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Moorfields at Brent Cross
For Glaucoma Week 2023 (12-18 March), we visited the Moorfields glaucoma clinic at Brent Cross Shopping Centre to speak to staff and patients. They told us how the hub has helped transform the way the NHS carries out routine diagnostics, tackle the Covid backlog and ensure patients receive sight-saving treatment as quickly and conveniently as possible.
What is Moorfields at Brent Cross?
The Moorfields Eye Hospital diagnostic hub is a dedicated space at Brent Cross Shopping Centre in North London, where Moorfields operates three eye clinics: for glaucoma, medical retina and cataracts. The hub opened in September 2021 in a large former retail unit on the first floor of the shopping centre, where it operates seven days a week throughout the year.
Patients who are referred by their GP or optician, or who are already being treated at a hospital eye clinic, receive a series of eye tests and checks using the latest equipment, operated by trained ophthalmic technicians. The tests are carried out in a streamlined way that maximises efficiency of space and time, making the whole process as quick and simple as possible for patients and staff.
Through carefully planned organisation and proactive management, the hub allows Moorfields to see a maximum number of patients each day. Test results are sent for analysis by specialists at Moorfields, who contact patients as soon as possible for any follow-up appointments or treatment that may be required.
“One of the challenges that’s still going on across the UK, and in London in particular, is delays in seeing patients. This is really a hangover from the pandemic. We’re so fortunate that in Moorfields, largely thanks to this project, we currently have no backlog for our glaucoma patients.”
Dr Hari Jayaram, Consultant Ophthalmic Surgeon, Glaucoma Service, Moorfields Eye Hospital
Why was the hub created?
The Covid pandemic meant that 120,000 hospital appointments for routine glaucoma checks had to be cancelled. This resulted in a significant post-pandemic backlog that threatened to delay diagnosis of common eye conditions like glaucoma. It was crucial to tackle this backlog, as there is a risk of irreversible sight-loss if people with glaucoma are not diagnosed and treated quickly. Moorfields decided to establish a new type of diagnostic service that could handle as many patients as possible outside a traditional hospital setting. The hub was designed to minimise appointment times and be as convenient for patients as possible.
Whereas patients coming to hospital clinics might have to spend three or four hours moving around different areas of the hospital to have all the necessary tests carried out, in this new space, everything could be done in 45 minutes, from check-in to departure, with minimal movement around the space.
“The primary aim of the research is to try to develop the most efficient … and also the most acceptable method for patients to be monitored in a timely manner.”
Dr Hari Jayaram
What is the research aspect of the hub?
The HERCULES project, funded by the NIHR Moorfields Biomedical Research Centre and UCL with support from Moorfields Eye Charity, was set up with involvement from a multidisciplinary team of academics from across UCL including clinicians, architects and specialists in space management and materials.
Because the hub model is a relatively new way for the NHS to deliver patient care, the clinicians at Moorfields who set up the Brent Cross hub wanted to ensure it was as efficient and effective as possible. That meant using rigorous scientific methods to establish the best way of organising the space and arranging the various tests, which all require different machines and set-ups. Patients who volunteer to take part in the research are tracked as they move through the space and interviewed about their experience at the end of their appointment.
By trying out different configurations and ways of working, and then measuring the impact on appointment times and patient experience, the team set out to find out which system would work best. Because the hub was set up in a large, modern, open-plan former retail space, it has been possible to change the configuration easily using temporary partitions. So far, three different layouts have been trialled, and a fourth layout will be implemented soon.
Project lead Prof. Paul Foster delivers a presentation on the HERCULES project, showing the initial layout.
“For a glaucoma patient, within a normal hospital setting, it can take from two to four hours for the whole patient appointment to be completed. However, within Brent Cross, because we have all the equipment streamlined within one area, the appointment takes 45 minutes in total.”
Joy Adesanya, Operational Lead, Brent Cross Diagnostic Hub
How successful has the hub been so far?
The hub has been extremely successful in reducing the backlog of patients waiting for routine eye check-ups at three Moorfields sites: Moorfields Eye Hospital (City Road Campus), Northwick Park Hospital and Ealing Hospital. Lessons learned from the Brent Cross are already being applied across Moorfields, including at the Hoxton diagnostic hub, and there has been interest in the results of HERCULES not only nationally within the NHS, but among internationally, as far afield as Singapore.
As well as helping patients and the NHS, the hub has also created valuable training and ongoing employment opportunities for highly motivated people from outside the healthcare sector who lost their jobs during the pandemic. Skilled jobs, such as technicians and senior technicians, have attracted people from a range of backgrounds, with high levels of job satisfaction resulting from face-to-face patient contact and pathways to promotion within the hub.
Some of the successes so far:
20,000 glaucoma patients seen in 18 months
Covid backlog eliminated at Moorfields
Average appointment time reduced from 2-4 hours to 45-60 minutes
Around 60 glaucoma patients seen every day
Referral times currently as little as two weeks
Covers patients in a large area of north-west London and beyond
3 different space configurations tested so far
2,598 glaucoma patients recruited to take part in research at Brent Cross
Overall, the hub has saved the sight of around 1,100 patients through faster diagnosis
Joy Adesanya, Operational Lead for Moorfields at Brent Cross
What impact has the hub had on glaucoma patients?
The hub has allowed patients to be seen more quickly by reducing the backlog following the Covid-19 pandemic. It has reduced the times between referral, appointment and follow-up. The shorter waiting and appointment times are hugely benefit to patients, especially those with other health conditions.
Ease of access and convenience for many people has improved, as they no longer need to travel to central London for their tests. They can take advantage of easy transport links to Brent Cross and the amenities of the shopping centre, including free parking. Many patients also appreciate the friendliness of the staff, who have been recruited specifically to provide a customer-focused service, in a quieter, more welcoming and relaxed atmosphere than a traditional hospital setting.
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