Primary care eye health services can significantly reduce the load on secondary care3, be more convenient for patients, provide good value for money, as well as make greater use of optometry skills.
Optometrists, the perfect fit
The demographic of the UK is ageing bringing with it increased numbers of patients with eye conditions, such as age-related macular degeneration (AMD), cataracts and glaucoma. As hospital eye clinics are already working at full capacity, it’s inevitable that the solution will involve moving care, where appropriate, into a primary care setting.
Community optometrists are best placed to take on the work because they are:
- Trained, qualified, regulated and registered eye care providers
- Equipped with modern examination and diagnostic aids
- Easily accessible, located at the heart of the communities they serve
- Able to provide appointments swiftly and when it suits patients
Optical practices, working together
The need for extended primary care eye services and the ways in which they are commissioned vary across the UK. We believe that primary care eye health services work best when all local practices participate. The workload can be shared and the financial outcomes of delivering them are also equally distributed. These services can be commissioned by the NHS, either nationally or locally, to provide services to patients, funded by the NHS, outside the traditional NHS sight test. However, it is important that, where eye health services are commissioned, the fees for those services are economically viable.
ScotlandIn Scotland many of the services that would need to be commissioned as primary care services elsewhere are included within the Scottish General Ophthalmic Services (GOS) system, which is a wider-ranging service than it is in the other UK nations. There is some local commissioning of services, often as pilot schemes with an intention to roll out nationally if successful.
WalesWales has a raft of nationally commissioned services covered by Wales Eye Care Services (WECS). WECS position community optometrists as the first port of call for anyone concerned about their eye health as opposed to their vision. WECS enables optometrists to identify, monitor, manage and treat eye conditions within the community where appropriate and to refer on to secondary care if necessary.
The Department of Health in Northern Ireland established the Developing Eyecare partnerships (DEP) scheme in 2012 as a five year programme. Through its lifespan there have been a number of initiatives to streamline eye care services, including a glaucoma referral refinement scheme. Potential developments include an acute eye care scheme at a regional level and cataract referral refinement and post-operative management in community. There are also plans for optometrists to have greater connectivity and access to the electronic care record and to enable electronic referrals. The Regulation and Quality Improvement Authority is undertaking a review of DEPs and its recommendations will help inform future strategy.
EnglandEngland is divided into 211 Clinical Commissioning Group (CCG) areas from a community health point of view. Many CCGs are already making greater use of optometrists by commissioning additional services. However, each CCG is responsible for commissioning eye health services individually. The result is considerable variation across England, including a few areas where there are no primary care eye health services.
There is also often inefficient commissioning process, where CCGs choose to reinvent the wheel, rather than share the overheads of commissioning a new service with other CCGs. Small procurements of the same service are inevitably wasteful. This approach prevents eye health services from delivering benefits to patients and to the NHS.
We believe that services should be commissioned nationally if possible, and if not, they should be commissioned across as large a regional area as possible to deliver the maximum efficiency and the greatest consistency of provision. Local Optical Committee Support Unit (LOCSU) have developed pathways that are available to commissioners to provide consistency of provision and efficiency of commissioning. Significant progress is being made in England with increasing numbers of active services covering repeat measures, Minor Eye Conditions Services (MECS) and cataracts.
Changing community eye health
Hospital eye clinics and general practice are under great and increasing pressure6. Primary care eye health services provide a range of benefits that can help:
- Greater accuracy of referrals into secondary care1,2
- More treatment and management of eye conditions within the community1,2
- Fewer patient referrals1
- Easing of pressure on secondary care1,2,3 and general practice5
- More efficient use of scarce resources in secondary care – financial, human and clinical
- Better use of spare capacity in primary care1,2
- Greater benefits for patients in local treatment, accessible sites, continuity of care appointments at convenient times4
Influencing decision makers
We will continue to work with the LOCSU and our partners in the Optical Confederation to promote the benefits of primary care eye health services to decision makers and encourage wider commissioning. In a response to the Health Select Committee Inquiry on primary care we outlined the benefits of primary care eye health services and called for NHS England to produce a national eye health pathway that could help reduce commissioning costs and variation by setting common outcomes and experience measures.
We also continue to lobby for a better system for optometrists to achieve the competencies to become Independent Prescribers (IP) and for reform to the prescribing system that would allow more optometrists to deliver MECS.
- Patel D (2013) Auditing a repeat readings service. Optometry Today
- Warburton T (2013) Holding back the flood. Optometry Today
- Smith HB, Daniel CS and Verma S (2013) Eye casualty services in London. Eye, Vol. 27, 320-8
- Sheen NJL, Fone D, Phillips CJ, Sparrow JM, Pointer JS, Wild JM (2009) Novel optometrist-led all Wales primary eye-care services: evaluation of a prospective case series. British Journal of Ophthalmology, Vol. 4, 435-8
- Royal College of General Practitioners (2007) Weekly Returns Service Annual Prevalence Report.
- Royal College of Ophthalmologists (2016) Increasing demand on hospital eye services risks losing patient vision.
Last reviewed: May 2017
Read the rest of the AOP position statements.