to introduce private centres across the country. "The programme is going through," says a department spokesman. Lee Bailey. "The department is unapologetic about wanting to provide the fastest care and get waiting lists down." Despite their reservations about private DTCs, Dr. Rosen and other similarly minded ophthalmologists remain committed to the concept of a public-financed DTC in the NHS "I think it will make planned procedures more efficient, and it will be a better use of resources, with better patient care," Dr. Rosen says. "I'm for competition and patient choice, too, but real competition, and not a situation where the Department of Health takes our patients, so a private DTC can become viable." Regardless of the government initiative to introduce privately-owned DTCs, publicly funded centres have a bright future, predicts Janice Nicholson, programme director for the NHS-run DTCs. "DTCs are about common sense," Ms. Nicholson says. "Firstly, we've been saying for years we need more space; secondly, it makes sense to me to separate planned and unplanned care, because we've all had the problem of emergencies compromising our elective procedures. Thirdly, it's not just about having capacity; it's about doing things differently. It's not about more of the same. It's about more patient choice."
Dr. David Allen , FRCophth, Paul Rosen, Consultant Ophthalmologist Vincenzo Maurino Kath Stoddart Ophthalmic Nurse
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