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AOP position

Primary care eye health services

The NHS should use optical practices in England to provide more eye healthcare

Optical practices in England can and should provide more eye health care services on behalf of the NHS. This will help patients, relieve pressure on hospitals and GPs, and save the NHS money.

What’s happening

Most eye health problems are treated in hospitals. Demand for hospital eye care in the UK is high and growing – in 2015/16, ophthalmology was the second largest outpatient speciality in England, with over 7.5 million appointments1. Around 8% of all outpatient appointments in England are for eye care, and attendances grew by 24% between 2010/11 and 2016/17. There were over 450,000 eye-related visits to A&E in 2016/172, and there are an estimated 2.6 million eye-related GP appointments every year.

Hospital eye clinics are already working at full capacity. The British Ophthalmological Surveillance Unit has found that at least 20 people a month3 are losing vision unnecessarily because of delayed follow-ups in hospital – a tragic and unacceptable situation. And as the UK’s population ages, with the number of people aged over 65 projected to rise by over 40% in the next two decades, more people will need treatment for serious eye diseases such as cataracts, glaucoma and age-related macular degeneration (AMD). The Royal College of Ophthalmologists estimates that glaucoma cases will increase by 44% over the next 20 years, and AMD cases by 60%4. In the absence of extra resources, hospitals will be unable to cope.

But help is at hand. Optometrists – who work in optical practices located in every community in the UK -

  • are highly trained and regulated eye care providers 
  • are equipped with modern examination and diagnostic aids 
  • can treat and manage a wide range of eye conditions and diseases. 

Nearly all UK optometrists already provide NHS services such as sight tests, as well as offering other eye healthcare services.  

Giving optometrists a greater role in eye healthcare is good news for patients, who can access the care they need quickly and conveniently in a local optical practice. Patients welcome the opportunity to receive prompt, high-quality care in these local settings rather than having to wait for an appointment at a busy and often distant hospital. For instance, a Minor Eye Conditions Service in the Morecambe Bay area has treated thousands of patients since 2016 with high levels of satisfaction – one patient described the service as “brilliant, efficient, friendly and a great use of NHS resources”5

Moving more healthcare into optical practices is also good for hospitals and the NHS. It means fewer and more accurate patient referrals into secondary care, and reduces the pressure on hospital eye clinics and A&E departments, enabling them to focus on patients with complex and urgent problems. 

What needs to change

Optometrists can only fulfil their potential to provide more eye healthcare, and relieve pressure on the rest of the NHS, if they are given the opportunity. The NHS in each part of the UK needs to commission the necessary ‘extended primary eye care’ services from community optical practices – and at the moment, this happens much less than it should. This paper explains the picture in each part of the UK, and how it needs to change. 

Healthcare in England is commissioned through a patchwork of Clinical Commissioning Groups which make their own arrangements. This has led to wide variations across the country. Many commissioners have set up services to enable optometrists in the community to monitor patients with conditions like glaucoma, to treat minor eye problems, and to provide post-operative care after cataract surgery. But these are usually on a small scale, and in some areas, there are no extended primary eye care services. 

This is inefficient, and creates a postcode lottery where many patients are deprived of the benefits that eye healthcare in the community can offer. We think eye healthcare services in England should be commissioned on as wide a scale as possible, to deliver these benefits to everyone. 

Ideally there should be a nationally commissioned service with every optical practice helping to share the workload. The fees for providing the service would need to be set at an economically viable level, unlike the current NHS sight test fee. 

The UK Government’s plans to change the way healthcare services are commissioned in England, using Sustainability and Transformation Partnerships (STPs) to design services across wider areas, offer a good opportunity to establish extended primary eye care services on a wider scale. The Local Optical Committee Support Unit (LOCSU) has developed model pathways that commissioners can adopt.

What we’re calling for

We want to see extended primary eye care and community monitoring services commissioned at national level in England. If this is not possible, pathways should be nationally endorsed, and services should be commissioned on as wide a scale as possible. Local Eye Health Networks and Eye Health Networks should be properly supported and resourced to enable them to drive forward service improvement.

THE STATE OF PLAY IN THE OTHER NATIONS

Scotland

In Scotland many eye healthcare services are already included within the Scottish General Ophthalmic Services (GOS) contract, which is wider-ranging than in the other UK nations where it largely covers NHS sight tests. There is some local commissioning of additional services, often as pilot schemes with an intention to roll out nationally if successful. 

Wales

Wales has a raft of nationally commissioned services covered by Wales Eye Care Services (WECS). This means that community optometrists are the first port of call for anyone concerned about eye health issues such as red eye and infections. WECS enables optometrists to identify, monitor, manage and treat eye conditions within the community where appropriate, and to refer patients on to secondary care if necessary.

Northern Ireland

The Department of Health set up a five year Developing Eyecare Partnerships (DEP) scheme in 2012, including initiatives to streamline eye care services such as glaucoma referral refinement. The scheme has now ended. Potential future developments include a regional acute eye care scheme, and cataract referral and post-operative management in the community. The Regulation and Quality Improvement Authority is reviewing the DEP and its recommendations will inform future strategy. The DEP recommends establishing a Norther Ireland Eye Health Network to help achieve the aims of creating a sustainable eye care service, able to meet the demands of an ageing population. We fully support this aim. 

We continue to work with Optometry Scotland, Optometry Wales and Optometry Northern Ireland to promote optometrists as eye healthcare experts in the community and to encourage the wider roll—out of pilot schemes. 

References

  1. Source NHS Digital “Hospital Outpatient Activity 2016-17”, Table 4, page 15
  2. https://digital.nhs.uk/data-and-information/publications/statistical/hospital-accident-emergency-activity/hospital-accident-and-emergency-activity-2016-17
  3. https://www.rcophth.ac.uk/standards-publications-research/audit-and-data/the-british-ophthalmological-surveillance-unit-bosu/abstract-surveillance-of-sight-loss-due-to-delay-in-ophthalmic-review-in-the-uk/
  4. https://www.rcophth.ac.uk/standards-publications-research/the-way-forward/
  5. See for example: https://academic.oup.com/jpubhealth/article/19/4/431/1591479 and https://www.uhmb.nhs.uk/media-centre/latest-news/community-eye-care-service-provides-nearly-6000-appointments-patients-its-first-year/

Reviewed August 2018

Read the rest of the AOP position statements.