NEHW 2026: enhanced services in primary eye care

Quicker and more convenient access to care, reduced waiting lists, continuity of care, and greater professional satisfaction – just some of the outcomes practitioners have seen from enhanced services in community practice.

For National Eye Health Week, OT asked practices to share how enhanced services benefit patients, shape perceptions of the role of optometrists, and what they can mean for professional satisfaction.

Building long-term relationships and personalised care

Gloucestershire-based practice, Norville Independent Eyecare, is involved in an array of commissioned and extended service pathways.

This includes a collaborative NHS integrated cataract pathway in Gloucestershire, which Aisling O’Donovan, an independent prescribing (IP) optometrist and practice partner, explains has been “progressively commissioned, transformed, and funded since 2018.”

Glaucoma repeat readings and enhanced referral schemes began in 2019, followed by Community Urgent Eyecare Services (CUES) in 2020 – with Gloucestershire among the first wave of regions to officially put the urgent eyecare pathway into action.

A longstanding ocular hypertension monitoring scheme has been running since 2017 with a small number of patients.

O’Donovan told OT: “As a practice owner and IP optometrist with a passion for medical retina, I have seen how these extended services have really enriched the way we can look after our patients.”

“Being able to provide more holistic care strengthens the trust between us as practitioners and our patients, as they can rely on us not only for vision correction but also for the assessment, management, and monitoring of a variety of eye conditions,” she shared.

Providing these services in community optometry is also beneficial for continuity of care and enables patients to see a familiar and trusted clinician.

O’Donovan said: “Building these long-term relationships helps patients feel listened to, supported, and confident that they are receiving personalised care from someone who understands their history and individual needs.”

By offering enhanced services, we are able to play a more active role in the patient journey, improving access to care and reinforcing our position as primary eye care professionals

Karen Gennard, optometrist at Norville Independent Eyecare, highlighted that the services benefit patients in accessing care while avoiding a trip into hospital unless necessary, sharing: “Our aim as practitioners is to make sure people are being seen by the right person at the right time so that the patient has the most timely and appropriate care – and that helps both the efficiency of the practice and also secondary care.”

As well as supporting the care needs of individual patients, the roll-out of these services has a broader impact for eye health.

Dr John Everett, IP optometrist at Norville Independent Eyecare, shared: “Most optometry practices in Gloucestershire are signed up to the CUES service which means patients are more likely to be seen within the recommended time frame even if the patient’s own practice is fully booked for that day.”

This system is also helping to take pressure away from other eye services, including ophthalmology, as well as other primary care settings such as GPs and pharmacies.

O’Donovan told OT: “I feel that these services help demonstrate to our patients that our role in eye care is far more comprehensive than simply screening for pathology and prescribing spectacles.”

She highlighted: “By offering enhanced services, we are able to play a more active role in the patient journey, improving access to care and reinforcing our position as primary eye care professionals.”

As well as improving convenience and continuity of care, O’Donovan said, this also helps to raise awareness of the contribution of optometrists within wider healthcare.

Shifting perceptions in primary care

Practices that are part of Valli Opticians are involved in a number of community enhanced services across Greater Manchester, Lancashire, Yorkshire, and Coventry.

These include urgent eye care services, glaucoma repeated measures and the ocular hypertension monitoring scheme.

Eleanor Swystun, clinical lead at Valli Opticians, told OT that these services are supporting care closer to home and that, increasingly, GPs, 111 and A&E are directing patients to local optometrists to be seen under the urgent eye care schemes in place.

She said: “In Huddersfield and Halifax, where I primarily work, these schemes have been in place for over 15 years. Since COVID-19 however, other healthcare professionals seem to be making more use of these schemes and signposting patients to participating practices.”

“Some of our practices are in rural areas, so getting to the hospital or GP can be a challenge – particularly in bad weather or if they are elderly,” she added.

Optometrists have the equipment, clinical skills, and knowledge, Swystun said, to carry out a detailed examination of the eye and to, in many cases, provide reassurance or treat the patient.

“This makes better use of NHS resources and allows the other health care providers, such as A&E and GPs, to see a more appropriate case mix for that setting. It’s a bad use of an A&E doctor’s time to be examining a patient with a stye,” she pointed out.

