01 October 2026
Around 780,000 people visit emergency departments in England each year with an eye problem.
Analysis by the AOP as part of the Eye care everywhere campaign reveals that up to eight in 10 of these cases could be safely dealt with in primary care optometry.
In this feature series, OT explores how the Community Urgent Eyecare Service is helping to divert eye conditions from secondary care within different regions in England.
Within Greater Manchester, the number of people who presented for CUES appointments in 2025 would come close to filling the Old Trafford stadium – with 72,118 patients receiving assessment for urgent eye conditions in the community. Eight in 10 patients were assessed in primary care without requiring an onward referral.
While many people are accessing CUES in Greater Manchester, there is scope for optometrists to do more.
Data from Manchester University NHS Foundation Trust shows that in 2024–2025 eye-related presentations accounted for 14,255 emergency department appointments – including 1330 patients with tear film insufficiency and 725 patients with allergic conjunctivitis.
A recent analysis of CUES presentations in Greater Manchester found that 40% of CUES referrals to secondary care could have been retained within primary care if an independent prescribing (IP) optometrist had been available.
The study authors highlighted that reducing barriers to IP qualification – such as cost and limited hospital placements – is key to improving the effectiveness of the CUES pathway.
Below, OT examines the challenges and opportunities for CUES in Greater Manchester – from a pioneering public awareness campaign to the professional development benefits for optometrists working in practice.
CUES in Greater Manchester
Primary Eyecare Services clinical lead for Greater Manchester, Cheshire and Merseyside, Rebecca Ireland, shared that CUES was initially commissioned across individual areas across England in response to the pandemic.
“Following NHS England’s directive that routine sight testing should cease during this period, the service was rapidly introduced to ensure continued access to urgent eye care,” Ireland explained.
Before CUES, Greater Manchester had an existing Minor Eye Conditions Service in four out of 10 localities. These services were replaced by CUES, with the remaining six localities rolling out a CUES service – achieving full coverage within Greater Manchester by 2022.
“As the NHS transitioned out of the pandemic, the ongoing value and demand for the service was recognised. Consequently, it has been retained and renamed as the Community Urgent Eyecare Service, maintaining the CUES acronym,” Ireland shared.
Catherine Turnham, who is also a Primary Eyecare Services clinical lead for Greater Manchester, Cheshire and Merseyside, highlighted that CUES has resulted in improved access to care for patients within Greater Manchester.
“Patients can access urgent eye care quickly within the community, often closer to home, reducing the need to attend GP or accident and emergency services,” she highlighted.
She added that timely assessment and treatment can help to improve patient outcomes and ease anxiety.
Turnham noted that CUES provides a convenient service and supports continuity of care.
“Care delivered via local optometry practices supports a more familiar
and accessible pathway, with many patients managed fully in primary care without onward referral,” she said.
Reflecting on the benefits for practitioners, Turnham highlighted that CUES enables optometrists to perform an enhanced clinical role, while also supporting secondary care capacity, ensuring only the patients that need hospital care are referred.
“Closer working relationships between primary care optometry and hospital
teams improve communication and collaborative care pathways,” she said.
CUES also benefits the hospital, Turnham noted, with fewer unnecessary referrals to secondary care.
“Hospital eye service clinicians can focus on more complex and higher-risk cases, as less urgent conditions are safely managed in the community,” she said.
Ireland shared with OT that Primary Eyecare Services data for 2025–2026 shows that only 17% of CUES presentations required referral to secondary care.
“The majority of patients are able to be managed fully within the Greater Manchester CUES pathway,” she said
Eye conditions assessed within CUES
Turnham noted that CUES in Greater Manchester supports patients with a broad range of acute and urgent eye conditions.
“Long-term or chronic conditions such as glaucoma, cataract and diabetic retinopathy continue to be managed through routine optometry or hospital eye service pathways,” she said.
She explained that CUES presentations can be separated into four main categories: anterior eye conditions, minor trauma and foreign bodies, acute visual disturbance as well as symptoms of flashes and/or floaters.
“Patients commonly present with red, painful, sticky or itchy eyes. These may include conditions such as conjunctivitis, blepharitis, allergic eye disease and dry eye,” Turnham said.
