Fit for the Future: 10-Year Health Plan for England

The College’s views

For the 10 Year Health Plan to succeed, we have recommended that the Government and the NHS fully engage with all primary and community healthcare professions, including optometry, and work collaboratively with us at all levels to inform strategic commissioning decisions and service planning. Having optometric involvement would ensure that all patients’ needs are considered and would allow multi-disciplinary teams to deliver integrated, patient-centred care. It would also ensure the entire NHS workforce is recognised and their skills effectively used to increase capacity across systems. Primary care optometrists can help commissioners deliver additional healthcare capacity in accessible locations, supporting the delivery of out of hospital services in local communities. 

Investing in eye health research also presents a major opportunity to advance our understanding of eye diseases and develop cutting-edge diagnostics and treatments. With an ageing population, such investment can reduce preventable sight loss and enable future breakthroughs – potentially reversing vision deterioration. Emerging innovations like telemedicine, AI, and digital therapeutics can transform eye care delivery. Increased funding will drive prevention, early detection, and better treatments, improving public health outcomes and strengthening the NHS for the future.

Finally, investment in education and training is essential to developing a sustainable eye care workforce capable of meeting growing patient demand. Supporting more students to enter the profession, and enabling more optometrists to gain Independent Prescribing (IP) and Higher Qualifications, will expand access to specialist care in primary eye care settings, enhance patient outcomes, and reduce pressure on NHS hospital eye services.

The College’s views

We have been consistently championing the role of optometrists as the first point of contact for patients with an eye concern. Optometrists lead and provide timely, accessible, and high-quality care within communities. Most optical practices already offer extended hours and weekend appointments within neighbourhoods. Neighbourhood Health Centres should build on this existing infrastructure, working with local optical services as core partners – avoiding duplication or unnecessary GP appointments and improving patient access to eye care without the need for GP referrals.

To deliver this shift, health services must make full use of primary care optometrists’ core skills. Optometrists are well-placed to provide routine and enhanced eye care closer to home, easing pressure on hospitals. With higher qualifications, optometrists can manage more complex cases, avoiding unnecessary referrals. Many optometrists hold higher qualifications, including Independent Prescribing, which are often underused.

Nationally commissioning and funding enhanced services like urgent eye care, cataract care, and glaucoma refinement will reduce hospital waiting times, A&E visits, and avoidable sight loss.

While IP-qualified optometrists in England are expected to have access to FP10 forms – enabling them to prescribe NHS medications for eye conditions – access remains inconsistent. This limits their ability to manage a broader range of conditions in primary care and can delay timely treatment for patients. Standardising FP10 access for all IP-qualified optometrists across England would improve patient outcomes, strengthen local service provision, and reduce pressure on GPs by enabling more care to be delivered in primary eye care settings.

The College’s views

We support the government’s ambition to build a digitally enabled NHS. We have consistently called on the Government and the NHS to improve digital connectivity as an enabler to speed up diagnosis and treatments. Many NHS-funded high street optometrists do not have access to the NHS.net portal, cannot access electronic patient records and cannot digitally refer to their local hospital eye service. Poor digital connectivity prevents optometrists and ophthalmologists from working better together to improve patients’ outcomes.

Furthermore, many digital images (including eye scans) cannot be shared between optical practices and the hospital, meaning that patients must have the same images taken again at the hospital after referral. This lengthens delays in diagnosis and treatment and increases unnecessary costs for the NHS.

We have asked the Government and the NHS to continue to support the work of the DICOM digital imaging Task and Finish group co-led by The College of Optometrists and the Royal College of Ophthalmologists. This group brings together healthcare professionals, the manufacturing industry and sector stakeholders to develop a set of DICOM imaging standards that will drive interoperability of digital systems.

The College’s views

We welcome the plan’s focus on prevention. This is an approach we have been championing in primary eye care where regular eye tests are vital for maintaining not only good vision and eye health but also can detect wider health problems. Optometrists play a critical role in primary and preventative healthcare and are in a good position to deliver important public health services to patients attending for regular eye examinations who may not be in regular contact with other healthcare professionals. Optometrists can identify both eye problems and other wider systemic diseases through regular eye examinations, and provide advice, treatment, referral, signposting and support to manage these.  For example, as well as identifying eye conditions, eye examinations can identify high blood pressure, high cholesterol and patients that may have diabetes or are pre-diabetic.  We called for more public awareness campaigns to promote the importance of regular eye tests, from an early age, to detect and treat eye (and other) conditions early and prevent avoidable sight loss. The digitising of the “red book” is a clear opportunity to embed eye health from birth.

The College’s views

We will be reviewing closely how commissioning responsibilities for community services will be organised. Despite the potential of enhanced primary eye care services to alleviate the pressures on the hospital eye service, inconsistent commissioning and fragmented approaches have led to a postcode lottery in service availability, perpetuating inequalities in access to care. We have called for pathways and services to be integrated at geographies larger than single hospital level where possible. There should be equity of access to enhanced services developed on the basis of population need. Eye care services also need to be appropriately and equitably funded to meet growing patient needs across primary and secondary eye care.

