Project VISION: Value Improvement through Switching Innovation in Ophthalmology; A BVBT led model for delivering efficiency and productivity

Oxford University Hospitals NHS Foundation Trust

Project summary

Project VISION (Value Improvement through Switching Innovation in Ophthalmology) demonstrates how a dedicated biologics best value team can unlock significant productivity gains while delivering exceptional value for money in a high-pressure clinical service.

Biosimilars are a well-established NHS strategy, delivering equivalent clinical outcomes and improved value, yet uptake is often constrained by clinical capacity. In ophthalmology, Aflibercept is administered as an intravitreal injection into the eye, meaning any biosimilar switch must be carefully aligned with both prescribing and procedural workflows, adding complexity to implementation.

At Oxford University Hospitals NHS Foundation Trust, the newly established Best Value Biologics Team (BVBT) addressed this challenge through a novel, delivery-focused model, taking operational ownership of switching Aflibercept to its biosimilar, Afqlir. This constituted one of the largest programmes of its kind in Oxford and the sector, encompassing approximately 2,000 patients.

Recognising the constraints of busy, often overbooked clinics, the BVBT spearheaded a proactive approach, undertaking the work required to deliver the switch. This included prospectively updating Medisight prescriptions ahead of clinic attendance, removing the need for ophthalmologists to complete time-intensive prescribing changes during clinics. This released clinician capacity, reduced workflow disruption, and enabled greater focus on patient care.

To the best of our knowledge, and certainly across our Integrated Care System, this represents the first instance of non-ophthalmology specialist pharmacists leading a large-scale biosimilar switch with this level of detail, including the updating of Medisight prescriptions. This innovative approach as modelled by the BVBT is not previously described.

The BVBT coordinated all aspects of delivery, including legal governance, stakeholder engagement, patient communications, stock management and query handling. This centralised model minimised burden on clinical teams, enabling a seamless transition without disruption to patient care or service capacity, while maintaining high levels of clinician confidence and patient reassurance.

The programme is forecast to deliver approximately £5 million in savings, demonstrating substantial return on investment while supporting optimal use of NHS resources. It also established a scalable, efficient delivery model for future high-cost medicine switches.

Project VISION shows that having a dedicated BVB team to lead and deliver complex switching programmes enables organisations to accelerate adoption of best-value medicines, reduce burden on clinical pharmacy teams and deliver greater efficiency, productivity and value for money at scale, without compromising patient care.