09 January 2025
Optical bodies, charities, and businesses have welcomed plans by NHS England and the Department of Health and Social Care to reform elective care, but many have called for the optometry profession to be fully utilised as part of the ambition to provide care closer to home.
The new plan, Reforming elective care for patients, aims to reduce hospital waiting lists and secure faster diagnosis and treatment for patients, with a target of delivering routine care to 92% of patients within 18 weeks.
Objectives include empowering patients with better data and choice, redesigning pathways, and increasing advice and guidance to support the prevention of ill health.
Amanda Pritchard, NHS chief executive, wrote in the plans: “We are determined not to hit the target but miss the point; the reforms set out in this plan are focused on improving how people access and experience routine care, as much as they are about waiting times.”
The plan seeks to support the provision of care closer to home where possible, with a focus on convenience, Pritchard said, adding: “It will also offer patients informed choice, greater control and more personalised, joined-up care – making them a true partner in their care journey.”
In an introductory comment for the paper, Wes Streeting, secretary of state for health and social care, said: “These elective care reform plans set out the steps needed to return to short waiting times and restore patients’ confidence in the NHS.”
The upcoming 10-Year Health Plan will share more about the Government’s three ‘shifts’ for the NHS, Streeting said, namely, “from hospital to community, from analogue to digital, and from sickness to prevention.” But he explained that the new elective care reform plans would “lay the groundwork for these to happen.”
Fully utilising primary care is essential
Commenting on the elective care reform plans, Adam Sampson, chief executive of the AOP, said: “We are encouraged by the Government’s clear commitment to tackling the backlog and improving overall access to elective care and treatment.”
Sampson pointed out that one in 11 people in England are on an NHS waiting list for a hospital eye appointment – the second largest of all outpatient appointments.
“We know only too well the impact that the wait can have on patients who risk losing their sight because the delay to diagnosis or treatment is simply too long,” he said, adding: “That’s why we have long called for action that will create efficiency in the NHS and better outcomes for patients through our national Sight Won’t Wait campaign.”
Optometrists in community practices on the High Street have the clinical skills, experience, and equipment to deliver eye care locally, the AOP highlighted.
Sampson welcomed the Government’s commitment to reform and investment in elective care, adding a hope that the same commitment would be mirrored in the 10-Year Health Plan.
He said: “It is essential that primary care, including High Street optometry, pharmacy and dentistry as well as general practice, is fully utilised as part of the Government’s wider shifts from hospital to community, from analogue to digital, and from a sickness to a prevention-based healthcare model."
We know only too well the impact that the wait can have on patients who risk losing their sight because the delay to diagnosis or treatment is simply too long
Untapped potential in High Street optometry
Dr Peter Hampson, AOP clinical and policy director, said: “We support the ongoing shift to care in the right place, but it will be important to understand what ‘more integrated working between primary and secondary care, community, diagnostics, tertiary centres and the independent sector’ will look like – including digital solutions, as well as the time and investment required to ensure change is productive and sustainable.”
The reform plans highlight the use of community diagnostic centres to help tackle the growing demand for diagnosis within elective care, with 170 expected to be running by the end of March 2025.
Though recognising that these centres and surgical hubs provide additional capacity, Hampson said: “Within eye care we urge NHS England to start by using the untapped potential of High Street optometry.”
As part of the elective care plans, NHS England will ensure primary and secondary care will be funded to deliver Advice and Guidance services.
Commenting on the plans, Hampson said: “The stated aim that NHS England will ensure both primary care and secondary care are funded to deliver advice and guidance by splitting the existing elective tariff to deliver better outcomes for patients is another area in which we will be looking for more detail.”
Policy briefing: reforming elective care for patients
The AOP’s summary – and what it means for optometry
Proven pathways and enhanced services
Commenting on the plans, Janice Foster, chief executive officer at the Local Optical Committee Support Unit (LOCSU), said: “Primary eye care is poised and ready to support with the elective reform plans outlined.”
LOCSU strongly encourages integrated care boards (ICBs) to engage with local optical committees (LOCs) and allow them to support with reducing waiting lists, Foster said.
“We need to work together to bring about changes and we need to do this now,” she added.
LOCs are already working closely with ICBs to explore a variety of proven pathways and enhanced services.
Foster pointed out that all LOCs and ICBs have at least one enhanced service in place to support patients, as of 31 December 2024, “but there are many more services that can make a tangible difference; primary eye care and LOCs are ready and able to do more.”
“Inviting LOCs to the table and discussions will enable them to support and help tackle ophthalmology waiting lists, helping to reform elective care by enhancing care closer to home for patients, improving access and fully utilising the primary eye care workforce,” she added.
Empowering patients
Zoe Richmond, clinical director for LOCSU, described the plan as “ambitious and encouraging.”
Discussing the new plan, Richmond shared with OT that LOCSU supports the focus on patient empowerment.
Agreeing that “the most appropriate setting to treat patients won’t always be in hospital,” she noted that significant numbers of people waiting for care in the hospital eye service could be appropriately managed in existing optometric practices.
Richmond explained: “A good example is the support primary eye care can provide to enhance local glaucoma pathways; reducing the number of people on ophthalmology waiting lists by implementing glaucoma referral filtering services in optometric practice and supporting the transfer of care for people with a diagnosis who need regular monitoring but can receive their care from their local practice team.”
