Croydon Local Optical Committee (LOC) announced last week that its community company would cease the running of the Croydon Community Ophthalmology Service (COS) following a decision to award the contract to Primary Eyecare Services (PES).
The Community Ophthalmology Service (COS) in Croydon provided eye care through local community-based optometrists and aimed to provide patients with recently occurring eye conditions treatment and advice closer to home without referral to Moorfields Eye Hospital. Triage and screening for Moorfields represented another function of the service, with patients in Croydon required to be seen through COS before they could be referred
In a statement, Croydon LOC said: ‘It is extremely disappointing that, having been involved in this Croydon service for over 11 years and having developed it into what has widely been acknowledged as an exemplar service, a decision has been made in Moorfields’ strategic interests rather than in the interests of all stakeholders in Croydon.’
The LOC’s statement added that it believed the Croydon Community Ophthalmology Service had become a ‘casualty’ of a competitive tender process that a recent NHS White Paper had specifically raised concerns around.
PES, which described itself as the largest single primary eye care provider of extended NHS eye care services in England, contested Croydon LOC’s assessment. Dharmesh Patel, CEO at the company, told Optician: ‘The Croydon Community Ophthalmology Service has not been affected by the procurement process. It is correct the service has been reprocured – through which the service’s name has been changed to Croydon Community Eyecare Service, as there are a number of pathways under this banner.’
Patel added that the commissioner of the service, Moorfields, had updated some treatment pathway protocols and processes, but said: ‘It is our belief that following transition the Croydon service will go from strength to strength.’
The claim that the service had not been affected by the procurement stood in opposition to what one disgruntled member of Croydon LOC told Optician. ‘What’s being provided [by PES] is a dumbed-down service,’ they claimed. ‘The casualty is that the existing, successful organisation is unable to continue to provide a successful service while another organisation provides something inferior in terms of the provision and organisation.’
The optometrist at Croydon LOC said they believed that same-day appointments, enhanced examinations such as OCT photography and school screening services would no longer be provided as part of PES’s service. Patel rebutted this and claimed that urgent appointments and enhanced examinations remained a key part of the service. He added: ‘The protocols and when these apply have, in some cases, been adapted as part of the new service. As far as we are aware, school screenings were never a part of the service and are not a part of the service that has been commissioned.’
Patel added that PES planned to introduce a number of new services to the area. ‘There are plans to introduce a number of monitoring services, focusing, in the first instance, on glaucoma,’ he said.
Tender Local Care
Croydon LOC’s frustrations were not limited to the loss of its contract to provide COS and extended to concerns with what one member called a ‘conflict of interest’ during the tender process. As an LOC, Croydon was supported by the Local Optical Committee Support Unit (LOCSU) during the bid for the contract and paid the organisation fees for that support. However, Croydon LOC has now separated itself from LOCSU membership.
A member of Croydon LOC explained: ‘In every LOC area LOCSU provides a lead who is supposed to help with procurement, bids and finance. In Croydon however, our LOCSU lead was a director at PES. So how were we supposed to go to them to ask for advice on procurement when our lead was a director of a company competing for the same procurement?’
PES confirmed that Croydon’s supporting lead from LOCSU had a non-executive role within the company at the time of the bid. However, the company explained: ‘His conflict will have been declared as usual and he will have offered the LOC support from the wider LOCSU team on the planned bid to mitigate any potential conflict. As ever, LOCSU have a team of people who support LOCs, not an individual.
‘Moorfields Eye Hospital is the commissioner of this service and ran an open and compliant process to enable the delivery of an effective service for patients in Croydon. This builds on the great work developed to date between the former provider, Croydon LOC and Moorfields.’
Why the change?
As the incumbent provider of what it called an ‘exemplar service’ Croydon LOC was surprised when it was informed that the contract for the service was put up for procurement, according to one member.
Asked whether they had been informed that the service they were providing was below the expected standard, this optometrist explained: ‘No, not at all. There was no logical reason to change from us as the provider except, ironically, that Moorfields were so pleased with our service that they wanted replicate it all over London.’
The contract that Moorfields put up for procurement was to provide services similar to those available in Croydon across London. PES, an organisation many times larger than Croydon LOC with experience of providing services such as this, won the contract. Patel explained: ‘A full NHS procurement process was followed with a pre-procurement market engagement exercise which had attendance from large parts of the optometry sector and many private sector providers.
‘After careful consideration, PES decided to submit a proposal for the tender due to the scope and breadth of the service proposals, which included services beyond Croydon in further phases.’
A Locsu statement on the reason for the procurement said: ‘All services commissioners have a duty to evaluate, re-evaluate and continually develop services to ensure patients can access services consistently and appropriately. Patients in Croydon are still able to access high-quality primary care. The services provided by COS delivered that and no doubt the services delivered by PES will do too.’
Moorfields explained its position in a statement to Optician. It said: 'An independent procurement company was used for the tender to make sure the selection process was both fair and open. The best interests of patients are central to any decisions we make about services we provide, and we will work with PES to enhance the community eye care service for people in Croydon.'
State of play
It has been planned that the newly procured service will be expanded across South-West London following a transition period. PES explained that it would seek to expand the geographic scope of its services and harmonise them across the area, where it was already the lead provider for all other extended eye care. Patel added that the majority of the practices previously providing COS would continue to do so while others would join the service.
‘We have worked hard to ensure as smooth a transition as possible on and around the 1st April,’ said Patel, ‘We expect the service to grow and develop whilst additional pathways and services are mobilised to achieve the wider ambition for greater care being delivered through optometry practices.’
Commenting on the continued viability of LOC-led eye care services, a LOCSU spokesperson told Optician: ‘This decision [to award PES the contract] endorses a model of delivery via optical practice. It also ensures that more care can continue to be delivered close to patients’ homes by optical practices and it places trust in the high-quality care delivered by practitioners in Croydon.’
Locsu added: ‘The practices delivering the clinical services are still able to deliver these clinical services, which they are now doing. Patients in Croydon are still able to receive high-quality extended care; there is no doubt that this high-quality care will continue to be delivered.’