Domiciliary urgent eye care in Wales

Before 2020, housebound patients in Wales who woke up with a sudden loss of vision or a red eye were faced with an unenviable choice.

They could travel to receive care, or they could wait while their already small world diminished further.

Optometrist and clinical adviser, Sharon Beatty, told OT that a lack of equity between High Street and domiciliary NHS-funded urgent eye care prompted a series of reforms within Wales.

“It was all about parity, safety and timely care,” she emphasised.

In 2020, the Domiciliary Emergency Eye Care Service was rolled out at pace in response to the pandemic. This was followed by overarching reforms to optometry in Wales in October 2023.

Sharon Beatty

The overhaul saw the introduction of the WGOS2 domiciliary urgent eye care service and the removal of the pre-visit notification requirement in Wales requiring at least 48 hours’ notice before a domiciliary visit.

“The thought behind it was ‘How do we lose all the obstacles to providing safe and effective care for everybody?’,” Beatty explained.

Now, when a housebound patient has an eye health concern, they are no longer troubled by additional worries – such as the fear of being in an unfamiliar environment or burdening a relative with a request for a lift.

The patient can see an optometrist who they may already be acquainted with through routine domiciliary visits.

“You know your optometrist. They’ve been coming to your house for years,” Beatty said.

She added that, because there is a significant proportion of people living in rural areas in Wales, previously patients may have had to travel some distance to attend a hospital or GP surgery.

“The fact that we have network of professionals who can bring that service to a patient’s own home means there is less travel involved. It’s better for the patient, it’s better for the environment and it takes the pressure off our GP colleagues and secondary care,” Beatty emphasised.

In addition to the benefits for patients, Beatty highlighted that the WGOS2 national urgent eye care service has released thousands of appointments each month from GP practices and secondary care.

“People can contact any optometry practice in Wales and receive free NHS-funded urgent eye care closer to home, or at home if meeting the eligibility requirements,” Beatty highlighted.

All practitioners in Wales on the NHS Performers List are signed up to deliver WGOS 2 as a core NHS service, while some contact lens opticians have also undergone additional training to provide WGOS 2 for anterior eye conditions.

Beatty shared that there are benefits from a professional satisfaction point of view of providing the service.

“As part of optometry contract reform, optometrists and dispensing opticians are working at the top of their licence, which is wonderful to see,” Beatty shared.

Beatty hopes that the ability for patients to receive urgent eye care services, both on the High Street and in a domiciliary setting, will reinforce the public standing of optometrists as healthcare providers.

“We need to ensure that everyone in Wales knows to contact their optometry practice as the first port of call for any eye problems,” she emphasised.

Each year, the General Optical Council surveys around 2000 members of the UK public to find out where they would go if they woke up in the morning with an eye problem.

In Wales, 43% of respondents said they would go to their optometry practice in 2024, compared to 31% in England, 44% in Scotland and 41% in Northern Ireland.

Patients really appreciate the service and the ability to be examined in their own home environment in a timely manner

The optometrist perspective

Cardiff optometrist, Jason Scaife, provides domiciliary eye care services to patients from Caerphilly to Ceredigion through his role as optometry director of Specsavers Home Visits. 

Scaife told OT that his team sees around 15 domiciliary patients each week through the WGOS2 domiciliary urgent eye care service.

Scaife highlighted the fulfilling nature of being able to provide urgent eye care to patients in their own homes.

“These services enable us to provide urgent eye care to patients with serious, pressing, or sight-threatening conditions – patients we might not have been able to support in the past,” he said.

“Many of these individuals would otherwise face delays or significant challenges in accessing hospital-based care,” Scaife added.

This helps to prevent more serious complications that can arise due to treatment delays, he shared.

Scaife observed that being able to ease pressure on ambulatory services and secondary care adds to his sense of satisfaction with the service. 

“It’s rewarding to know that our work is not just helping individuals but also contributing to a more efficient, sustainable and patient-focused healthcare system,” he said. 

Scaife shared that being able to offer WGOS2 as a domiciliary business increases the volume of appointments and enhances the continuity of service provision. 

The service also enables his business to reach a broader patient base.

“Offering enhanced NHS services under WGOS2 allows most domiciliary eye care businesses to diversify their service offerings, contributing to long-term sustainability,” he said.

Domiciliary optometrist, Lisa Evans, sees patients with a range of eye conditions in Cardiff, Vale of Glamorgan and Rhondda Cynon Taff through WGOS2.

“The eye conditions we detect from a WGOS2 examination are variable from very serious eye conditions such as iritis, angle closure glaucoma, sudden onset diplopia, retinal haemorrhages and retinal blood vessel occlusions to less sight threatening eye conditions such as conjunctivitis and sub-conjunctival haemorrhages,” she said.

She added that the service means only patients who require treatment by the hospital eye service need to be transported to hospital.

“Patients really appreciate the service and the ability to be examined in their own home environment in a timely manner,” Evans highlighted. 

Avoiding the need to travel to an optometry practice or hospital can reduce the physical exhaustion some patients experience – and in turn reduce their risk of a fall. 

“Especially since the COVID pandemic, patients value having a face-to-face examination in their own home,” Evans shared. 

She added that the portability of domiciliary equipment minimises the amount that patients need to move in order to receive their eye care examination. 

Evans highlighted that WGOS2 has reduced the strain on GP practices, with staff kept informed of the findings of examinations.

“This is appreciated by both patients and GP surgeries. With improved links within the NHS, WGOS2 is a great credit to all health care practitioners working collectively as a team for the best interest of the individual patient,” she said.

Jason Scaife

IP domiciliary services

A small number of domiciliary optometrists have completed their training in independent prescribing.

Locum domiciliary optometrist, Hector Marcos, has been offering WGOS5 independent prescribing optometry services to patients in their own homes.

Marcos told OT that he decided to start studying IP during the pandemic. During the height of social distancing restrictions in Wales, primary eye care was predominantly provided by optometrists with IP qualifications.

“I didn’t know of any optometrists who were offering IP in a home care setting. I thought I could upskill and use that qualification to help patients,” he said.

After qualifying in 2023, Marcos has been able to manage and treat patients in their own homes with a range of conditions, including uveitis, marginal and bacterial keratitis, ocular hypertension and glaucoma.

He highlighted that patients are very grateful to be able to receive convenient care without the need to travel.

“Patients appreciate that you've gone the extra mile to help them, and you've seen them in the comfort of their own homes,” Marcos said.

He observed that previously patients could be nervous about leaving their own homes and reluctant to call an ambulance or request help from a relative.

“There is a sense of relief that they don’t have to burden someone else,” Marcos shared.

There are also benefits from a professional satisfaction point of view for the South Wales practitioner.

“Even though it might be more difficult than a simple refraction, providing an IP appointment is very rewarding,” he said.