Cancellation of MECS in Coventry and Warwickshire is having a negative impact on patients, practitioners say

The cancellation of a long-standing minor eye conditions service (MECS) in Coventry and Warwickshire is negatively impacting patients, optometrists practising locally have told OT.

South Warwickshire MECS, which was commissioned by Coventry and Warwickshire Integrated Care Board (ICB) and had run since 2015, ceased to operate on 31 October.

Dilesh Makwana, secretary of Coventry and Warwickshire Local Optical Committee (LOC), told OT that the cancellation is “limiting patient choice, first and foremost.”

“The knock-on effect [of the cancellation] is that patients are now confused. They are still coming into our practices asking for the service, and we have to tell them that it’s not available on the NHS anymore,” he told OT.

The ICB has requested that patients with minor eye conditions are referred to pharmacies or GPs, but Makwana believes that this is not a practical solution.

Patients’ other options are to attend eye casualty at University Hospital Coventry and Warwickshire, which is on the far eastern edge of the city and might mean two buses for some, or to pay privately, which might not be possible, he added.

Hugh Sorrill, chief executive of Coventry Vision Hub, a local charity that supports blind and partially sighted people, noted that patients in the west of Coventry are likely to have trouble accessing the hospital, and that this access is likely to be worse for those in areas of high deprivation.

Patients’ ability to navigate the emergency eye referral service is “now reduced significantly” and paying privately “can be out of the reach of many people,” Sorrill said.

“There is a very real risk that people in towns in South Warwickshire will effectively get little to no eye care for minor conditions, or conditions where they don’t know what they are, because it’s a two-and-a-half-hour journey to the hospital,” Sorrill told OT.

Patients have “had their eye appointments pushed back by three or four months” when previously they were being seen every few weeks, he said.

The LOC was given notice on 31 July that MECS in South Warwickshire would cease from 31 October.

Shajidur Rahman, optometrist and owner at iCare Vision Specialists, and a committee member on Coventry and Warwickshire LOC, told OT that minor eye conditions, or possible emergencies that could be easily treated in practice, are now “going unseen, whether that condition is getting worse or not.”

“These patients are left without any emergency treatment or emergency appointments,” Rahman said.

He added: “We don’t know what they are going to do.”

We’re already seeing people having their treatment or appointments delayed, and by a significant amount. That is the immediate impact. Treatment delayed is treatment denied

Pressure on the hospital eye service

Makwana told OT that the situation means “putting extra pressure on our eye casualty service” at University Hospital Coventry and Warwickshire.

“For our existing service users, it’s the impact at the hospital that is the greatest issue,” Sorrill said.

“We’re already seeing people having their treatment or appointments delayed, and by a significant amount. That is the immediate impact. Treatment delayed is treatment denied,” he added.

The LOC plans to track how many patients with minor eye conditions are being turned away from practices in the area and present this data to the ICB, Rahman told OT.

He noted that pharmacies are also “doing their best” to treat patients who would previously have been seen under MECS in community optometry.

Patients who could previously be treated in community optometry will now find themselves frustrated by waiting times in eye casualty, which will in turn be increased, Rahman said.

Rahman added: “I dread to think what will happen long-term.

“The scheme was there for reason. It ran quite well. I appreciated the fact that it was there, to help the people of Coventry.”

The cancellation will increase inequality because those who can pay privately will continue to do so, while others will now miss out, Rahman said.

OT has reached out to University Hospital Coventry and Warwickshire for comment on the impact the cancellation of MECS is having on their services, including whether the hospital is seeing increased waiting times in eye casualty as a result of cases no longer being seen in community optometry practices, and whether staff have been redeployed to emergency eye clinics, but has not yet received a response.

“Contrary to the prevailing winds” of the 10-Year Health Plan

Sorrill told OT that the cancellation of MECS is “perversely contrary to the prevailing winds, not just in eye health, but of all healthcare – that more of it should be done in the community.”

A key tenet of the Government’s 10-Year Health Plan is to move more care from hospitals to communities.

