NHS Neighbourhood Health Framework “a huge opportunity missed,” AOP says

A failure to fully utilise primary care within the NHS Neighbourhood Health Framework is “a huge opportunity missed,” the AOP has said.

The NHS Neighbourhood Health Framework, published on 17 March, details how community healthcare will be organised in the coming years, as the Government seeks to move care from hospital to community as set out in its 10-Year Health Plan.

When the 10-Year Health Plan was published in July 2025, the AOP noted that it was “light on detail” and that additional information should be published in order to provide essential clarity on how the system would work.

The NHS Neighbourhood Health Framework provides this detail, including on areas of priority and how new structures will fit together, the AOP acknowledged.

The goals identified within the framework are sensible, the AOP said.

However, the association emphasised that the utilisation of primary care as outlined in the framework is only “primary medical care” and that primary care has been narrowed to mean GP-led care only.

“The framework makes it clear that community pharmacy, dental services, optometry and other services are not, largely, included in the initial priorities, with a vague commitment to look at how these can contribute to neighbourhoods in the ‘next few years,’” the AOP’s policy briefing said.

This is a missed opportunity, the briefing emphasised, adding that “primary care providers are the first port of call for people needing healthcare.”

Primary care acts as “the front door to the NHS,” already brings healthcare to every neighbourhood, is where the public goes for advice, treatment and referrals, and is able to provide strong continuity of care, the AOP said.

The policy briefing stated that “the framework is also specifically a missed opportunity to utilise optometry; a professional sector that uniquely has the people, premises and equipment to have a significant impact on NHS healthcare delivery, if funded and utilised effectively.”

Optometry can ensure that patients do not present to their GP for eye problems, freeing up capacity and meaning that patients who do need to be referred for urgent care can be seen more quickly, the document emphasises.

More than 1.5 million prescriptions are issued every year by GPs for eye-related medications, and these patients could easily be seen in optometry settings instead, the AOP said – emphasising that optometrists already have the skills and equipment to manage these cases.

The framework is also specifically a missed opportunity to utilise optometry; a professional sector that uniquely has the people, premises and equipment to have a significant impact on NHS healthcare delivery

The AOP acknowledged that a focus primarily on GPs makes sense because these services are underfunded and the public is concerned about access.

However, “given the limited resources the NHS has at its disposal and the fact that optometry, dentistry and community pharmacy are not part of the initial wave of priorities, our concern is that by the time attention turns to primary care providers, the new ways of working will already be established,” the association said.

The wider primary care professions are at risk of becoming an afterthought, with their potential “untapped and wasted,” the briefing continued.

The AOP added: “In our view, this isn’t what was meant by a ‘left shift’.”

Lord Darzi’s 2024 report into the NHS advised “utilising and funding the whole of the primary care system,” the AOP said.

Good eyesight also helps to reduce falls, and optometry can make “an important and cost-effective contribution” in this area, the policy briefing also noted – something that is addressed in the AOP’s Transforming eye care for older people for better health policy.

The lack of a timeline on when wider primary care will be utilised is “both of deep concern and adds weight to the argument that all primary care providers remain undervalued and underutilised,” the AOP said.

“In our view, if the framework is a missed opportunity for utilising primary care, it also fails to seize the opportunity to transform eye care and eye health,” the association said.

The briefing added: “Optometry-led services, despite chronic underfunding, are not beset with the issues facing other parts of the NHS. Workforce and access to those services have been resilient, with the profession finding ever more innovative ways to ensure the service provided to patients does not suffer.

“Arguably, this innovation and resilience has often been to the sector’s detriment when it comes to funding, with the NHS well aware of, but unwilling to tackle, the pressures facing optometry because it is not struggling as much as peer professions.”

The AOP continued: “Optometry-led services have the potential to help the NHS tackle the challenges it faces, but to do so the profession must be enabled to do so.

“Unfortunately, clear direction from the centre is lacking.”

We repeat our call on the Government to issue guidance to ensure that every patient has access to a range of services that can be delivered in primary eye care

A missed opportunity to transform access to primary eye care services

Optometry must now look to where it can demonstrate value to the wider system, including improving access to GPs, meeting targets on 18-week waits, and reducing NHS red tape, waste and inefficiency, the AOP said.

However, the association noted that the support it can offer is secondary to the core skills that could be used if the profession was utilised fully.

“Optometry is ready to support, but the benefits are marginal. The true change that is needed for eye care and eye health in England, and the change that will improve the patient experience of eye care and prevent avoidable irreversible sight loss, is transforming access to primary eye care services,” the policy briefing said.

It continued: “Optometry-led care is uniquely placed and qualified to deliver this aim. The framework fails to enable optometry to press on with this essential goal; it says that primary eye care has to wait. We say that this is not good enough. The public deserves better. And the solutions needed to ensure the public feel and see the difference are simple to implement.

“Which is why we repeat our call on the Government to issue guidance to ensure that every patient has access to a range of services that can be delivered in primary eye care. Services that are safe, cost effective, free-up much needed NHS capacity in other areas, and most importantly provide patients with reassurance and a better experience and outcome.”

Read more

Policy briefing: Neighbourhood Health Framework

The AOP’s summary – and what it means for optometry