Monitoring by Primary Care Trusts of services from providers is poorly structured according to two ophthalmologists in a letter to the British Medical Journal. The two have looked at steps to gauge provision of cataract surgery but say good quality monitoring is essential in all areas.Paul Brogden, specialist registrar in ophthalmology and Ian Simmons consultant ophthalmologist, from Leeds Teaching Hospitals NHS Trust, say that in accordance with the patient choice scheme, all 303 English Primary Care Trusts have been obliged since January last year to offer patients a choice of at least two providers for cataract surgery. Patient Choice allows patients to have a say in how, where, and when they are treated. Providers can be NHS trusts, diagnostic and treatment centres or independent sector providers from this country or abroad.

By February 2005, they say, 13 000 extra operations had been performed under the independent sector treatment programme but concerns were raised about variations in clinical safety between different providers.

As a result surveys were sent to the leaders of patient choice in each PCT, asking how the quality of care from their providers was monitored. The responses from 125 trusts showed the largest number – 36 – relied on patient questionnaires and 33 – used non-specific or service level agreements. An audit system was used by 24 PCT’s but 15 didn’t know what measures were in place and 3 had none.

Based on these results the doctors say, “The quality monitoring of providers by primary care trusts is poorly structured and variable.” They go on to ask who should be monitoring standards and what variables they should use and whether this should be the role of the Strategic Health Authority, the provider, or the purchaser in the form of primary care trusts to monitor the product offered to the patient.

They add, “The public expect that safe cataract care should be commissioned for them, and robust methods of monitoring need to be agreed and implemented so that patients can make a truly informed choice. These decisions need to be made not only for cataract surgery but also for other elective procedures that will increasingly be made available to patients through the patient choice scheme.”