Comprehensive eye care in Scotland

The Scottish Government introduced a reformed eye care system in 2006 and have continued to refine it since⁴.

Unlike in the rest of the UK, everyone in Scotland is entitled to a free NHS primary eye examination at least every two years and also to attend an optometrist for an NHS-funded examination of any eye problem that arises between times, including emergencies.

There are three levels of eye examination in Scotland: primary, supplementary, and enhanced supplementary. Optometrists carry out a secondary or enhanced secondary examination when the primary examination indicates that further investigation is required or for an extra examination to investigate something which occurs between routine primary examinations. 

As part of this scheme optometrists are obliged either to treat patients with emergency eye conditions or to secure treatment for them elsewhere. Many Scottish optometrists have qualified as independent prescribers (IP), which enables them to provide definitive treatment for more patients and to prescribe using a NHS prescription pad. A new national scheme to fund IP optometrists to treat complex eye conditions has been agreed with the Scottish Government. This will further reduce referrals to the Hospital Eye Service (HES) for a number of conditions by allowing referral from community optometrists to an IP optometrist instead of the HES.

In 2018 Optometry Scotland issued GOS Works⁵, a review of the success of the new system. The findings included that the new GOS “led to a significant shift in the balance of care from GPs, A&E, pharmacy and hospital eye clinics”, for example leading to over 80% of eye emergencies being treated in the community setting in 2016/17, compared with 35% before the new GOS was introduced.

Optometry Scotland estimates that 350,000 hospital attendances are prevented each year.

An expert working group comprising representatives from ophthalmology, optometry, pharmacy, dentistry, patient groups and academia produced a report in February 2021⁶. Its task was to examine whether the principle of universal NHS-funded eye care remains the correct approach in Scotland, to review the performance of primary eye care services within Scottish communities, and to identify how they can be enhanced across Scotland. 

The group recommended that universal NHS-funded eye care should continue and that in order to maintain its viability, there should be at least a 3% increase in spend per year.

It also recommended that the Scottish Government work with Optometry Scotland and primary care more generally to:

• Provide funds to facilitate greater uptake of technology such as optical coherence tomography (OCT)
• Achieve greater consistency in working practices across Scotland, drawing on best practice examples, to provide equity for patients
• Encourage investment in continued professional development for practitioners
• Enhance the uptake of domiciliary services by increasing knowledge and cooperation across primary care
• Develop better links between optometry and community health and third sector organisations
• Establish a Low Vision Plan, learning from the experience in Wales

References 

4. www.gov.scot/policies/primary-care-services/eyecare/
5. www.optometryscotland.org.uk/wp-content/uploads/2019/05/GOS-Works-Executive-Summary.pdf
6. www.optometryscotland.org.uk/wp-content/uploads/2021/03/Expert-Working-Group-Report_Version-3-1.pdf