An overview of optometry in Scotland, Wales, Northern Ireland and Ireland

Delegates to the National Optical Conference in Birmingham received an overview of different approaches to primary care optometry within the UK and Ireland (18-19 May, Hilton Birmingham Metropole).

From progress on eye examination reimbursement in Scotland to contract changes in Wales, OT outlines some of the key points from the discussion.

Scotland

As part of a pre-recorded video presentation, Optometry Scotland past chair, Julie Mosgrove, highlighted that in Scotland patients can access free eye examinations.

These appointments are booked either at routine intervals, when a patient is symptomatic, or when an optometrist wishes to review a patient.

“Some examples of when we would review a patient is for things like post-op cataract refractions, suspect glaucoma reviews, paediatric reviews or if an optometrist is offering catch up referral advice and counselling outside a standard appointment,” Mosgrove explained.

She highlighted that having a funding model that provides universal access to care has enabled optometrists to catch conditions early and relieve pressure on other parts of the healthcare system.

“At Optometry Scotland, the main focus over the past few years has been to secure funding increases within the sector,” Mosgrove said.

She added that the standard eye examination fee for those younger than 60 is now £44.74, with a fee of £54.43 for patients over the age of 60.

Mosgrove shared that there has been a shift in how optometry is viewed by the Scottish Government, so it is now seen as part of primary care services.

“One of the biggest developments that has been announced this year is the introduction of GOS specialist supplementary services. It will allow a number of conditions to be treated in practice by IP optometrists,” she said.

Anterior uveitis, marginal keratitis and blepharitis, ocular rosacea, ocular allergy, infective keratitis and foreign body removal are among conditions that will be included in the scheme.

Mosgrove shared that this enhanced scheme will be effective from August 2025.

“This will help to reduce the need for referral and it will also improve access to care for patients,” she said.

Mosgrove noted that new undergraduate optometry programmes in Scotland have incorporated IP training.

Glasgow Caledonian University has introduced this change already, while the University of the Highlands and Islands will incorporate IP from the start of the coming academic year.

Mosgrove highlighted that Scotland is facing workforce challenges within optometry – particularly in remote and rural areas.

“Understanding our workforce and planning for the future is going to be key,” she said.

Wales

Optometry Wales chief executive officer, Judy Misra, explained that in Wales there are three Regional Optical Committees (ROCs).

The North Wales ROC spans a large geographic area and covers the Betsi Cadwaladr health board.

Misra explained that the South West Wales ROC covers the Swansea Bay, Powys and Hywel Dda health boards.

She added that while Powys is the biggest county in Wales – taking up a quarter of the land mass – it is sparsely populated.

“There are more sheep than people. It is geographically really huge but it only has a small number of optometry practices so there are challenges from that perspective,” she said.

The South East Wales ROC covers Aneurin Bevan, Cardiff and the Vale and Cwm Taff health boards.

“We have more practices in South East Wales than we do in the rest of Wales combined. That is our more urban area,” Misra said.

Optometry Wales clinical adviser, Sharon Beatty, outlined the introduction of a new contract for optometrists in Wales in October 2023.

She explained that initial discussions with the Welsh government in 2019 centred around rethinking how eye care is provided in Wales.

“We thought, ‘how could we do things differently if we had a blank piece of paper?’,” Beatty said.

The optometry contract in Wales has five levels of service. Level one is the standard eye examination, including some prevention and holistic advice, while level two covers urgent eye care assessments, pre and post cataract assessments and glaucoma repeat measures.

Level three covers the Low Vision Service, while level four covers referral refinement and monitoring services for glaucoma and medical retina, as well as a hydroxychloroquine monitoring service.

Level five involves IP optometrists managing certain urgent eye conditions within primary care. There is also provision for the management of suitable glaucoma patients by IP optometrists in primary care.

Beatty explained that level one and two are now core services that are mandatory for optometry practices to provide, while optometrists with appropriate qualifications can opt in to level three, four and five.

“If your practice doesn’t hold the qualification, then you must send that referral to a practice that does hold the qualification,” she said.

We thought, ‘how could we do things differently if we had a blank piece of paper?

Northern Ireland

Head of ophthalmic services for the Department of Health in Northern Ireland, Raymond Curran, shared that in Northern Ireland primary care ophthalmic services are provided through around 266 contracts.

This provides for the employment of around 700 optometrists and dispensing opticians.

Curran shared that electronic referrals are provided through a Clinical Communications Gateway in Northern Ireland.

“That referrals system allows the referrer to include scans, images, field plots and scrollable images from OCT, for example,” he shared.

He highlighted that this approach to triage allows for the provision of guidance by secondary care.

“Where people don’t need to be seen, we can send the referral back with advice and notes,” Curran said.

He explained that the primary care glaucoma pathway in Northern Ireland incorporates repeat measures and the review of low-risk glaucoma patients and patients with ocular hypertension.

“We put that in because we know that the skills, the capacity and the appetite is there among our cohort of primary care optometrists,” Curran emphasised.

He shared that more than 2000 low risk glaucoma patients have been referred out to primary care optometry with clinical treatment plans.

Curran highlighted that post-op cataract reviews are delivered in the community. The Northern Ireland Primary Eyecare Assessment and Referral Service (PEARS) sees optometrists treat eye conditions that have developed in the past 14 days, including red eyes, sudden reduction of vision, flashes and floaters and foreign body removal.

“It really does free up capacity in both general practice and secondary care ophthalmology,” he said.

Curran shared that initially the aim was for the scheme to see around 1000 patients per month.

“We now have around 4000 patients per month with very good outcomes,” he highlighted.

Understanding our workforce and planning for the future is going to be key

Ireland

Optometry Ireland president, Tania Constable, explained that within primary care in Ireland most of the population is covered by a social insurance scheme and medical card.

She added that most of the population is covered by a standard funded eye examination.

Constable highlighted that the working age population receives a funded eye exam through social insurance, while the medical card scheme covers eye examinations for people with chronic conditions, those over the age of 70 and the unemployed.

“There are a number of challenges with respect to children between the ages of 12 and 16 years of age, who effectively have no public cover,” she said.

Constable noted that parents have to self-fund eye care within this group of children.

She shared that there are workforce challenges within optometry in Ireland, with only 30 optometrists trained each year in Dublin.

Constable outlined how there has been no increase in the fee paid to optometrists for a standard eye examination in a number of years.

“The social insurance fee for a regular eye examination is €30 while the medical card fee is €20,” she said.

Constable highlighted that within secondary care there is a staffing embargo because of budgetary constraints. This has created significant issues within paediatric eye care.

She added that Ireland does not have an orthoptist training programme, so the majority of orthoptists working in Ireland are UK-trained.

Constable shared that optometrists have only been working within hospitals in Ireland since 2017.

“It is evolving quite rapidly and ophthalmologists are recognising the contribution that optometrists can make and the value they bring,” she said.

She highlighted that optometrists working within Ireland do not have prescribing rights.

“Optometry Ireland is working at the moment on legal options to get us started on that road. We have a number of potential options available,” she said.