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    Case Study > PAH: Ophthalmology Demand and Capacity Programme

PAH: Ophthalmology Demand and Capacity Programme

The Princess Alexandra Hospital NHS Trust asked Four Eyes Insight to develop a thorough demand and capacity model across the ophthalmology pathway in order to comprehend how anticipated changes will affect waiting times and performance.

The ophthalmology team at Princess Alexandra Hospital NHS Foundation Trust (PAH) has experienced significant challenges over recent years. Waiting lists are growing, with demand for the service outweighing capacity. Demand and capacity is particularly challenging for long-term-condition follow-up patients. These patient cohorts do not form part of routine activity performance monitoring and, therefore, nationally are afforded less focus than other patient groups.

A recent visit by GIRFT and subsequent workshops helped to challenge the views on what improvements could be made with the current workforce and capacity. Four Eyes Insight was asked to support the programme by undertaking a detailed demand and capacity exercise for ophthalmology to understand how the planned changes would impact waiting times and performance.

Delivery Approach:

A pathway-wide model was designed to understand the demand and capacity for the ophthalmology service at a sub-speciality level. A series of bespoke scenarios were tested to review the impact of service improvement and productivity enhancement initiatives, such as:

1. The expansion of virtual Outpatient appointments for Glaucoma and Medical Retina patients

2. The introduction of high-volume cataract lists in theatres

3. An improvement in utilisation across the service (outpatients, diagnostics, POA, theatres).

For the duration of the programme, a weekly workgroup was established that brought together a multi-disciplinary team of key stakeholders to validate the model inputs, agree on reasonable assumptions and sign off on the accuracy of the final outputs.



The model delivered a robust understanding of the true gap between capacity and demand at a sub-speciality level across the full patient pathway.

It was established that backlogs for theatres could be controlled in line with the national target of 85% (0.65 additional patients on the average list) and introducing 3 high-volume cataract lists per week into business-as-usual processes.

The model also demonstrated improvements that could be made in outpatients by increasing virtual capacity and improving productivity to 95% (booked). However, it was clear that further changes would be required to meet follow-up demand fully.


The ophthalmology team continues to work alongside GIRFT to redesign outpatient pathways, supported by the outcomes of our analysis.