Key interventions to transform eye care and eye health

The Association of Optometrists, Fight for Sight, Primary Eyecare Services and Roche Products Ltd have provided financial support for this activity and have had editorial input and reviewed all associated output

About the report

This report is by PA Consulting. The Association of Optometrists, Fight for Sight, Primary Eyecare Services and Roche Products Ltd have provided financial support for this activity and have had editorial input and reviewed all associated output.

The report explores new approaches to eye care and eye health in the UK. Each organisation is committed to seeing Government, the NHS and wider stakeholders embrace the strategic case for change, based on both clinical and socio-economic impact. The report analyses the value of General Ophthalmic Services; explores the wider challenges in eye care and eye health, and the case for change; and identifies how four high-impact system-wide changes can improve the delivery of end-to-end eye care, including the costs and benefits. 

Findings

A summary of findings from the Key Interventions to Transform Eye care and Eye health report are set out below, across four key themes.

Theme 1: The value of General Ophthalmic Services

• The High Street-based optometry sector plays a well-established role in supporting the NHS through providing General Ophthalmic Services (GOS) including both sight tests and a range of related services
• Using the NHS Disability-Adjusted Life Year (DALY) economic modelling technique, GOS delivers c£1.63 billion of value from correcting refractive error in children and young people and c£0.46 billion from the adult population, most notably from early detection of glaucoma and age-related macular degeneration (AMD) in older people
• Based on the estimated total cost of GOS at £525m, this represents a return of £2 billion that’s £3.98 for every £1 spent on GOS by the NHS
• This is very likely to be a significant underestimate of the true socio-economic value of GOS, as there are important areas of strategic benefit which are hard to quantify using DALY, underpinned by investments from eye care providers in their own services which benefit their customers/patients
• It is clear that the High Street optometry sector has both the willingness and the capability to contribute significantly more to the end-to-end provision of eye care and eye health.

Theme 2: The wider challenges in eye care and eye health

• The most prevalent eye conditions are predicted to increase between now and 2032. Prevalence of some major eye conditions is expected to grow by ~25% over the next decade – around seven times faster than overall population growth
• Hospital Eye Services (HES) are struggling to meet current demand. Waiting lists and times for hospital eye care have been growing for more than a decade, were significantly worsened by Covid, and even now remain close to their peak
• Demand for HES is growing faster than ophthalmology workforce capacity. Only 24% of eye units believe they have enough consultants to meet current demand
• There is significant variation in both eye care activity and outcomes. Some areas refer patients to HES three times more than others, and there is a 26-fold difference between areas in the rate of people registered blind or partially-sighted.

Theme 3: Four high-impact system-wide changes identified

1. A national roll-out of Community Urgent Eye Services – using the skills of primary eye care practitioners to triage, manage and prioritise patients presenting with urgent and/or minor eye conditions
2. A national roll-out of the Integrated Glaucoma Pathway – including ongoing monitoring to prevent the development or exacerbation of glaucoma for patients at risk
3. A national roll-out of the Integrated Cataract Pathway – primary care optometrists confirm patient eligibility for surgery. After surgery they check for and treat post-operative complications and monitor patient outcomes
4. To transforming the potential of OCT – making use of the OCT that takes place in community settings and harnessing its continued technological advance.

Theme 4: The costs and benefits of the four system-wide changes 

• All four interventions are considered highly feasible as they build on existing good practices and proven technologies and, importantly, also have low upfront costs to implement for the NHS and other stakeholders
• Given the community presence and trusted customer relationships of optometrists, they also have a high propensity to reduce burdens to patients and inequalities in access to care
• These four interventions could release approximately 1.9m appointments per year across Hospital Eye Services, A&E and GPs. Of these, around 1.2m are in Hospital Eye Services, equivalent to around 9,600 appointments per year for each Acute Trust in England
• The four interventions will also generate greater annual benefits than the costs required to deliver them, meaning an overall net gain in use of NHS resources
• Overall direct net benefits are estimated at £98m per year, assuming national roll-out of all four interventions (modelled for England, but benefits would be similar in other UK nations)
• In addition to benefits to the NHS, these changes will also bring significant (but as yet not fully qualifiable) benefits to patients, clinical staff, the wider economy and society.

Methodology

This report analyses the economic impact of four eye care interventions: national roll-out of Community Urgent Eye Care Services; national roll-out of the Integrated Glaucoma Pathway; national roll-out of the Integrated Cataract Pathway; and transforming the potential of Optical Coherence Tomography (“OCT”) in community settings and harnessing its continued technological advance.

To analyse the economic benefit of each intervention, PA Consulting first developed an underlying logic model which translated the intervention into one or more quantifiable benefits, including:

• Shifting activity into community eye care from (sometimes) higher-cost and (always) more under-pressure services – including hospital eye care services, GP surgeries and A&E Departments; and/or
• Removing activity from those same, other services.

Each intervention was then quantified in activity terms, using published evidence or (where required) expert assumptions to determine the number of appointments which could either be shifted in setting, removed as no longer required, or both. These appointment numbers were then multiplied by the cost to the NHS for each type of appointment to give a total benefit. Net benefits were then derived by deducting the cost of the service (assuming national rollout).

Finally, it is important to note that this economic analysis is set within the context of wider benefits which are highly important but difficult to quantify. These include greater convenience for patients, reduced anxiety from resolving issues more quickly, and increased staff satisfaction from relieving operational pressures (in hospital settings) a wider range of clinical work (in community settings).

Downloads

• Read the report in full [PDF]
• Read the executive summary [PDF]
• Read the report in full – accessible clear print format [PDF]