New regulations for Wales optometry contract published

New ophthalmic services regulations, due to take effect in Wales on 20 October, have been released by the Welsh Government.

The regulations, which can be viewed online, were released on Friday 29 September by the Welsh minister for health and social services, Eluned Morgan. 

They specify the expectations that will be placed on optometrists practising in Wales after 20 October, including around the provision of optical vouchers.

The new regulations will “expand the core eye care services provided in primary care in Wales to include eye examinations in addition to sight tests,” the published document says.

Optometrists are “an integral part of the transformation of eye care services” and will be able to “utilise full professional capability in the delivery of eye care at primary care level” under the new regulations, it adds.

The reforms will “seek to improve patients’ access to eye health services ensuring that support is delivered by the right professional, in the right place across the entire eye care pathway of primary care optometry and specialist hospital eye care services.”

The legislation goes on to emphasise that it is “imperative to expand provision in primary care, in which there already exists a skilled workforce to support hospital eye services (HES). Optometrists are an integral part of the transformation of eye care services.”

The reforms will align optometry in Wales with pharmacy and dentistry, the publication says, adding that “practitioners have the capacity and skill set to diagnose, treat, and manage more patients in primary care, providing care close to home and improving patients’ access to specialist eye care services in a timely manner. This approach is intended to reduce the demand for a hospital-led opinion and intervention, thereby, reducing the delay and backlog in patient appointments in HES.”

The aim of the reforms is to “reduce the number of referrals into HES by approximately one third and enable the monitoring and management of low and medium risk patients within primary care, whilst maintaining specialist oversight in HES.”

Patients “must be at the forefront and centre of all services delivered,” the publication says. Benefits will include reduced waiting times in the HES, timely access to eye health treatments in primary care, access to enhanced eye care services within primary care optometry practices, and improved, timely access for patients with eye pathology that could cause irreversible permanent sight loss.

The legislation also details changes to the responsibilities of Local Health Boards, including to the way their ophthalmic lists are managed.

It also emphasises that practitioners will be more fairly paid for their clinical work in the future, ending the cross-subsidy from retail sales that has existed since the 1980s.

This change “will require a change in the business model for optometry practices which will require a period of readjustment,” the legislation says.

It comes after more than a year of discussion over the new regulations, including around voucher values and payment for domiciliary visits.

A public consultation on the changes was held between April and June 2023.

The AOP has confirmed that it will be reviewing the legislation and will produce new guidance for members by 20 October, when the new regulations come into force.

Responding to the publication, AOP chief executive, Adam Sampson, said: “We welcome many of the reforms put forward by Welsh Government to ease the burden on other areas of healthcare and cut the backlog.

“It makes simple sense to use the skills and clinical expertise of a workforce that is trained and ready to help on every High Street. We have been open about the concerns of some members on the original proposals, particularly for the most vulnerable patients in Wales, who mustn’t miss out on vital eye care as a consequence of moving funds around to make this model work.”

Sampson added: “The reforms need to be right for every patient so we will be taking the time to scrutinise the documents published last week and our position.”