The optometrist added that more complex anterior eye conditions, such as anterior uveitis and keratitis, may be managed within Greater Manchester CUES by independent prescribing (IP) optometrists.
Foreign bodies and corneal abrasions can also be treated within a CUES setting.
Turnham shared that where patients present with new-onset flashes and floaters, a full dilated fundus examination is undertaken to assess for retinal tears or detachment.
“Where patients report new central distortion or scotoma, they may be referred into the Greater Manchester CUES OCT pathway. This enables community optometrists to perform OCT imaging to support the diagnosis and referral management of macular pathology,” she said.
Boosting public awareness
Ireland shared with OT that Greater Manchester CUES features in the Get to Know Where to Go public awareness campaign which encourages members of the public to choose the most appropriate health service at the right time.
“Launched in 2022, it continues as an ongoing, year-round campaign with a particular focus during peak pressure periods such as winter,” she said.
The campaign delivers clear guidance across a range of channels including social media, radio, posters and television displays in GP and pharmacy practices. The CUES video which plays in GP waiting rooms can be viewed online.
“Its aim is to help the public better understand which NHS service to use for different symptoms – for example, pharmacy, GP, optometry, urgent care or accident and emergency,” Ireland explained.
“By improving awareness of available services, including encouraging patients with eye symptoms to contact their local CUES clinician rather than attending GP or emergency departments, the campaign supports timely access to care, promotes appropriate use of primary care pathways, and helps to reduce avoidable demand on GP and hospital services,” she said.
The view from practice
Alongside his role as chair of Manchester, Salford and Trafford Local Optical Committee (LOC), Andrew McGrail is an IP optometrist and director of Wallwork Opticians in Swinton.
He shared with OT that the neighbourhood is mixed in terms of socioeconomic status.
“If you go left out the practice, it's a really affluent area, but if you go the other side of the practice, within a couple miles it is quite deprived,” he said.
Wallwork Opticians has offered CUES since it was rolled out in Salford in 2022.
McGrail said he was interested in becoming involved in CUES as an optometrist because of the variety that it added to his day.
“It’s very rewarding in a professional sense – you can manage more complex cases. I would encourage anyone who has IP to offer CUES, because your scope of practice is a lot wider,” he said.
Within his practice, around eight to 10 patients present for a CUES appointment each week.
Patients present with a broad range of conditions including dry eye, posterior vitreous detachment, anterior uveitis, conjunctivitis and preseptal cellulitis.
McGrail estimates that around one in 10 CUES appointments result in a prescription being issued.
In his LOC role, McGrail has helped to organise a series of foreign body workshops for optometrists at Manchester Royal Eye Hospital.
“We’re trying to reduce the number of people presenting for emergency care with ocular foreign bodies when they could be managed in primary care,” he explained.
McGrail highlighted that there was strong demand in the series of five workshops, with 100 people applying for 20 places in the first event.
He said that after the course he received feedback from delegates saying that they had managed patients in practice who they previously would have sent to secondary care.
In practice, McGrail has removed small pieces of metal and on one occasion, a wood shaving, from patients’ eyes.
“They are incredibly happy when you can do it in practice and they don’t have to spend half a day waiting in hospital,” he said.
It’s very rewarding in a professional sense – you can manage more complex cases
Insight from the AOP
AOP clinical and policy director, Dr Peter Hampson, highlighted that the data on CUES from Greater Manchester makes a strong policy case for rolling out the service more widely.
“CUES shows what happens when the system gets it right – ensuring that patients receive timely care close to home, reducing pressure on emergency departments, and enabling hospital clinicians to focus on complex disease. This is the kind of capacity-shifting care the NHS needs, yet it is only available in parts of England,” he emphasised.
Hampson highlighted that urgent eye care must be commissioned consistently to reduce avoidable pressure on hospitals.
“Optometrists must be supported to work to the full extent of what they're trained to do,” he said.
The clinical and policy director shared that the AOP is calling for two measures to support the work of optometrists in delivering CUES: building independent prescribing capacity where the evidence shows it would have the most impact and widening the scope of medicines that optometrists can supply under the Human Medicines Regulations.
Hampson added that the second measure would mean that optometrists could supply medicines for routine conditions, such as conjunctivitis and allergic eye disease, without a GP referral.
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