Giving Patients Standardised Choice Of Cataract Surgery Provider Through An Automated Single Point Of Access (Spoa)

The UK NHS Constitution mandates that patients receive information to support provider selection. With an increasing number of cataract surgery providers, referrers face challenges in selecting appropriate providers based on medical criteria, offering patient-specific details like travel distance, and sharing up-to-date provider information such as wait times. To address these issues, NHS South East Region implemented a Single Point of Access (SPoA) with an AI agent, Dora (Ufonia Limited, Oxford). Dora engages patients via telephone, requiring no digital literacy or devices, facilitating informed decision-making and standardising referrals.

This study was conducted in a UK regional healthcare system (Buckinghamshire, Oxfordshire and West Berkshire Integrated Care Board (ICB)) covering a population of 2 million. All patients referred by their optometrist or GP for cataract surgery were contacted by Dora as part of the SPoA.

Dora attempted calls up to four times on different days and allowed 24/7 patient-initiated calls. If contact was unsuccessful, a human follow-up call was made.

Dora’s conversation comprised 1) shared decision making about surgery,  2) assessment of suitability for a high-volume low complexity (HVLC) pathway 3) collection of medical history for surgical pre-assessment, 4) patient choice of provider. Provider-reported waiting times and distances were shared with patients to inform their decision. Patients that did not meet ICB-defined HVLC criteria were offered NHS providers. Uncontactable patients were referred to their nearest NHS provider.

All patients were asked to give a customer satisfaction score (CSAT) on the call.

In six months (1/9/24–28/2/25), 6016 patients were referred via SPoA, with 90% aged 60–89. Referrals came from 168/177 (95%) optometry practices. 13% of patients were unsuitable for HVLC, most commonly due to ocular comorbidities (n=413) or inability to lie flat/still (n=292). After the SPoA, 58% chose NHS providers, while 41% opted for independent sector providers (ISPs). Nearly half (47%) selected their nearest provider, averaging 16.1 km in travel (based on a straight line travel between outcodes). Patients who chose NHS sites chose their nearest possible location less frequently than those choosing ISP sites (47% versus 54%, chi2 p<0.05).

 The mean CSAT was 4.7/5 with a mode of 5/5 (given by 72% of patients).

The AI-powered SPoA system effectively standardised the cataract surgery referral process, ensuring patients had access to up-to-date information and a structured choice of providers. The approach led to an increased proportion of patients selecting NHS hospital providers compared to previous trends  (Royal College of Ophthalmology UK showed 41% of patients had surgery at an NHS provider in January 2024). Additionally, the system provides commissioners with transparent information around patient complexity and referral choice rationales.  High levels of patient satisfaction further support the potential for broader implementation of this model within European healthcare systems seeking to improve patient choice and referral efficiency.