Examples of good practice in extended services highlighted by Specsavers

Examples of good practice in optometry from Wales and Scotland to Australia were discussed during Specsavers’ A vision for the NHS: optometry’s role in the NHS 10-Year Health Plan panel at the Labour Conference.

Specsavers clinical services director, Giles Edmonds, opened the discussion by setting out the current state of eye care in England, and emphasising how examples of optometry being empowered to take on further work are paying dividends elsewhere.

“Ophthalmology has the biggest caseload going into hospitals, as well as the busiest outpatient department in any hospital,” Edmonds said.

“With an ageing population, clearly that demand is growing, and waiting lists for things like outpatient glaucoma services are growing and growing.”

“Optometry can be, and is in certain parts of the country, a big solution to that,” Edmonds told attendees.

There are almost 15,000 optometrists in England, many of whom have the capability to take on extended services and are already working with hospital-grade equipment, he said.

Edmonds added: “We have the capability, we have the equipment, and we have the capacity and the willingness to help.”

“We really believe that we, as optometrists, are part of the solution.”

This aligns well with the Government’s plans to move care from hospitals into communities, he believes.

Edmonds highlighted the changes to the optometry contract in Wales, which came into effect in autumn 2023, as an example of this.

In Wales, “optometrists are fundamentally linked up to secondary care and deliver all sorts of services in the community, whether it be community urgent eye care schemes, macular schemes, or monitoring stable glaucoma patients in the community,” Edmonds said.

He also praised the role of optometry in Scotland, in terms of treating minor eye conditions.

“In Scotland, they have had a national minor eye care scheme for a number of years,” he noted.

“They have done a lot of public service messages around promoting it. When you look at the data, and when you ask the public where they would go with red eye, it is about double in Scotland what it is in England, because it’s really clear in Scotland that your first point of contact is optometry.”

“We think there are about 600,000 appointments that would be saved in A&E and GPs by having the minor eye care conditions scheme across the whole of England,” Edmonds added.

He also noted that Scotland has at least a part-time optometric adviser for every health board, whilst Wales has a chief optometric adviser.

Irene Campbell, the MP for North Ayrshire and Arran, also spoke on the Specsavers panel.

Campbell said that the optometric advisor within her local health board plays “a hugely important role.”

The optometric adviser liaises with a health board committee that includes community optometrists and leads on practice inspections, Campbell said.

“There is a really good network. It’s all about personal relationships,” she said.

Examples of good practice from the four nations are highlighted in Specsavers’ Access to Care 2025 report, which was published ahead of the 2025 party conference season.

The challenge in England is a postcode lottery when it comes to integrated care board commissioning, and this is something that “we really need to talk about ending,” Edmonds said.

He also highlighted an optometry-led High Street glaucoma service in Manchester as a successful example of enhanced service commissioning in England.

The service was also praised by NHS Confederation chief executive, Matthew Taylor, during the NHS Confederation Expo in June this year.

Taylor had previously visited a Specsavers practice in Sale, which he said was doing “fantastic work” in community glaucoma care through the commissioned service.

There are “lots of great examples where primary care optometry and secondary care ophthalmology work really well together,” Edmonds added.

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Public awareness of optometry in North Ayrshire and Arran

Campbell told attendees about a joint initiative that was set up in 2017 to encourage residents in Ayrshire and Arran to visit their local optometrist when experiencing eye problems, rather than A&E or their GP.

The service, which is managed by NHS Ayrshire and Arran, allows optometrists to assess and manage patients, and either issue a prescription that can be picked up from a pharmacist or refer if needed.

Developing the Eyecare Ayrshire initiative included a postcode analysis of the 400,000-strong population and collaboration between a consultant, a primary care manager, and GP and pharmacy managers, Campbell said.

The optometric adviser at NHS Ayrshire and Arran also worked with Specsavers and other providers across Ayrshire in order to ensure the scheme was successful, Campbell explained.

A public awareness campaign included a radio advert featuring a patient with a sore eye being treated by a local optometrist.

The scheme was a “bit slow to start, but now it is the norm, and most people will go to their optometrist,” Campbell said.

A successful financial model demonstrated by Macmillan

Simon Opher, the MP for Stroud and a former GP, used an example of a pathway developed by the Macmillan cancer charity that he believes demonstrates good practice in terms of financial flows.

The charity has worked across England to develop a new end of life care pathway, Opher explained.

The model involves Macmillan going into trusts, using data to identify how many days on average people at the end-of-life spend in hospital, and then demonstrating how their care pathway can reduce that by half, Opher said.

“They then give the money to the system to create that different pathway, or to commission them to create that different pathway on the basis that once they have created it, the trust or system can then pay money back,” Opher said.

