The High Court decision1 on 21st September 2018 widens the choice available for the treatment of wet age-related macular degeneration (AMD) for clinicians, and for patients. This will have a significant impact on organisations involved in the commissioning and service delivery of these interventions.
The offer of a choice of treatment is central to this judgement. It would be inappropriate for commissioners to consider introducing any changes to treatment without providing this choice, regardless of cost considerations.
Changes in therapeutic practice will have implications across the whole wet AMD pathway, affecting patients at various stages in their management from referral to active treatment and subsequent monitoring. This will require additional capacity to manage patient flows across the service system, and this will need to be planned for to safeguard patients during any treatment transitions.
NHS Commissioners and NHS Trusts should therefore set out their plans for:
i.How patient choice will operate to enable shared decision-making and informed choices.
ii.Maintaining supply and availability of all NICE recommended drugs for the treatment of wet AMD.
iii.Service capacity management to accommodate any change to therapeutic practice, including clear evidence-based protocols and processes for reviewing and monitoring the change, in accordance with safe practice.
[A suggested model is the SAFE-AMD Service System2 developed by the Clinical Council for Eye Health Commissioning]