Improving primary and secondary care relationships

Here, Fionnuala Stott, optometrist and chair of Cheshire Local Optical Committee (LOC), and Kate Ness, ophthalmology manager at Mid Cheshire NHS Foundation Trust, tell OT how they manage it.

What are the main projects that Cheshire LOC and Mid Cheshire NHS Foundation Trust have been collaborating on?

Kate Ness (KN): I’ve been with the trust, as ophthalmology manager, for the past two years. In that time, I’ve worked closely with the Local Optical Committee (LOC), because they are the main referral route in for our service.

Over the past two years, we have built open communication channels and coordinated the most appropriate pathways for patients, ensuring a smooth transition from primary care to secondary care, and back again. The information that we are able to send back to optometrists after a referral is key, and is much better now.

Fionnuala Stott (FS): We have been focusing on deepening our understanding of how both primary and secondary care manage patients, and more importantly, how each sector influences the other. A key part of this work has been exploring what each side needs to function effectively and collaboratively.

For instance, what does secondary care require in order to receive high-quality referrals? And conversely, what does primary care need to feel confident in making those referrals? We're also looking at opportunities to shift appropriate care into the community, which could help ease the pressure on secondary services while enhancing continuity and accessibility for patients.

Underlying all of this is the need to build trust and strengthen collaboration. We want to reach a point where primary care feels assured that its patients will be well-managed in secondary care, and where secondary care trusts that primary care has the capacity and capability to handle more complex cases when appropriate. It is about creating a shared sense of responsibility and mutual respect, supported by clear communication, aligned expectations, and joint problem-solving.

At the outset of this work, we identified a recurring issue where patients referred to the trust were not always receiving timely follow-up or communication. This prompted early discussions around how we could improve specific pathways — particularly the cataract referral and treatment process.

One of the key resources that informed our thinking was the Getting It Right First Time (GIRFT) report on ophthalmology, which provided valuable insights into optimising patient flow through both pre-operative assessments and post-operative care.

The process of mapping and analysis was instrumental in identifying areas for improvement and helped us move from anecdotal concerns to actionable insights.

KN: We’ve done a lot of work on our referral pathways. From talking to Fionnuala and listening to some of the frustrations, we developed a pathway for simple cataracts. It was only through working in conjunction with Fionnuala and her colleagues in the LOC that we were able to identify what the bottlenecks and the frustrations were, from an optometrist point of view, in that referral process.

We also secured an agreement for a cataract navigator post within the trust, which allowed for communication with patients very early in process and direct contact with optometrists through the OPERA platform. This gave optometrists a named contact to communicate with directly.

“We also secured an agreement for a cataract navigator post within the trust, which allowed for communication with patients very early in process and direct contact with optometrists through the OPERA platform”

It was very important to the LOC that it was a consultant-led process, so there is the reassurance and backing behind it. Via that pathway, we send the patient back to that optometrist that has referred them for their four-week follow-up post-surgery. All of that is communicated directly into their computer system. That’s just one of the pathways we have redesigned.

We have also worked on our YAG pathway, which had significant waiting times previously. The wait for care was impacting patients’ lives, including their ability to drive. In some cases, it was keeping patients out of work.

We developed a one-stop YAG pathway, with strong governance in place. This was only possible through our communication with community optometry, which now means that patients are prepared, and because of great collaborative working and understanding of the pathway in primary care at the point of referral. We could not deliver this pathway without optometrists' collaboration.

FS: Mid Cheshire is one of the few hospital trusts in the region to operate a dedicated glaucoma monitoring service. This innovative model allows the trust to discharge both ocular hypertensive patients and glaucoma patients who are stable on treatment into community-based monitoring. Over time, this approach has significantly eased pressure on hospital clinics and improved access to care.

A key factor in the success of this service has been the strong relationships between the hospital and community optometrists. By fostering open communication and mutual understanding, both sides have been able to collaboratively address challenges and refine the process. When each party understands the other’s constraints and priorities, solutions become much more straightforward.

As the ophthalmology manager at the trust, Kate has been instrumental in building these connections. Her commitment to collaboration was evident at the Cheshire LOC Annual General Meeting (AGM), where she attended alongside several hospital optometrists. This presence helped put faces to names and opened up direct lines of communication — making it easier for practitioners to reach out and resolve issues quickly.

KN: It doesn’t matter how good a service is: there is always room for improvement. LOC members are a really important part of that improvement, because they see our patients day-to-day, and they get a lot of feedback. It was about listening to what they saw as the priorities.

As a result of doing that, we have developed a number of pathways to reduce waiting times and address needs that they see with their patients. Things have developed over these two years, by opening those communication channels and being open and honest with each other.

FS: The ambitions of the NHS 10-Year Health Plan are already being brought to life through the collaborative work between the LOC and Leighton Hospital. We’re committed to building on these strong foundations as we move forward.

Optometry is uniquely positioned to support this shift in care. We’re embedded in every community, we have the capacity, and we bring a broad and highly developed skill set. This makes us ideally placed to take on more responsibility as care continues to move out of hospitals and into the community.

In Cheshire, we’re already piloting a blood pressure monitoring initiative — an important step toward greater involvement in preventative healthcare. It’s a clear example of how optometry can contribute meaningfully to early intervention and long-term health outcomes.