The money can be paid back once a reduction in cost has been clearly demonstrated and when the trust has had time to consider how it repurposes the freed-up capacity, he explained.

“That’s a fantastic model. It has been replicated around the country,” Opher said.

He emphasised: “We need more examples of that tight way of putting together business propositions, where the payback is quite quick, and then we can start to accelerate the kind of feedback that drives the bigger change that we want.

“I would say, generally speaking, when I see great practice, I’m not seeing business cases that are tight enough to convince system leaders and hospital managers [of their value].”

The impact of better connectivity for patients in Australia

Edmonds also noted how better interoperability has meant that Specsavers in Australia has been able to bring charities into glaucoma and diabetes referral pathways.

“We have much better connectivity between primary care and secondary care [in Australia],” Edmonds said.

Specsavers has more than 380 practices in Australia, after opening its first two practices in the country in 2008.

Edmonds explained: “If we suspect someone has got glaucoma, for example, or diabetes, we will link in the charity electronically. The patient gives permission for the charity to then contact them and to have counselling conversations, or to talk them through the process.

“That’s something we haven't got in the UK, but it’s a really well-developed scheme [in Australia].”

Better connectivity between primary and secondary care is needed generally, Edmonds said, but in UK the funding “doesn’t quite get there.”

“In England, we need NHS England to decide what connectivity platform they have between primary care and optometry,” he said.

A procurement process around three years ago led to seven different schemes being implemented, Edmonds explained.

“I understand the reason why, in terms of trying to get a better deal for the NHS, but it has just added to complexity, and we haven’t been able to plug them all in,” he said.

Also, Edmonds noted, “That doesn’t link us into GPs – it only links us into hospitals, so we’re still missing a link with the GPs.”

Holding systems to account

The reality of private providers taking on NHS work and the issues that can arise from this was also discussed during the event.

“It’s really important to talk about good practice and to spread good practice,” Taylor told attendees.

He added: “I think it’s reasonable to hold systems to account when they’re not doing stuff that really does seem to be obvious and to work.”

Taylor emphasised that fair financial models are needed if NHS partnerships are to work effectively.

“We need to make sure, as we work in partnership, that it is financially sound and fair,” he said, adding: “Sometimes, when the NHS works with our partners in the private sector, it’s great, and sometimes it’s not so great.”

Productivity gains made by private providers should not be seen as windfall profits but should instead be shared so that “we can do more for patients,” Taylor believes.

Opher noted the challenge that is presented if the “easy” work is taken out of the hospital setting.

“That’s their bread and butter,” Opher said. “If the funding rewards the easy stuff, those departments in the hospitals get a new bit of funding. [If] they get [only] the tricky stuff, the whole thing collapses.”

He added: “We have to create a clever funding model that works for our providers, for example for Specsavers, but doesn’t denude the specialty of much needed income. We have to be very careful how we work it through.”

Edmonds noted that 70% of Specsavers’ business is NHS, whilst 30% is private.

“Private will always be more profitable than the NHS,” Edmonds acknowledged. “We know what the tariffs are. Ultimately, we accept that we won’t get that level of tariff [for NHS work].

“That’s just the nature of it. The way that we always approach it is to get everyone in the room and have a really good discussion.”

How to promote best practice

The eye care profession needs to be able to identify examples of best practice and run with them, ophthalmologist Nishani Amerasinghe told attendees.

“We have professional bodies, like the Royal College of Ophthalmologists, that can highlight areas of best practice,” Amerasinghe said.

“We can use the UK and Eire Glaucoma Society to highlight areas of good practice, and promote it to our colleagues, and then put the pressure on to make sure it’s rolled out from a professional point of view.”

Opher emphasised the importance of retaining high quality care whilst services are undergoing change.

“Professionals want to do the right thing. They come into medicine or optometry because they have a sense of public service. And so that collective power of professional standards is really important,” he said.

Engaging patients in sharing their experiences is also vital, Opher believes.

He added: “We need to empower patients as well. As any retailer will tell you, the best customer is the customer who complains, because that enables them to improve their service.

“We’ve also got to encourage and support patients, if they’ve had good experiences, to share that, as well as talking about bad experiences so that we can learn from them.”

Opher noted: “It’s that combination of individual empowerment, professional standards and central oversight.”

Opher was also asked whether he believes health secretary, Wes Streeting, is “bought in” to the concept of optometry taking the pressure of hospitals.

“Yes, I think so, because it hits at least two of the three paradigms of the shift he wants, which is hospital to community, and [treatment to] prevention,” Opher said.

“Good optometry is about prevention,” he added.