All-Party Parliamentary Health Group (APHG) call for evidence inquiry on improving access to primary care

The All-Party Parliamentary Health Group commissioned Policy Connect to conduct a call for evidence inquiry on improving primary care access. Their rationale is stated as follows:

“Robust evidence consistently identifies persistent workforce shortages, outdated infrastructure, patchy digital integration, structural health inequalities and barriers to access, and inconsistent funding streams as primary obstacles to effective service provision. This inquiry…will critically assess and identify further actions required to ensure primary care becomes sustainably accessible, equitable, and responsive to the evolving needs of the UK population. In alignment with the Government’s 10-Year Health Plan…this inquiry will develop a strategic recommendation that provide coordinated policy solutions, capable of delivering lasting improvements in primary care that transcend electoral cycles”.

The call for evidence covered detailed aspects of potential obstacles for patient accessing primary care, split into key themes:

• Reducing health inequalities and access barriers
• Harnessing digital transformation and system integration
• Securing long-term sustainability through mechanisms such as funding/commissioning and contracts/workforce.

Seeking evidence and examples of good practice as well as examples and suggestions of workable policy changes, the consultation seeks to make comprehensive recommendations to bring the ambitions of the 10-Year Health Plan for England to realisation.

Our response

We took the opportunity to highlight that optometry remains an underutilised resource in primary care and to emphasise the myriad ways in which the system could benefit from our profession’s clinical expertise and community reach. We offered several examples and recommendations to some of the key questions posed in the consultation.

Firstly, considering the barriers to access and health inequality's theme, we emphasised that the NHS sight test is exemplary in terms of physical accessibility and waiting times. Further noting that optometry practices have an excellent geographic distribution with zero or minimal waiting times, and that unlike other services, there is no need for a GP referral to access optometry services. We also suggested certain metrics that can define “good access” and encouraged that enhanced optometry services, if universally commissioned across England, could make in-roads to freeing up capacity elsewhere in the system and reducing waiting times.

We highlighted the example of Cheshire and Merseyside ICB where optometry is well integrated into local systems, noting the strides made in generating improvements in the population’s eye health, with a focus on reaching the most vulnerable patients.ⁱ

For the digital integration theme, we asserted the necessity to facilitate shared access to electronic patient records, and to ensure that referral systems that are used across primary care are inter-operable and can provide bidirectional data transfer. For the latter point, we suggested that providing all practices with access to the NHS Electronic Referral Service (eRS) would be the best option to pursue.

To illustrate how this can work to the advantage of the patient and wider health system, the Gloucestershire ICB was presented as an exemplar. Their Community Ophthalmic Link Project won the 2025 HSJ Partnership award.ⁱⁱ The IT team set up a system where community optometrists can access secondary care eye examination results in real-time. It included search features where optometrists can access information and statistics, including comparing all exams and ophthalmic imaging taken over time. All 66 optical practices in the county – as well as 250 optometrists and dispensing opticians – are participating in the project. It has had a direct impact on improving referrals and quality of care across the county.ⁱⁱⁱ

For the artificial intelligence (AI) aspects of the consultation, we noted that practitioner vigilance is vital. Asserting that adherence to MHRA standards and registration of Artificial Intelligence as a Medical Device (AIaMD) and Software as a Medical Device (SaMD) products for anything directly affecting patient care must be followed. Further, we stress that patients should made be aware when AI is used, be aware of how their data is used and be offered the right to opt out of non-direct care uses.

The consultation’s third theme, securing long-term sustainability, was an opportunity to showcase the landmark report Key Interventions to Transform Eye Care and Eye Health^iv by PA Consulting. Detailing the four interventions from the report, we make the point of how optometry can be instrumental in shifting eye care from hospitals to community and how it could address rising demand and reduce waiting lists in secondary care.

We also make the fundamental point about core funding for NHS optometry. The general ophthalmic services (GOS) contract is the building block of clinical primary care eye services. Practitioners will be fully aware that this contract has received below inflation uplifts for around 10 years, which has created an unsustainable pressure on the core services. As all the enhanced services are built upon this base contract, there is a risk that it becomes unsustainable for practices to provide NHS services. Transformative enhanced services and interventions that could be delivered in optometry are not universally commissioned currently.

If optometrists are enabled/funded to work to the top of their clinical abilities, huge capacity gains could be made. The Key Interventions to Transform Eye Care and Eye Health^v report suggests almost 2 million appointments could be diverted from the known pressure points of the NHS (including General Practice).

Next steps

• We will continue to amplify the voice of optometry as a key partner in the wider primary care team and will work with the APHG team to ensure that the patient access offered by our members is fully capitalised upon for the benefit of patients
• We will continue to monitor the implementation of the 10 Year Health Plan for England to ensure that it supports excellent eye care for patients, with optometrists at the heart.

For further information, please contact [email protected]

References

1. Improving eye health and tackling inequalities - NHS Cheshire and Merseyside
2. Award win for collaborative eye care project: NHS Gloucestershire ICB
3. Community Ophthalmic Link
4. Key interventions to transform eye care and eye health
5. Key interventions to transform eye care and eye health