Sir,

We see in the Short Notes from Council (12 September 2003) that the College felt that ‘medical intervention was vital in order to ensure that the diagnosis and indications for surgery were appropriate, at a stage before the actual day of surgery’.

At Peterborough, we have been running a one-stop cataract surgery project since September 1999 where patients are listed by trained optometrists. Patients have their surgery on the first day they come to the eye department, following a brief examination by the surgeon at the slit lamp after mydriasis.

We recently looked at the difference of rates of cancellation of surgery on the day for ‘one-stoppers’ and conventionally listed patients for the period January 2002–August 2003. This difference would be a broad measure of the appropriateness of listing of the one-stoppers.

Of roughly 600 one-stoppers, 67 (11%) were cancelled on the day. This compared with 153 (8%) of around 1800 conventionally booked patients cancelled on the day. This 3% difference equates to the loss of 18 surgical slots, but our theatre coordinators estimate that they refill 90% of slots with patients prepared to come in at short notice, or even with patients just listed during the same session by other surgeons in clinic. This comes as a surprise for the patient concerned, but is not compulsory and saves a theatre slot.

Thus, over the given period, without medical intervention before the day of surgery, we have lost about two operating slots, but saved 600 outpatient appointments.