Optometry responds to NHS England’s Medium Term Planning Framework for England

The eye care sector has responded to NHS England’s Medium Term Planning Framework for England.

The framework, published on 24 October, sets out how changes to the NHS will be delivered between 2026–2027 and 2028–2029.

It aims to “close the gap” between the NHS and local service delivery – the latter of which is a key tenet of the Government’s 10-Year Health Plan.

The framework also promises to mark “the beginning of a new way of working” and “the return of locally-led ambition in the NHS – creating the platform for NHS boards and leaders to truly listen to their communities and drive the change they want and need.”

It sets out a new operating model for a variety of areas of the NHS, such as primary care, including broad aims about how quickly patients should be seen and how the new NHS will operate.

The framework notes the NHS setting national outcomes, individual regions taking control of leadership interface, integrated care boards (ICBs) becoming strategic commissioners, and providers taking responsibility for collaboration, productivity and quality.

ICBs will be expected to develop five-year plans that will allow them to transform services. The plans are expected in time for the next financial year.

A Model Neighbourhood Framework, a Strategic Commissioning Framework, a Foundation Trust Framework and a System Archetypes Blueprint are expected to follow within the next month.

Specific conditions where there is potential for major improvements in both quality and productivity are highlighted in the framework. The first three of these are cardiovascular diseases, serious mental illness, and sepsis, with dementia and frailty expected to follow.

A new contract-based delivery method will be created via the implementation of integrated health organisations.

Eye care in the Medium Term Planning Framework: “Still many unknowns”

The busiest outpatient specialties, of which ophthalmology is one, are a focus of the Medium Term Planning Framework.

The framework makes a commitment to “ending outpatient care as we know it” and for patients to “receive more specialised support closer to home.”

This means working with GPs and community and neighbourhood teams, and being “digitally enabled where appropriate,” the framework said.

A key priority will be planning, alongside ICBs and primary care, for how greater access to specialist advice and direct access to diagnostics for specific specialties could support GPs to manage more patients without the need for referral. More details on this are expected to be set out in the upcoming Model Neighbourhood Framework.

There will be a focus on reducing the number of “clinically low value follow-ups,” using the Getting It Right First Time specialty level good practice guides, the framework said. The first pathway for this is expected in December, with others to follow.

For the 10 busiest outpatient specialties, the framework makes a commitment to expanding ‘straight to test’ pathways and ‘one-stop clinics.’

The specialties will be prioritised by volume. Ophthalmology is currently the largest outpatient specialty in the NHS.

The framework aims to have implemented changes for all clinically-appropriate specialties by March 2029.

Whilst welcoming further detail on the plans, the AOP has expressed its disappointment that optometry has not been mentioned directly.

“The absence of any direct reference to optometry, opticians, or eye care and eye health in the Planning Framework,” is a concern, the AOP said in its policy briefing on the framework.

The AOP noted that primary care appears to have been given a “narrow definition,” to only include primary medical care.

The association emphasised that, although GPs are central to the NHS, they are “one important pillar within an ecosystem that also includes pharmacy, optometry, and dentistry.”

The services provided by community optometry allow patients access to high quality, timely care across the whole country, the association emphasised.

The AOP noted, however, that “there are areas in England where enhanced services are not commissioned, leading to inequalities in access for patients due to a postcode lottery of care.”

“The core sight testing service is chronically underfunded, but continues to be an exemplar in how to innovate and ensure patient-focused care delivers nationally,” the policy briefing added.

The association’s co-commissioned research, published in November 2024, shows that if all patients in England could access the full range of enhanced NHS eye care services that community can offer, almost two million GP and secondary care appointments would be saved.

This would have an overall direct net benefit of £98 million per year, the research estimated.

“We continue to call on the Government to include optometry in the planning of these services,” the AOP said.

The policy briefing emphasised: “By optimising optometry as part of the transformation of the NHS, we believe this reform will be possible, and ensure that every member of the public has access to eye care, closer to home, with better clinical outcomes, wherever they live in England.”

The College of Optometrists also expressed that it is “deeply concerned by the omission of primary eye care as a priority opportunity in the Medium Term Planning Framework.”

Dr Gillian Rudduck, president of the College of Optometrists, said: “Ophthalmology is currently the largest outpatient speciality in the NHS, with almost nine million appointments in England a year and long waiting lists that lead to avoidable sight loss.

“As one of the four pillars of primary care, alongside GPs, pharmacy and dentistry, optometry is integral to increasing earlier intervention and reducing appointment pressures on hospitals and waiting times for patients.”

The framework is “a missed opportunity to commit to universal funding and commissioning of enhanced primary eye health pathways across England as a critical service in Neighbourhood Health Plans,” Rudduck believes.

She added: “Optometrists have the clinical skills to provide a wider range of enhanced eye care services in the community to meet patients’ needs, including urgent eye care, pre- and post-cataract care, and glaucoma referral refinement services.

“For example, evidence from urgent eye care schemes that have been commissioned in some areas of England show that optometrists can safely manage most acute eye cases in the community, delivering timely care while reducing unnecessary hospital visits.”

Rudduck encouraged ICBs to include enhanced primary eye care pathways as part of their three-year plans to deliver on the aims of the 10-Year Health Plan, in order to “enable all patients to access timely care and treatment close to home.”

More widely, the AOP noted that there are “still many unknowns as we await the additional frameworks which will shape the future of the NHS.”

The association acknowledged that a commitment to enabling longer term contracting would deliver much-needed assurance for healthcare providers.

“We have highlighted that the short-term nature of contracts has prohibited innovation and investment, and a decision to address these issues is long overdue,” the policy document stated.

Read the full AOP policy briefing here.