We welcome the mention of primary care optometry in Gloucestershire in this section of the plan as a successful example of care moving closer to home. This explicit mention is a positive recognition of optometry’s impact on both public health and NHS capacity.

The College fully supports the plan’s aim to give patients greater choice over their care and to enable them to make a fully informed decision to select the provider that best meets their needs. This should be supported by clear and impartial information on waiting times, travel, quality, outcomes, and patient experience.

The College’s views

We welcome the focus on better data and informed patient choice; however, we await more detail on whether patient experience and outcome metrics will be collected and published for primary eye care and how they will impact patient choice – especially via single points of access.  We will need more information to better understand the shift from National Service Frameworks to Modern Service Frameworks (MSFs), and we are ready to work with the DHSC and NHS to design these MSFs. We will continue to advocate for the inclusion of primary care optometry as a key partner in service development discussions.

There is also an urgent need to improve and streamline the process for the collection and sharing of data within NHS systems. There is currently no shared understanding or consistency of the data that is collected, which metrics are useful and how data is used for performance monitoring, evaluation and research. Better quality data across eye care pathways is essential. Commissioners cannot make strategic decisions on eye care or properly understand its importance when they have too little data. We called on the Government to fund the UK National Eye Health and Hearing Study (UKNEHS) which aims to gather high-quality data to better understand the prevalence and causes of vision and hearing impairment, blindness, and deafness in people aged 50 and over. This crucial evidence will help commissioners understand local demand for eye care and identify any unmet need. Without high quality data, developing innovative approaches to preventing sight loss will be severely hampered.

The College’s views

Improving access to training placements and ensuring consistent funding are vital to expanding the optometry workforce's specialist skills. We have long called for sustainable workforce planning in eye care underpinned by investment in education and training. In addition, we need a national improved approach to removing the current bottlenecks in clinical placement opportunities so that we can increase specialist skills in the optometrist workforce and help relieve pressure on NHS hospital eye services. The College could, with funding, improve access to training placements by mapping availability and increasing awareness of existing funding opportunities. This would support the provision of placements for Higher Qualifications and Independent Prescribing, facilitating multi-setting experiences. By investing in and increasing placement capacity and accessibility for optometrists, we can accelerate upskilling across all regions. This would enable more specialist care to be delivered by a primary care-based workforce, and improve access, continuity, and outcomes for patients closer to home.

The College, through its Workforce Vision, has developed the UK Eye Care Data Hub — a tool to estimate current workforce and eye disease trends and support planning and commissioning. This should be used nationally to inform and target education, training, career and service development where it is needed most. There is a need for education to be consistently accessible, aligned to nationally agreed standards, and responsive to the distinct needs and specialisms across healthcare professions.

Data from a national UKNEHS will provide vital population-level insights, alongside information on service user experiences and attitudes. This will help identify barriers to care and inform workforce planning by highlighting where specific skills and services are most needed.

The College’s views

We welcome the principle of not repeating evaluations for proven services. Evidence-backed enhanced optometry services should be rapidly adopted across the NHS to improve care and reduce inefficiencies. As highlighted in our policy review of urgent/emergency eye care services in primary care across England, optometry services for minor and urgent eye conditions are safe, effective, and cost-efficient. These should be rolled out across all NHS regions without delay.  We will be developing similar evidence reviews for other enhanced services.

We have also urged improvements in eye care data collection and sharing. Better data is vital for service planning, performance monitoring, and innovation. Data from GOS and hospital systems should be consolidated at ICS level to inform local and national service design. Eye health presents a significant opportunity to gather valuable data not only on ocular conditions but also on wider systemic health. It is also a promising area for the development and use of wearable technologies that can monitor broader health indicators, including fall risk and other age-related health concerns.

The College is also committed to supporting clinicians with the guidance, training, and resources needed to integrate AI into practice ethically and effectively. We have recently published our interim position on the use of artificial intelligence (AI) in eye care. This sets out the UK optical sector’s collective stance on the safe and responsible implementation of AI in eye care. The College’s full policy position, research and clinical guidance for AI in eye care will be published later in 2025.

The College’s views

The proposed reform of payment mechanisms, including the phasing out of block contracts is consistent with the College’s vision for patient-centred care. We particularly support the piloting of ‘year of care’ payment models, which could incentivise integrated, primary care-based services and better support patients’ eye health needs closer to home.

Regarding the development of Public-Private Partnerships (PPPs) to support Neighbourhood Health Centres, the College recognises the potential benefits of leveraging private sector investment to enhance community health infrastructure. However, we emphasise the critical role of existing local optical practices, which already provide accessible, high-quality eye care services within neighbourhoods. Any new partnerships or developments must link with and build upon this established optical network to avoid duplication and ensure continuity of care. We advocate for careful consideration to maintain high standards of care, transparency, and equitable access for all patients, with primary eye care fully embedded as a key partner in these community-based services.