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In 2001, the NHS plan concluded that there was a significant lack of capacity within current NHS structures to deliver adequate volumes of cataract surgery for England and Wales. The initial central 'solution' for this was to invite in overseas surgical teams to existing NHS centres for short-term surgical initiatives. However, with the advent of the Waiting, Booking and Choice Strategy, a target was set for treatment centers (TCs) to be carrying out an additional 250 000 inpatient/day-case episodes, across all specialties, by 2005. This paper outlines how these Ophthalmology TCs were commissioned, and some of the policy and medical agendas that surrounded their evolution. The concept of 'take or pay' contracts, which placed the onus on local Primary Care Trust organisations to provide the promised number of suitable cataract patients for the TCs, and the 'additionality' of medical and nursing staff are discussed. In September 2003, Netcare was awarded the contract to carry out 41 600 cataract procedures over a 5-year period in a mixture of mobile and fixed site units. Netcare's proposed patient care pathways are examined, as is the reality of its interaction with local Ophthalmology Departments and the response of the Royal College of Ophthalmologists to its standards of patient care. Although Netcare TCs may have contributed to reduced waiting times for cataract surgery in some districts, the quality of care provided by the Netcare TCs has yet to be established. There are ongoing concerns about both the continuity of care and the management of postoperative complications, as well as the economics of neighbouring NHS units.

Independent sector treatment centres (ISTCS): early experience from an ophthalmology perspective