Makwana told OT that the LOC had worked with the hospital in recent years to improve eye casualty and access to urgent and emergency eye care.

Post-pandemic, this included the implementation of a booking system, Makwana said.

The cancellation of MECS means that this work “has basically fallen by the wayside, which is a shame,” he said.

Makwana emphasised that, although ICBs have had to cut their budgets by 50% in recent months, seeing a patient for a minor eye condition in the community costs far less than it would to see them in eye casualty.

This goes against the 10-Year Health Plan, Makwana believes.

“The 10-Year Health Plan, nationally, is to bring care into the community, and we’re already doing that in terms of eye care in Coventry and Warwickshire,” he said.

Before the cancellation, Coventry and Warwickshire LOC had been speaking to the ICB about how the service could be improved, Makwana said.

He explained to OT that, because the service was 10 years old, the LOC had felt that it could be improved to better reflect the increased number of independent prescribing optometrists and those with higher qualifications working in community optometry practices.

The LOC had been under the impression that it was on the correct path with regards to improving the service, Makwana told OT.

In the long-term, cancelling MECS will not save the ICB money, Makwana believes.

He noted that not seeing these cases in optometry practices “clogs up the hospital’s diary. [It means that] people with serious eye issues, like potential retinal detachments, end up waiting three or four days as opposed to being seen the same day and having treatment. That’s what we're concerned about.”

Makwana added: “It has a potential of someone losing their livelihood, because they weren’t treated in time, and they could have been.”

Taiwo Owatemi, MP for Coventry North West, has also been involved in discussions around the cancellation of the service.

Owatemi told OT: “As the local MP, my priority is ensuring that residents in Coventry can access timely, community-based urgent eye care without being left stranded, facing long waits, or travelling across the city to the eye hospital for conditions that could be managed closer to home.”

“It is also vital that any changes to eye-care pathways do not overwhelm our already stretched GP practices and community pharmacies,” Owatemi added.

To ensure that local voices are heard, Owatemi has launched a survey for both healthcare providers and local residents. 

Owatemi’s team delivered the survey to GPs, pharmacists and optometry practices in her constituency in early November.

“Their insight will help us present a clear and accurate picture to the ICB of how important accessible, continued eye-care services are for our community,” Owatemi told OT.

The ICB response to the MECS cancellation in Coventry and Warwickshire

A spokesperson for NHS Coventry and Warwickshire ICB told OT: “Following a thorough review, NHS Coventry and Warwickshire ICB decided not to extend the contract for the South Warwickshire minor eye conditions service.

“The majority of patients will continue to be able to receive treatment for eye care in the community through local pharmacists or GPs, with more serious cases still referred directly to hospital eye casualty services.”

A full assessment was carried out ahead of the decision, and an Equality and Quality Impact Assessment suggested the cancellation would have a low impact on patients and that other local options were still available, the ICB said.

The ICB told OT that it has a statutory duty to ensure NHS resources are used to deliver the greatest value for local populations, and that its assessments showed that the service was duplicating up to 80% of treatments that could also be by delivered by pharmacists and GPs.

In response to the suggestion that GPs would be unwilling to see patients for minor eye conditions previously seen under MECS, the ICB told OT that patients are able to seek treatment from GPs for a range of conditions, including minor eye conditions, but that there is no expectation that GPs will pick up more specialised eye treatment outside of their contract.

These services will continue to be provided through eye casualty, the ICB said.

The ICB also noted that a six-month monitoring dashboard to track service quality, patient outcomes, patient experience, and any unforeseen impacts on patients or pressures on local services, began on 1 November.

Future non-urgent community eye care pathways are expected to be commissioned at a local neighbourhood level or by Integrated Health Organisations, rather than at ICB or system level, the ICB added.

The ICB also told OT that it has begun work on a new urgent care model for Coventry and Warwickshire, the scope of which is currently being finalised.

The new model will include urgent eye care provision as part of a holistic urgent and emergency care pathway, the ICB said.