Gloucestershire ICB

The NHS in Gloucestershire has a long history of innovation in eye health commissioning. Gloucestershire was the first to develop diabetic eye screening, commission out of hospital follow up care for cataracts, and one of the first to commission Covid Urgent Eyecare Services.

Gloucestershire ICB was selected as one of the NHS England Eyecare Transformation Programme Accelerator sites. The funding and central support has meant that the ICB has made significant strides in designing and commissioning services that improve patient eye healthcare and benefit the older population in the area.

Here are some examples of how Gloucestershire ICB, in partnership with local services, have been meeting the care needs of older patients in the community.

Gloucestershire Eye Health Clinical Programme Group

The Gloucestershire Eye Health Clinical Programme Group (CPG) was set up in 2015 to:

Provide a holistic approach to transform, integrate and lead on the development of Eye Health services in the county. The CPG aims to ensure patients receive the best experience by prioritising service user involvement and service quality, improving delivery of service and utilising public health intelligence to reduce variation.

The CPG identified three priority areas:

• Reducing inequalities
• Digital transformation
• Investing in workforce.

Gloucestershire ICB has rolled out services in support of these prioritise, including;

Low Vision Service

A pilot by Gloucestershire Eye Health Clinical Programme, in conjunction with Primary Eyecare Services (PES), started in summer 2021. The scheme continues to provide a domiciliary low vision service and access for patients who are not in easy reach of the hospital service.

Eye Care Liaison Officers

Eye Care Liaison Officers (ECLO), provided in conjunction with the RNIB and GHNHSFT, have proven invaluable for patients. Almost 30% of all patients on Care of the Elderly (COTE) wards have benefited from ECLO support with either urgent provision of spectacles, emotional help, and help with aids and adaptations and fast-tracked onward referral. Patients are not discharged without a plan in place for their eye health needs.

Sid K Maher

Low Vision Practitioner and Dispensing Optician, Cotswold Ocularis Ltd

"The Adult Low Vision pathway is a service that continues to make a profound difference in addressing health inequalities and providing accessible, patient-centred care across the county. 

I want to share a specific example that underscores the value of this pathway, highlighting the far-reaching impact it has had on vulnerable patients, even in remote areas. 

In November, I received a referral from the hospital ECLO (Eye Clinic Liaison Officer) for a patient residing in a semi-rural area near Berkeley, close to the banks of the River Severn.

The patient, in her late 90s, lives alone in a mobile home park. Her daughter reached out to explain that her mother was struggling to see clearly – both for near vision tasks and watching television. With the holidays fast approaching, the family hoped she could enjoy crosswords, television, and her Christmas cards. 

Moved by the circumstances and recognising the urgency, I scheduled a home visit on the weekend before Christmas, 21 December. 

During the visit, I assessed the patient and provided practical solutions. With her magnifier and the correct near-vision prescription, she was able to spot-read spot N5 text.

After discussing appropriate magnification and lighting adjustments, the patient demonstrated reading subtitles and recognising faces on television. Most heartening for me, was her ability to spot read Christmas cards from loved ones (with magnification). 

This positive result reminded me once again of the transformative power of this pathway. With minimal cost, it delivers impactful results, offering independence and improved quality of life to patients in need.

As the LOC reflect on the pilot’s success, the need for continued funding is clear. This service effectively addresses key barriers faced by older adults, such as mobility issues, rural isolation, and limited access to hospital eye services. Its high impact and low cost make it an exemplary model for reducing health inequalities."

Community Ophthalmic Link project

The Community Ophthalmic Link project is still in an early phase of implementation but is already breaking ground in terms of eye care collaboration through coordinated IT Connectivity solutions.

Phase 1 saw a 24% reduction in e-referrals for Gloucestershire GP registered patients compared to 2022/23 as well as a reduction in new ophthalmology patients languishing on waiting lists.

The project has proven to be invaluable to the older population locally – providing continuity of care, ensuring patients access the care they need, when they need it.

Becci Zawadzki

Optometrists, Norville Opticians Gloucester

“In September 2023, a 92 year old patient phoned Norville as a new patient looking for a Community Urgent Eyecare Service (CUES) appointment; he'd been turned away by his regular Optometrist. 

He had experienced a sudden change in his vision, he could no longer see his son’s face.

We booked him on the same day for a CUES OCT scan appointment. My initial diagnosis was Wet AMD.

On talking to the patient, he is very vague about his previous history and being a new patient, we have no previous ocular history. 

The OCT confirms there is significant AMD with some signs of Wet AMD in one eye but no other pathology can be seen. With the patient's permission I was able to look at his hospital records via the Community Ophthalmic Link (COL). 

From there, I can see he has received 53 Intravitreal injections for Wet AMD. He was last seen in January, with a four month recall. I was able to compare the OCT from that last appointment with the images we had taken. It looked very similar and therefore could not be the cause of the sudden deterioration in his vision. 

From having this knowledge - I decided to look further into the cause of the vision loss. I conducted some further tests which appeared to show a left hemianopia – commonly caused by Stroke. I referred the patient to Gloucestershire A&E. It was confirmed that he had a mild stroke – but thankfully no lasting effects. If I hadn’t been able to access his previous hospital records I would have referred the patient via our Medical Retina pathway with a diagnosis of Wet AMD but knowing he had already been diagnosed with AMD, made me look further."