Community-based services
Giles Edmonds, clinical services director for Specsavers, welcomed the Government’s commitment to working with the independent sector to tackle waiting lists for elective care, but said: “We now need to see the same ambition in working with primary and community care providers to improve access to care.”
Highlighting the role that the optometry sector already plays in delivering NHS services in the community, Edmonds said: “If the Government wants to cut NHS waiting lists, we can help. We already have hundreds of community-based practices offering diagnostic services on the High Street.”
“Let’s not miss the opportunity to help hundreds of thousands of people waiting for hospital eye care by treating more in the community,” he added.
Edmonds pointed to developments in Scotland and Wales as examples of how extending services can deliver benefits.
Let’s not miss the opportunity to help hundreds of thousands of people waiting for hospital eye care by treating more in the communit
Levelling-up access
Dharmesh Patel, CEO of Primary Eyecare Services, welcomed the publication of the plans, suggesting that “with the plan’s key focus on improving how people access and experience care, this should enable real improvements for the public.”
Primary Eyecare Services is the largest not-for-profit provider of primary and community eye care services, utilising more than 2500 optometry practices.
Patel commented on the new plan: “It balances clearly ambitious targets with levelling-up access and quality across England. For eye care, this is critical. Ophthalmology is the number one cause of outpatient attendance in England, and supporting timely, high-quality care in the right place is vital to preventing sight loss.”
It balances clearly ambitious targets with levelling-up access and quality across England. For eye care, this is critical
The plan includes several actions for different parts of local systems, in order to enable the NHS to meet the 18-week standard by March 2029.
Patel shared: “What is heartening to see is that Primary Eyecare Services, as an organisation, and optometry practices, which together are in-effect an elective care provider in primary care, already deliver much of what is within the plan.”
“We look forward to progressing on other elements to align with the plan, including the digital innovations that will support the sector and the NHS to deliver even more care in optometry,” he added.
There is a greater role for optometry to play in supporting elective care demand in England, Patel suggested, pointing to the Key Interventions to Transform Eye Care and Eye Health report by PA Consulting in demonstrating the opportunities that scaling up the utilisation of optometry could provide in reducing waiting times and providing cost savings for the NHS.
The AOP, Fight for Sight, Primary Eyecare Services and Roche Products Ltd provided financial support, editorial input, and reviewed associated outputs of the PA Consulting report.
“It is critical that the NHS supports both the effective commissioning and sustainable funding of optometry services to enable it to take advantage of this,” he said.
Patel concluded: “We look forward to working with local optical committees, practices, and the NHS in utilising this plan to support improved patient care.”
We look forward to working with local optical committees, practices, and the NHS in utilising this plan to support improved patient care
Local care
Leightons Opticians and Hearing Care agreed that community optometry practices are well-placed to support the reduction of NHS ophthalmology waiting times.
Andrew Bridges, director of professional services at Leightons, told OT: “Community-based optometry practices have clinicians with both the core skills and diagnostic instruments to provide convenient, local care for patients and who can support the reduction in NHS ophthalmology waiting times. Now is the time to utilise this valuable resource.”
He added: “Whilst cataract services may have already had some transformation, patients with other sight threatening conditions should have the benefit of care from community optometrists. Utilising direct referral pathways to secondary care with shorter waiting times along with those suitably qualified both diagnosing and treating in their local community, will mean they can live their lives as fully as possible.”
Tackling follow-up waiting lists
Vivienne Francis, chief social change officer for the Royal National Institute of Blind People, welcomed the aim of shifting care into the community, suggesting this could offer benefits from the greater use of the optometry sector “which has a willingness and a capacity to support people with eye care needs.”
Welcoming the plans to tackle eye care waiting lists, Francis said: “Nearly 600,000 people in England were waiting for their first ophthalmology appointment as of October 2024. We know this is only the tip of the iceberg because ophthalmology also has the highest number of people waiting for follow-up appointments.”
Prompt access to treatment saves sight, Francis emphasised: “For conditions such as glaucoma and age-related macular degeneration, delays to treatment can result in avoidable irreversible sight loss.”
For conditions such as glaucoma and age-related macular degeneration, delays to treatment can result in avoidable irreversible sight loss
Responding to the reform plans, Matthew Taylor, chief executive of the NHS Confederation, said: “This updated elective plan is a serious attempt to reduce waiting lists in a more sustainable way and marks an important step forward in helping bring an end to a period of long waits.”
Taylor described the plans as a “welcome step forward in focusing on the overall size and shape of the waiting list,” rather than focusing on the longest waiting lists.
“The only way to achieve real reform in healthcare is to shift the balance from hospital to the community”
AOP chief executive, Adam Sampson, on the Government’s 10-Year Health Plan, the work of the AOP in the year ahead, and why Dunbar in Catch 22 was onto something
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Anonymous11 January 2025
Interesting
So optoms in primary care are going to help clear NHS waiting lists ,(deliberately caused by Government under-funding and privitasation by stealth)
Are the majority of optoms skilled enough to provide the services required? The majority cannot prescribe or even safely remove foreign bodies etc etc.
But even bigger point is who pays ( not the same people paying the currently underfunded NHS eye exam :) and how much are optoms going to be paid to make providing these services commercially viable.
Seems like policy of deliberately create waiting lists, destroy NHS by stealth. Cherry pick juicy bits and get some others to pick up rest of work at a lower price.
Living is easy with eyes closed misunderstanding all you see:)
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