Policy briefing: Extend medicines for optometrists and contact lens opticians – open consultation

What has been announced

The Government has announced a consultation into expanding the medicines exemptions within the Human Medicine Regulations 2012 for optometrists and contact lens opticians. If enacted, optometrists would be able to access additional antibacterial medications alongside a suite of additional anti-allergy medications. Also within scope for the amendments are the reintroduction or the addition of several other medications, including atropine, pilocarpine, diclofenac and acetylcysteine.

Alongside the changes for optometry are similar, but less wide-ranging, changes for contact lens opticians (CLOs). These changes will allow contact lens opticians to provide additional medications for allergic eye disease and to provide additional antibacterial medications; they will also clarify the access requirements to anaesthetic drops for CLOs so that they are able to utilise them to perform other activities beyond contact lens fitting, such as contact tonometry and the insertion of punctal plugs.

In announcing the consultation, the government has said that it is the “ambition of NHS systems across England, Wales, Scotland and Northern Ireland to make better use of the primary eye care workforce.”

The government adds: “Extending the range of medicines that can be sold or supplied and, in some cases administered, by optometrists and contact lens opticians across the UK, so they can treat a wider range of minor eye conditions in the community, will: make it easier for patients to get the medicines they need; and avoid the need for patients to see additional healthcare professionals for administrative purposes, just to receive medicines, helping to release capacity across other parts of the NHS.”

What do we say

We welcome this consultation and the proposals it contains, as these changes will have a significant impact on the care experience for patients, and on the opportunity for optometry to provide the clinical care it is trained to deliver.

Access to these types of medicines will make it easier for patients to get treatment for a range of eye conditions, without the need to visit their GP or hospital, alongside freeing up capacity in hospital and other areas of primary care.

At the end of 2024, we published an updated position statement in support of this change.

The Human Medicines Regulations (HMRs) have not been updated since 2012 and, in that period, we have seen an expansion of minor and urgent eye care services that enable optometrists to see and manage a greater range of conditions in primary care. The government, via its 10-Year Health Plan, has been clear that care must be delivered closer to where patients live, and that primary care must do more if we are to tackle the challenges that the NHS faces.

These medicines changes broadly make the currently available Additional Supply (AS) list medications available to all optometrists. This is for two reasons: there are practically no active AS courses in the UK and there are only around 10 practitioners with that qualification – understandably most practitioners undertaking prescribing training choose to become independent prescribing optometrists.

The outdated HMRs have meant that for those without an independent prescribing qualification it has been necessary in many cases to refer patients to their GP for medications to manage low risk eye conditions. These changes will enable more patients to receive a completed episode of care in one visit and will also help to rightly establish optometry as the first port of call for all eye problems, releasing much-needed capacity across the eye care ecosystem, as well as other areas of the NHS.

Some may suggest that it would be better to simply increase the number of practitioners with IP. While this could also be effective, the cost of the training and the availability of placements has been, and in England will likely continue to be, a limiting factor. Instead, the change put forward will utilise the extensive skills and training of all optometrists, and for some this will be a stepping stone that encourages them to undertake IP training. For those where that is not possible, or the case mix is not compatible with maintaining competent IP practice, these changes will enhance their patient management options.

These proposals do not diminish the importance of IP. Instead they support IP and the aims of many with IP, letting those with higher qualifications manage the patients only they can manage and permitting a more collaborative joined up optometry workforce.

Looking at the specific details of the changes that are being proposed, they will provide better options for management of patients with bacterial conjunctivitis, provide cover for gram negative bacteria and enable very young patients to be more effectively managed as some of the additional antibacterials are suitable for all ages. The changes will also guard against some of the supply chain issues that have been seen in recent years where medicine availability has been limited or cost-prohibitive. The increased access to anti-allergy medications will enable practitioners to manage a wider range of allergy types and to provide combination agents that offer more efficient treatment options for patients.

The proposed reintroduction of atropine and pilocarpine are also welcome. These medications were available to optometrists for around 50 years and were removed for reasons that are not fully clear and had no evidence base. In the case of atropine, availability of this medication may also be useful for other purposes such as myopia management, if new products are licensed in the future. Pilocarpine provides an emergency option for practitioners in rare situations where they encounter a case of angle closure glaucoma, and it may take some time for the patient to reach more specialist care. This change, along with acetylcysteine, which will also rarely be used, is largely due to the changes to the AS medications more widely. Cataract surgery is one of the most common surgical interventions and diclofenac will enable those patients suffering from mild post-operative pain and inflammation to be managed more effectively.

The changes for CLOs are equally as important. CLOs have expanded their scope of practice with MECS qualifications, supporting optometrists and helping to manage patients more effectively by increasing access. This change has the potential to be a step forward for the eye care profession more broadly, rightly recognising that optometrists and contact lens opticians are best placed to provide more minor eye conditions services, so that patients get faster access to care, available locally, with better outcomes.

A number of years ago, our members rightly questioned when orthoptists were granted additional access to medications and wondered why optometrists did not have the same access. Our view is that members were right to ask that question, and these changes will hopefully redress that imbalance.

The AOP will be responding in support of the consultation, and we encourage all members to do the same, we will continue to engage with members as the process develops. Additionally, we will also be providing advice for members who would like to submit individual responses to the consultation. We recognise that this change may require a period of adjustment for members, and should these changes be successful we will be supporting members via guidance and targeted CPD. Finally, we believe this consultation demonstrates a significant recognition from the government of the important and growing role that optometry can play to deliver healthcare to the public.