Lord Darzi review of health and care

The consultation

The independent Lord Darzi Review aims to examine the state of quality in health and care services on the NHS’s 70th birthday and make recommendations for future funding and reform of the system.

The AOP’s response

We welcome this important, long-term strategic approach to health and social care planning. We will respond to questions 1,2, 6 and 7 and will focus on the increasing demand for eye care services, linked to the aging population, and what the community optical sector can do – and is already doing in some areas – to relieve pressure on other parts of the NHS and to provide a closer-to-home service for patients.

We would be happy to provide more information about the issues we’ve covered, and to meet the review team to discuss if that would help.

Question 1: What should our vision for the health and care system be in 2030?

The health and care system should now and in the future focus on prevention rather than cure. In our view, the only way the NHS can ensure long-term sustainability is to keep individuals independent, well and out of hospital and the care system, especially as they age. As NHS England’s Five Year Forward View recognises, this means reinvigorating primary care and managing more patients, in a more holistic way, outside hospital and in the community. Primary care optometrists have the skills and expertise to deliver NHS eye care services over and above the sight test, reducing pressure on GPs, hospital eye services and A&E, and should be the first port of call for eye problems.  

Question 2: What is state of quality in the health and care system today? 

The review intends to examine the ‘safety, effectiveness, timeliness, efficiency and equitability’ of NHS and Social Care Services. The immense pressures currently facing the National Health Service are seen in ophthalmology, with hospital eye departments struggling to cope with the demand of an aging population. The British Ophthalmological Surveillance Unit reports that 20 people a month are losing their vision due to delayed follow-ups in hospital, and this is likely to be an under-estimate. These capacity issues are now the subject of investigation by the All-Party Parliamentary Group on Eye Care and Visual Impairment.

In 2015-16 there were over 7 million ophthalmology appointments – the second most numerous by specialty. More than 10% of all outpatient appointments in England are for eye care and between 2010 – 2015, attendances grew by 30%. There are also 2.6 million eye-related GP appointments per year. 

The demand for eye health services is rising linked to the growth in the ageing population. The number of people aged 65+ is projected to rise by over 40% in the next 17 years to over 16 million.

A solution to help deal with the burden on hospital eye departments and create a sustainable solution able to cope with the demands of an aging population and new technologies and treatments already exists. Optometrists working in the primary care setting can play a greater role in the delivery of eye care services. Such services provide a more convenient service for patients. As well relieving pressure on hospital eye departments, they can also help increase capacity in A&E departments and GP surgeries. 

These services, known as extended primary eye care services, are being delivered in various parts of the country. 

In Gloucestershire, Optometrists are delivering a number of services over and above sight tests, including post-operative cataract follow-up appointments. During the first year of this service, over 1000 patients were seen in an optical practice, which helped free up nurses to be redeployed in the emergency eye service.

There is sufficient evidence from across the UK that where Minor Eye Conditions Services (MECS) are commissioned, enabling community optical practices to accept referrals from GPs, pharmacists, and other professionals for patients with eye problems that are outside the scope of the sight test, the vast majority referred to these services can be managed out of hospital. 

Question 6: What changes to care models should be undertaken post five-year forward view? 

While the New Care Models described in the Five Year Forward View have improved patients’ access to extended primary eye care services in some areas (one such example is the Better Care Together vanguard in Morecambe Bay – where a ‘staggering’ 5950 patients have been seen in optical practices, freeing up hospital appointments for complex cases), there are currently barriers in place preventing the widespread adoption of these schemes. NHS England needs to support and promote national pathways for care, and agree national tariffs, to encourage take up.

Question 7: What reform to the system is needed to enable these changes to take place?

A key enabler in achieving a sustainable future for eye care services is cost–effective is investment in IT infrastructure to ensure that community optical practices are effectively integrated with the wider NHS. This is crucial to ensure patient referrals between primary and secondary care are well managed.

1. www.rcophth.ac.uk/2016/03/increasing-demand-on-hospital-eye-services-risks-patients-losing-vision
2. www.rnib.org.uk/appginquiry
3. digital.nhs.uk/catalogue/PUB22596 
4. Sheldrick JH, Wilson AD, Vernon SA, Sheldrick CM. Management of ophthalmic disease in general practice. Br J Gen Pract. 1993 Nov;43(376):459-62; Sheldrick JH, Vernon SA, Wilson A. Study of diagnostic accord between general practitioners and an ophthalmologist. BMJ. 1992 Apr 25;304(6834):1096-8 
5. National population projections for the UK, 2014-based, Office for National Statistics, 2015 
6. www.locsu.co.uk/uploads/annual_reports/2016_17_ar_final.pdf
7. bmjophth.bmj.com/content/3/1/e000125
8. www.bettercaretogether.co.uk/News.aspx?ID=55