The College of Optometrists

08 February 2006

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The Health Bill and GOS Review have provided an opportunity for the College to define and propose a new approach to primary ophthalmic services, which, it believes, offers the greatest benefits to patients and maximum utilisation of the skills of optometrists, dispensing opticians and optical practices.

Complementing the ongoing lobbying activity driven by ABDO, AOP and FODO, the College convened an expert group, along with input from its Lay Advisory Panel, to determine what a three tier primary ophthalmic service should look like. The College’s policy paper has now been submitted to the Department of Health, with the full support of all the representative bodies and the GOC.

The policy paper proposes the content of the three levels of service that the Health Bill enables the Secretary of State to define, namely Essential Services, Additional Services and Enhanced Services. Under the College’s proposals:

Level 1, Essential Services cover the NHS Sight Test and include providing advice on flashes and floaters, dry eye, watery eye etc. Essential Services would be provided to all eligible patients by all GOS contractors, at agreed intervals as set out in the Health Bill and GOS Regulations.

Level 2, Additional Services would cover needs-driven examination and treatment, which may include in depth examination; therapeutic - supplementary and independent – prescribing; chronic dry eye treatment/management; glaucoma detection/referral refinement by additional diagnostic tests; and diabetic retinopathy detection/referral refinement. Additional Services would be provided to all eligible patients by most optical practices on a needs basis by referral, including patient self-referral. Clinical protocols and remuneration tariffs would be agreed nationally.

Level 3 Enhanced Services. Schemes would work within locally agreed protocols for working in partnership with the Hospital Eye Service, and locally agreed funding arrangements. Enhanced Services might include diabetic retinopathy screening; low vision screening and dispensing; cataract co-management; stable glaucoma monitoring and treatment; ARMD care; screening and co- management for ‘at risk’ groups; diagnosis/treatment of children with strabismus; out of hours emergency services; smoking cessation advice. Enhanced Services would be commissioned locally from some practices as part of a community multi-disciplinary team.

Bryony Pawinska, Chief Executive of the College commented, “The College has a very special role for the profession. As a public benefit body we are able to stand back from the structural, contractual and funding implications, and get into the nitty gritty of what, professionally, the new service should look like. Everything that this government wishes to see in terms of more accessible patient care, free at the point of delivery, with a less confusing patient journey, can be provided by optical practices. For too long the profession has had to operate at a fraction of its capability within NHS funded services – this is a nonsense when the capacity of ophthalmology, orthoptics and ophthalmic nursing is already struggling to meet the demands that demographic changes are bringing. The College’s proposal addresses the challenges, putting forward services that are innovative and cost effective and better for the profession, NHS and patients alike.”


In a joint statement, ABDO, AOP, GOC and FODO added their support to the College's proposal “We welcome this blueprint demonstrating how primary eye care services can fit within the tiers of service envisaged by the Department which opens up the possibility for optometrists and dispensing opticians to play a much greater role in delivering these services in the community.”