Optometry Scotland publish community low vision service recommendations

Optometry Scotland has published seven evidence-based recommendations to inform plans for a national community low vision service.

The recommendations are intended to inform the Scottish Government as it resumes planning and development of the service.

The paper, Community Low Vision Service in Scotland: Considerations and Recommendations for Implementation, sets out the workforce, funding, access, pathway and infrastructure required for a consistent national model.

Optometry Scotland said the proposed service could support around 10,000 people each year and enable “substantially more low vision care to be delivered through community optometry.”

Eilidh Thomson, chair of Optometry Scotland, said: “Scotland already has a highly skilled community optometry workforce with the expertise and local reach to make this service work. Optometrists and dispensing opticians bring complementary skills and both must be recognised as direct providers.”

The new service should build on community optometry’s experience of “extensive and increasingly complex” NHS-funded eye care in Scotland already provided through General Ophthalmic Services and enhanced services, Optometry Scotland has said.

The seven recommendations include sustainable funding for the service that reflects the true cost of delivery; designing the service to support local access, patient choice and flexible referrals; and setting a national timeline for community-based Certification of Visual Impairment.

The recommendations encourage an integrated workforce model that enables optometrists and dispensing opticians to work to their full scopes of practice, and that procurement, training, digital infrastructure, funding and roll-out should be coordinated before service delivery begins.

The recommendations promote early and ongoing engagement with optical bodies including Optometry Scotland, and the establishment of the service as an integrated health and social care pathway.

Cost modelling

Thomson commented: “Protected consultation time, proportionate accreditation, straightforward claims and digital processes, timely access to low vision aids and clear referral routes must be built into the model from the outset.”

The paper proposes a minimum fee of £150 for an initial or full assessment and £85 for a standard face-to-face follow-up of up to 30 minutes, based on indicative practice-cost modelling by Optometry Scotland.

The modelling indicates that the central full cost of maintaining one hour of available clinical capacity is approximately £169, with Optometry Scotland suggesting: “£150 is a pragmatic minimum rather than full cost recovery.”

The optical body emphasised that fees should be tested against actual activity and provider costs during early implementation.

Separate provision would be required for administration, low vision aids, equipment, training, digital infrastructure and non-attendance. Domiciliary, mobile, remote and island delivery would also require separate provision.

Support for patients navigating low vision

Optometry Scotland highlighted that the service should not operate as a standalone clinical intervention.

In an introduction to the paper, Frank Munro, chair of the Community Low Vision Service Short Life Working Group, noted: “clinical care does not sit in isolation.”

National standards should help patients navigate between clinical assessment, rehabilitation, social care and third-sector support, Optometry Scotland has said, suggesting community-based Certification of Visual Impairment should be planned alongside the service, with access to wider support based on need rather than delayed pending certification.

National procurement should provide an appropriate range of optical, non-optical and electronic aids, with systems designed for timely provision at the point of assessment.

Digital infrastructure must support clinical delivery, ordering, referral, claims, data capture and monitoring without creating unnecessary administrative burden for practices, Optometry Scotland said.

Evidence and experience

Munro commented: “These recommendations are intended to inform, rather than pre-empt, the formal development process.”

“They bring together evidence, practitioner experience and learning from existing services to help ensure that the next phase produces a model that works for patients, practitioners and delivery partners across Scotland,” he explained.

Optometry Scotland noted that current programme discussions indicate implementation is not expected before late 2027.

Timing will depend on coordinated progress across the service specification, procurement, accreditation, digital systems and payment processes.

Phased roll-out should be governed by clear readiness criteria and early evaluation of service activity, patient experience and provider costs, Optometry Scotland has said.