Bupa Ophthalmic Network

We’re committed to ensuring our customers receive high quality, good value healthcare. Our Ophthalmic Network agreements, which run until June 2025, will help us to do that.

Any Bupa recognised hospital or clinic providing cataract services can apply to join the new network.

Yes, all hospitals/clinics in the network will need to have an up-to-date Bupa Core Quality Assessment, valid within the last three years. To find out whether your hospital/clinic needs to complete one, please call us on 0161 240 4346^{^}.

The network runs for three years, and is due for renewal on 1 July 2025.

Once we've received your hospital/clinics application we'll let you know if it meets the network criteria and is able to join. If your hospital/clinic doesn't meet the criteria we'll let you know why.

You can reapply to join the new network if your hospital or clinic’s circumstances change. If you’d like to resubmit an application or have any questions, please call us on 0161 240 4346 ^{^}.

A Standard Pathway agreement is where hospitals and consultants and anaesthetists all bill us separately for each individual element of cataract surgery.

A Full Pathway agreement is where hospitals manage the cataract surgery care pathway and all associated costs, including reimbursing consultants and anaesthetists, setting remuneration and delivering the pathway in line with the Royal College of Ophthalmologists’ guidelines and our network specifications.

The hospital invoices us for a cataract surgery package, which covers all hospital fees, the patient’s initial consultation, pre-and post-operative tests (up to six weeks after surgery), cataract surgery, anaesthetist's fee (if appropriate), and up to two follow up consultations with a consultant or optometrist.

Yes. While we hope hospitals will consider renewing their network agreement on a Full Pathway basis, we appreciate this may not be an option for all consultants at the hospital. So, we’re happy for you to renew your agreement on a Standard Pathway basis or have an agreement that combines both Standard and Full Pathway options.

If your hospital/clinic joins the network on a full pathway basis:

• Your hospital/ clinic will reimburse consultants and anaesthetists who have agreed to accept referrals for the Full Pathway and pay them for the care they provide
• We’ll reimburse your hospital/ clinic for the total cost of cataract surgery treatment in accordance with the terms of the Full Pathway agreement
• Your hospital/ clinic will pay consultants for treating Bupa cataract surgery patients
• If a consultant or anaesthetist who is listed in your Full Pathway agreement invoices us for any of the services included in the Full Pathway, we’ll need to recover the payment from them or your hospital/ clinic (if the consultant or anaesthetist has not yet been paid by your hospital/ clinic) as we’ll have paid your hospital/ clinic for it already

We’ve looked at the Royal College of Ophthalmologists’ recommended pathway for high quality cataract services, reviewed self-pay rates and the NHS Tariff, and set fees for both the Full Pathway and Standard Pathway options that we believe enables hospitals and clinics to provide these services while keeping premiums affordable for our customers.

The Full Pathway cataract service is a package and the fee includes all services relating to the delivery of the cataract pathway. The charge covers all the following services:

• initial consultations
• out-patient diagnostic tests with a consultant or optometrist
• local anaesthetic or anaesthetists’ fees
• cataract surgery
• hospital fees and all post operation follow-up appointments (we’ll usually expect two follow-up appointments per eye in line with guidance from the Royal College of Ophthalmologists)
• any other services required from the first point of contact to the point when approved treatment ends



The Full Pathway fee is for a “Fixed Price Package” under our Business Rules - more details about what the fee includes is included in the Services and Charges Rules (paragraphs seven and eight) which can be found by following the links on the application landing page.

No. By joining the network fees you’re agreeing to the fees until 1 July 2025.

If, after assessment, there’s a clear clinical rationale that indicates a Bupa patient is unsuitable for treatment on the Full Pathway, then the patient is able to transfer to the Standard Pathway and continue treatment with the same consultant, provided that the hospital/ clinic offers that pathway too. If the hospital doesn’t offer that pathway, the consultant will need to see the patient at another hospital/ clinic that does.

Consultants and hospitals have told us that more preoperative preparations and more intensive post-operative management are needed for patients choosing multifocal lens implants than when mono-focal lenses are used.

As well as explaining to Bupa patients when they pre-authorise their treatment that they’ll be responsible for the additional charges if they choose a non-standard lens, we’ll also be clearer that they need to pay any additional charges associated with the surgery, such as extra diagnostic tests and consultations.