Swystun is also IP-qualified and noted that managing a case of anterior uveitis in practice under the CUES scheme will cost the NHS less than a typical A&E appointment followed by ophthalmology appointments.

For many patients, their local optometrist has traditionally been somewhere they visit every year or two for an eye examination and a new pair of glasses, but that perception is changing

In the case of the ocular hypertension monitoring scheme, discharging patients into the community for monitoring can help to improve waiting list times for those needing to see the specialist.

The provision of these services through community optometry helps to build patient trust and alter public understanding of the role of optometrists.

Swystun shared: “For many patients, their local optometrist has traditionally been somewhere they visit every year or two for an eye examination and a new pair of glasses, but that perception is changing.”

“It is surprising the amount of patients who are in disbelief that their GP advised them to see an optometrist for their red eye, which was then successfully diagnosed and treated by us. Once this has happened, the patient then understands why the GP was, perhaps, not the most appropriate person for them to see,” she added.

Evolving pathways for community optometry

Based in Herefordshire, BBR Optometry has been involved in a variety of shared care schemes from the outset and has seen these services shift and evolve over time.

OT received a brief look into the history of community-based services at BBR Optometry from BBR Optometry colleagues: Georgia Wootton, therapeutic optometrist, Magda Peppa, dispensing optician and contact lens practitioner, Daniel Read, practice manager and dispensing optician, Suzanne Wadsworth, senior optometrist, independent prescriber and director, and Nick Black, CEO and contact lens and low vision practitioner.

This began with a low vision service in the mid-90s, followed by a pre-cataract scheme and a post-cataract scheme. The team explained: “CUES had gone through many different iterations since it’s outset in the early 2000s as GPERS, with BBR being part of that initial trial for Hereford GPs. It then became PEARS, then MECS, before becoming CUES.”

The scheme proved essential during the pandemic, the team highlighted, adding that, with IP qualified optometrists gaining NHS prescription pads, it helped optometry to provide essential and emergency care, reducing pressure on other healthcare providers.

A glaucoma refinement scheme was introduced, followed later by glaucoma enhancement and Community Optometric Glaucoma Service (COGS).

The team shared that this allowed for “better referrals and supporting secondary care by monitoring ocular hypertension and stable glaucoma patients in the community.”

A children’s vision screening service came in the 2010s, directing referrals from screening in the first year of school, and hospital contact lens services have moved into registered practices in the community.

The team noted that a stable wet AMD in the community (STAC) service was introduced again five years ago, allowing for patients to be monitored in the community.

“Easier and more widespread access to the best qualified professionals to the patient’s needs is a huge benefit to patient care,” the team told OT.

Access to schemes such as post- and pre-cataract, COGS and STAC means patients can be seen in “a more familiar, convenient, and less intimidating environment than a hospital.”

CUES supports fast access to frontline emergency eye care, normally with less of a wait and in more convenient environment than A&E or a GP surgery.

The team highlighted that CUES research during the pandemic, and in more recent primary eyecare services data, has indicated the high numbers of presentations that could be dealt with by accredited optometrists and IP-qualified optometrists.

The BBR Optometry team emphasised: “Areas across England are having the usefulness of CUES questioned, when all the evidence suggests these are good for patients, secondary care relief, and practitioner enjoyment in providing this care and fully utilising their skills.”

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Hospital contact lens patients seen in the community benefit from a significant reduction in waiting times for appointments.

BBR Optometry noted that the waiting list at hospitals for contact lens patients can run up to twelve months, while patients seen at the practice have an appointment within one month on average.

“As a result, patients feel safe and confident that they are treated as soon as possible and this experience can be considered life-changing to them,” the team shared.

Similarly, patients accessing low vision services in the community can receive “vital help” in maintaining independence and supporting their quality of life.

The benefits of community-based services ripple outwards beyond the patients themselves.

The BBR Optometry team shared: “As these schemes have developed, they have brought with it a better trust, understanding and respect between optometry, GPs and hospitals, that has benefitted everybody.”

“It does this whilst also saving the NHS money. It is just sad that there cannot be a more joined-up national roll out of all these schemes to halt the cross-country border funding issues that mean these services are not available to all of our patients,” the colleagues noted.

They added: “This has had the effect of making optometry the recognised first port of call for patients across the county for any vision or eye related issue, which will continue to take the pressure off secondary care, freeing them up to see the patients who have more complicated care needs.”