Queensland eyecare professionals have voiced concerns over “unnecessary” changes to referral requirements, with patients being bounced between specialists and allied health professionals and contributing to what’s being described as a hidden waiting list.
Ophthalmologists and optometrists from the state have told Insight that since the COVID-19 outbreak, public hospitals have been rejecting some referrals and stating that they must now be resubmitted by either an optometrist or GP – or both in some cases.
It’s also been revealed that some Category 3 patients are being discharged back into the care of optometrists and removed from surgery waiting lists entirely. This is despite deterioration of their eye health and the fact they need an ophthalmologist to diagnose and treat their condition.
Like other state health systems, the Queensland Government is working to address an elective surgery backlog. This was caused by a suspension on non-urgent cases at the height of the pandemic to ensure health systems were prepared for an onslaught of COVID-19 patients.
Although this never eventuated, the public system has been placed under further strain after thousands of people dropped their private hospital insurance cover earlier this year amid the economic uncertainty.
Australian Society of Ophthalmologists deputy director Dr Bill Glasson, who performs eye surgery in both private and public settings, said there were around 52,000 Queenslanders on waiting lists. There was also approximately 7,000 more people awaiting ophthalmic surgery than what would normally be the case.
He said many referrals to public hospitals during the COVID-19 period had been deemed null and void, with the patient needing to be re-referred by an optometrist and/or GP.
“It’s frustrating for the optometrist, the GP and the patient – and it’s completely unnecessary,” he said. “But it’s the way [public hospitals] can control demand, they are constrained by budgets and therefore can only perform a certain number of cases per year, and the way to reduce demand is by sending people around in circles.”
Glasson said because those patients never got to see a specialist as medically required, this was forming “a hidden waiting list”. Instead, they were often being seen by non-medical and allied health professionals.
“And then it’s being said that the patient has been ‘seen’ by a doctor – and this isn’t the case. A doctor is the only person who can book them for surgery,” he said.
“We need to get a handle on those people who are waiting to be seen to be assessed by a doctor.”
Removed from waiting list
Meanwhile, Mr Justin Gribbin, whose practice Eye Envy Optometrist is based in Morayfield north of Brisbane, said approximately 11 of his Category 3 patients had received letters stating they had been removed from ophthalmology waiting lists and returned to his care.
In the worst case, he had a cataract patient who had been on the waiting list since October 2018. He’s a commercial driver but no longer reached the licensing requirements due to his vision.
“The letter said if you feel the condition deteriorates don’t hesitate to provide us with a new referral. In this gentleman’s case, there had been a significant change in his vision; he was initially 6/19, but this had dropped down to 6/30. So we sent another referral saying that he’s a commercial driver, he needs his vision and they rejected him a second time.”
Gribbin said some other patients discharged back into his care without seeing an ophthalmologist were glaucoma suspects. He found this was not an isolated case, with many optometrists also reporting similar experiences in the state.
“With COVID-19 I understand raising the criteria for surgery to a certain extent, but removing from the list entirely – that’s the bit that has got me annoyed.”
Additional changes introduced during COVID-19 that now require patients to have a referral by both the optometrist and GP were also causing logistical headaches, with cases being rejected if the referrals aren’t sent simultaneously.
“If there’s a lag between my referral and the GP’s referral, its rubber stamp rejected,” Gribbin said.
In one letter seen by Insight, the public hospital said the measure was introduced for non-urgent referrals to “allow a more holistic understanding of the patients’ requirements”.
‘A very small number’
Glasson was hopeful the Queensland Government’s $250 million allocation for a backlog surgery ‘blitz’ – announced in June – would help address waiting list issues and ensure patients are treated within appropriate timeframes.
According to Queensland Health, that funding has already seen the number of patients waiting longer than clinically recommended drop to 2,774 from a projected peak of 7,000.
While public hospitals continued to deliver 11,723 urgent lifesaving surgeries during the restriction period, a spokesperson said approaches would differ for Category 3 patients depending on whether they are waiting for elective surgery or specialist care.
“Individual Hospital and Health Services across the state continue to monitor their own wait lists, and are continuing to put actions in place to reduce the time for patients waiting longer than clinically recommended,” the spokesperson said.
Queensland Health Minister Mr Steven Miles acknowledged to the ABC that Queensland Health could do better managing patients who were “bounced around” between specialists and allied health professionals.
“We need to improve those pathways so that does not happen, but it is important to realise that is a very small number,” he said.
In response to questions from Insight, he said elective surgery services are now routinely at their pre COVID-19 levels in many hospitals.