“Optometry is uniquely positioned to support this shift in care. We’re embedded in every community, we have the capacity, and we bring a broad and highly developed skill set”

What results have you seen from the relationships that you have built and the work that you have been doing?

FS: One of the key shifts that I have seen as an LOC chair over the past few years is a real appetite in optometry to get involved in further pathways. We’ve seen a big shift towards practices now seeing appointments under the community urgent eye care service (CUES).

We have 32 optometrists across Cheshire and Mersey doing the independent prescribing course at the moment. We’re hoping for really good collaboration between the optometrists doing their placements within the trusts, building those relationships to shift that care out into the community and trying to provide care in the most appropriate setting, reserving hospital care for the most in need.

There’s definitely a movement in optometry, ready to take this work out the into community. It is becoming routine.

What is the importance of having an open relationship between the LOC and the ophthalmology manager?

FS: I probably have at least one conversation with Kate every week. We are both committed to having open and honest conversation, with patient care at the centre, which allows us to take our ideas and suggestions forwards to our teams to develop pathways and processes for all.

As a result of our discussions and the feedback received, we have created many opportunities to learn and improve our services. There has been definite acknowledgement on both sides that neither side is going to get it right all the time.

When the trust opened the surgical Hub at the Victoria Infirmary Northwich, this included a dedicated ophthalmology theatre, injection suite and consulting rooms. The LOC was included from the initial planning stage, which resulted in community optometrists being updated at every stage of the project and being invited to a launch event, which also included training. In Cheshire, we are now in a position to complete our patients’ fast track cataract surgery, including bilateral and toric cases, in less than three weeks.

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How you have communicated this work to practices, and how are you making sure it has benefit on the ground?

KN: Fionnuala and I have had many open and honest conversations. There have been areas where we’ve both learned things that were different to what we initially thought. It’s helped to develop the relationship between the optometrists and the consultants. I’m not a clinician, but I am here to put the patient first, so we need to find ways of working that help us to deliver that. It’s about being prepared to listen and be honest about what you can and can’t do.

FS: At our AGM, we took a strategic approach to seating arrangements to encourage meaningful dialogue and peer-to-peer learning among optometrists. While it’s natural for attendees to gravitate toward familiar colleagues, we grouped tables by geographical area — for example, practices from Crewe, Macclesfield, and Congleton were seated together. This allowed practitioners to put faces to names, particularly useful when coordinating services such as CUES referrals.

Additionally, we intentionally paired practices with varying levels of involvement in glaucoma monitoring. By seating more experienced practices alongside those less engaged in this area, we aimed to spark conversations that could lead to increased participation and shared learning.

We were also pleased to welcome Tasmin Berman, a glaucoma consultant from the Countess of Chester Hospital, who previously worked as an optometrist. Tasmin delivered CPD training and had the opportunity to meet with Kate, further reinforcing the collaborative spirit of the event. Having representation from two NHS trusts underscored our commitment to integrated care and cross-organisational partnership.

KN: Whilst we’ve held CPD evenings, which have been well attended, with really positive feedback, we gain more insight from speaking to practitioners. Whilst I could continue to just speak to just Fionnuala as the chair of the LOC, there are ideas that come from other optometrists too. Engagement, on an individual level, is really important.

LOC members have been keen to meet with me and have provided some really valuable feedback. They have helped me to understand the importance of two-way communication in providing the best possible patient care.

How would you say that this relationship is improving patient care?

KN: None of us get it right all the time, and it’s about acknowledging those moments, but also building on the on the bits that are going well and are improving patient care.

We’ve worked hard to reduce waiting times in particular areas, and we’ve been able to do that in conjunction with the LOC, because it’s something that they talked to us about, and told us that there was a need for. It was about listening to those concerns and seeing if there was anything we could do that would ultimately improve patient care, but also show to them we were listening, and that we were able to change and adapt to the requirements.

FS: We are fortunate to have two outstanding clinical leads for Primary Eyecare Services in our region: Rebecca Ireland and Catherine Turnham. Their leadership has been instrumental in driving forward high-quality, patient-centred care across Cheshire.

Primary Eyecare Services itself is a unique provider — a not-for-profit organisation that contracts on behalf of optometry practices. Their infrastructure and support enable the delivery of enhanced services in the community, and their role is absolutely central to the work that Kate and I do. Without their partnership, many of the developments and improvements we have achieved would not have been possible.

What would you say to other LOCs or to other areas about the lessons you have learned through carrying out this work?

FS: At the heart of everything we do is the strength of our relationships. Building individual connections is essential — it’s through these relationships that real progress is made. While not every meeting we attend as LOCs yields immediate outcomes, our consistent presence is vital. It ensures that optometry remains visible and included in strategic planning, rather than being the forgotten sector.

Optometry has so much to offer: a highly skilled workforce, significant capacity, and an unmatched presence on nearly every High Street. Few other NHS professions can claim that level of accessibility and expertise. We are uniquely positioned to be part of the solution to many of the challenges facing the NHS.

It’s also important to recognise the collective effort behind our work. We benefit from strong, approachable relationships with consultants, and we collaborate closely with other LOCs across Cheshire and Mersey. With five LOCs in the region, we maintain regular communication and a shared commitment to representing the optometry voice. Regardless of who is on a call or in a meeting, we speak with a unified perspective that reflects the needs and strengths of the entire area.