Standard service specification for minor and urgent eye care progresses
OT spoke to Zoe Richmond, LOCSU clinical director, who has led the delivery group for the standard service specification, to learn more about the development of the project
The Local Optical Committee Support Unit (LOCSU) has provided an update on the development of a standard service specification for community minor and urgent eye care.
LOCSU revealed in November that it had been tasked, along with the Clinical Council for Eye Health Commissioning (CCEHC), to develop the standard service specification for Integrated Care Boards (ICBs) to reduce unwarranted variation across England.
In an update on 3 January, LOCSU suggested the project had “progressed well” with wide sector engagement.
The delivery group has enacted feedback received through a recent survey, and identified “essential service improvements to be implemented.”
- Allow face-to-face appointments without the need for remote consultation, but enable remote consultations where clinically appropriate and convenient for the patient
- Improve emphasis on care navigation and redirection from other services where clinically appropriate
- Broaden the eligibility criteria to allow all minor and urgent eye care to be delivered within a single service
- Make it an expectation of the service that optometrists with independent prescribing capability have access to FP10s.
Key resources including a Standard Service Specification, Patient pathway flow diagram, and Risk Stratification Conditions table, were sent to NHS England, CCEHC and Department of Health and Social Care on 21 December to invite final feedback, with a deadline of 8 January.
The intention is to share the key resources with local optical committees (LOCs) towards the end of January.
The delivery group said it aimed to maintain clinical endorsement from the College of Optometrists and Royal College of Ophthalmologists. Zoe Richmond, LOCSU clinical director, suggested that this should provide commissioners with confidence in the service specification.
Discussions regarding when the resources will be made available to ICB commissioners are ongoing.
In response to the update, Adam Sampson, AOP chief executive, re-affirmed a commitment to assist where needed: “We’re pleased that good progress is being made to design a standard service specification for minor and urgent eye care services. We've long called on the Government to utilise extended eye care services delivered by primary care optometry to alleviate pressure on hospitals and GPs, improving care for patients.”
Sampson shared that the AOP has “extended our hand to help” wherever possible, adding: “We look forward to continuing to work with our colleagues in LOCSU and CCHEC to ensure this piece of work is fulfilled, with an approach that is right and sustainable for optometry.”
The chief executive highlighted the importance of the standard service specification, sharing: “Crucial to its success will be a consistent service for minor and urgent eye care needs that is available nationally and accessible wherever you live, eliminating the current postcode lottery of care.
“We know the current model, where some ICBs have commissioned MECS and CUES services and others have not, is failing patients. Which is why we urge LOCSU and CCEHC to be resolute in its asks to ensure we secure eye care services that are fit for the future,” Sampson concluded.
Inside the delivery group: “What we were really looking at was a refresh”
The request for a standard service specification came from then-Parliamentary Under Secretary of State for Primary Care and Public Health, Neil O’Brien.
Zoe Richmond, LOCSU clinical director, who has led the delivery group for the standard service specification, explained that, “to some extent, the ministerial request came at the wrong time in the commissioning cycle, because we knew that commissioners were already starting to have these discussions.”
There were two options: to aim for the 2024/25 commissioning cycle, or to move “at considerable pace” and with a view to making resources available to those commissioners ready to implement from April 2024. It was this latter approach that was settled on.
“We felt that this was the best approach. There was a risk that the stakeholders didn’t necessarily have the capacity and resource to invest in this piece of work. Arguably, for some stakeholders, it wasn’t necessarily a top priority,” Richmond added, highlighting concerns around long-term glaucoma care which are arguably a higher priority at the current time. “But I think the risk would have been greater if we hadn’t moved at the pace we did.”
Richmond emphasised that the group was able to work at such high momentum because: “We’re not starting with a blank piece of paper.”
The group are looking at established services that are already working well across England and building on the COVID-19 Urgent Eyecare Services (CUES) specification published in 2020.
“What we were really looking at was a refresh – a pulling together of best practice into a new national standard service specification,” Richmond explained, adding that creating this along with key resources was achievable in the short timeframe provided.
“What will take us a little bit more time, is to build a robust evidence-base that sits alongside and underpins that. We know that there is a huge amount of rich data sitting in silos in local systems,” she said.
Back in 2021, LOCSU had already carried out work to understand from LOCs what needs to be maintained within the CUES service specification, and what adaptations are required.
For example, because the CUES specification was written in response to COVID-19, it includes references to the pandemic and enhanced infection control measures that were in place at the time.
“We’ve worked with local stakeholders, developing the local service specifications, so we are building on that work,” Richmond shared. “The piece of work we have just undertaken was much more, and more widely, collaborative. I think that is a key point: that we have demonstrated really effective collaboration, with everybody coming together from across the wider sector, to present a united voice,” she added.
A national standard with local implementation
The service specification allows for local implementation.
“It is really important to recognise that there are lots of established services,” Richmond said, emphasising that the delivery group do not want the work to disrupt the services already serving local populations in “pockets of excellence” across England.
“We can create a national standard, but this isn’t a nationally commissioned service. There are pros and cons to that, but it does allow local innovation. I think that should be celebrated; I’m always enthused by the innovation that our local leaders and LOCs bring to pathway development,” Richmond added.
Advocating for the specification
In its update on the development of the project, LOCSU invited LOCs to “be advocates” of the new standard service specification.
LOCSU aims to hold webinars to launch the service specification and answer questions, with more details to follow.
All of the key stakeholders closely involved in the development of the service specification have been asked to be strong advocates for the standard, Richmond explained.
“We are aware that while some have been quite well engaged with the work, we’ve been working at some pace here, and we need to spend some time now explaining why certain decisions have been made and take our LOCs and local leaders along with us,” she said.
“A careful balance,” is required, Richmond noted, between the opportunities of a national standard, and existing local services.
“We need to be providing the LOCs with the tools so that they can fully articulate the benefits of having a national standard to the sector, but most importantly to our patients. This is about enhancing the experience for the patients, and improving their access to minor and urgent eye care locally,” she said.
Measures for success
Speaking with OT, Richmond reflected on what it means for the profession to be asked to form the standard service specification.
She commented: “For a minister to recognise that as a sector, we can collaborate to produce a national standard service specification in this way, is great recognition that the extended care being delivered on the High Street is much needed for local populations.
"We know that much of the NHS is under considerable strain, ophthalmology and general practice being good examples of that. It’s excellent that the minister recognised the great work that’s already happening in primary eye care and wants to build on that and work with us on that,” she said. “That is certainly something to be celebrated. But we shouldn’t overlook the great work that has been done over many years.”
Richmond also pointed to a change in the behaviour of the public when it comes to seeking urgent eye care.
“More and more we’re seeing that when the public wake up in the morning with an eye issue, they would go to the optical practice first to seek support on the High Street from the clinicians; the optometrists and dispensing opticians, who are best placed to meet their needs.”
Richmond added that there are examples of established services building in routes of effective care navigation, supporting patients who present to another area of the NHS to be navigated to the optometry service.
“That change in public behaviour has taken years, but we’re seeing it happening,” Richmond said. “That, for me, is one of the best measures of success.”