Patients should only be asked to pay charges for tests and additional consultations that result from them choosing a non-standard lens and for hospital/ clinic or consultant care that’s not included in the Full Pathway. Hospitals/ clinics and/or the consultant will need to itemise all additional charges and agree them in writing with the Bupa patient before surgery.

The patient will be responsible for settling these charges with the hospital/ clinic and/or consultant, as these charges aren’t usually covered by their health insurance policy.

We don’t cover laser assisted cataract surgery because currently there’s no evidence that using it for cataract surgery is clinically better than using conventional methods.

Where hospital and clinics offer Femtosecond laser-assisted cataract surgery as part of a randomised controlled trial in line with NICE guidance1 and Bupa patients choose this option, we’ll pay for the procedure at the same rate as we’ve agreed with you for standard cataract procedures. These charges are fixed and there should be no additional charges relating to the manner in which the procedure is carried out.

• When a patient calls us to pre-authorise treatment, we’ll explain the treatment options available and let them know that all the costs of their care will be covered when they choose to have their surgery at a Full Pathway hospital/ clinic.
• We’ll also encourage them to use Finder (finder.bupa.co.uk), our online directory of healthcare professionals and services, to look up any hospitals/ clinics they’re considering so they can make an informed choice about where to have their treatment.

• Increasingly Bupa patients are choosing to have their surgery at hospitals and clinics that offer them the reassurance of high-quality care and the guarantee of an all-inclusive treatment package. We’re now making it easier for patients to search for these hospitals and clinics, and the consultants that practise there.
• All hospitals and clinics that offer the Full Pathway will be promoted with the Cataract Full Pathway badge on Finder (finder.bupa.co.uk), our online directory of healthcare services and professionals. When patients call us with an open referral, we’ll also explain to them the benefits of the Full Pathway.

Yes, your hospital/clinic will still be able to treat Bupa cataract surgery patients; however, we’re unable to guarantee patient volumes. We know that many customers prefer full pathway and this, together with the benefits we offer under the full pathway (see answer above), may impact the number of Bupa patients your facility treats.

The guidelines can be found on page 19 of the Royal College of Ophthalmologists’ Adult Cataract Surgery Commissioning Guide January 2018 at:

https://www.rcophth.ac.uk/wp-content/uploads/2018/02/Cataract-Commissioning-Guide-January-2018.pdf (PDF 0.75MB)

Recommended high quality cataract care pathway

An overview of an exemplar cataract care pathway is shown below, and this is derived from the Royal College of Ophthalmologists’ Adult Cataract Surgery Commissioning Guide, the NHS Institute for Innovation and Improvement for best practice guidance on cataract and incorporates the recommendations previously made by the Royal College of Ophthalmologists on cataract surgery commissioning.

Key points

1. Patient visits GP or optometrist for assessment and is referred directly to the hospital eye service. Patients may also be listed for cataract surgery from hospital eye clinics.

2. Preoperative assessment:

• Measurement of visual function and ocular examination, including biometry.
• Provision of patient information leaflets.
• Verification of suitability for day case surgery, including discussion of anaesthesia options (usually topical or sub-tenons anaesthesia, but general anaesthesia may be required in some circumstances).
• Identification of need for second eye surgery if there are cataracts affecting both eyes, postoperative anisometropia or another indication for second eye surgery.
• Completion of cataract consent form and discussion / choice of postoperative refractive target.
• Verification that the case is appropriate to the level of expertise of the operating team and its clinical facilities. Adequate account must be made for any ocular or systemic co- morbidity which might increase the technical difficulty of the procedure or increase the risk of complications.

3. Day of surgery:

• Ophthalmologist or appropriately trained nurse marks eye and confirms consent. Preoperative check using NPSA surgical safety checklist performed by an ophthalmologist or appropriately trained nurse prior to surgery.
• Patient reviewed by appropriately trained nurse following surgery - postoperative patient information, postoperative appointment date confirmed, and postoperative drops dispensed.

4. After-care:

• Initial review by week review by nurse, optometrist or ophthalmologist.
• Second review within four to six weeks post-operative by nurse, optometrist or ophthalmologist, refraction by optometrist.

(This may be combined as a single postoperative visit)

Providers of cataract care should be able to demonstrate to commissioners that the service makes appropriate provision for complications of surgery or other unexpected events which may occur during the cataract care pathway, including arrangements for urgent review or handover of care.

Providers of cataract care should be able to demonstrate that the service makes appropriate provision for complications of surgery or other unexpected events which may occur during the cataract care pathway, including arrangements for urgent review or handover of care.