How UK eye care services are delivered

In England, there are more than 200 Clinical Commissioning Groups (CCGs) responsible for the planning and commissioning of health care services for their local area. They also manage around 60% of the NHS budget, or about £60 billion per year. 

Set up in 2013 to replace Primary Care Trusts, CCGs are essentially membership bodies, with the local GP practices as members. Funds allocated to CCGs are based on the local populations, mediated by projected need, accounting for deprivation. The most predominant community (enhanced) services commissioned and paid for by the CCGs are repeat measures and minor eye condition schemes. 

In 2016, the NHS and local councils have come together in 44 areas covering all of England to develop proposals and make improvements to health and care. These proposals, called sustainability and transformation plans (STPs), are built around the needs of the local population. They aim to help meet a triple challenge set out in the NHS Five Year Forward View – better health, transformed quality of care delivery, and sustainable finances. Proposals have now been published for every part of England. They are all at different stages and now patients, the public and NHS staff must help to develop and shape them.

You can find information and guidance for commissioners in England by visiting the Clinical Council for Eye Health Commissioning (CCEHC) page. 

In Northern Ireland, service developments making use of optometrists’ skills are commissioned as local enhanced services (LES).

In 2012, a five year strategy was launched to ensure that service delivery models are shaped to offer early interventions, improved access and outcomes, and integration of eye services.  The strategy is outlined in the policy document, 'Developing Eyecare Partnerships (DEP): Improving the Commissioning and Provision of Eyecare Services in NI' (2012), which gives authority to develop a pathway approach to managing acute and long-term eye conditions. Led by the Health & Social Care Board (HSCB) and Public Health Agency, it draws from a wide range of stakeholders, including GPs, optometrists, ophthalmologists, pharmacists, social care, and service users. 

There are twelve objectives, including a focus on prevention of eye disease, expanding community care, improving IT connectivity, and collecting better data. Acheivements so far include Local Enhanced Services for glaucoma/OHT repeat measures and for enhanced case finding, a local acute eye service, and planning for community-based reviews for OHT and stable macular conditions.

Since 2006, the optometrist has become the first port of call for eye conditions in the community in Scotland. Every Scottish resident is entitled to a fully funded NHS eye examination. Optometrists can then carry out supplementary examinations to refine and review results, and to perform any follow-up treatment.  

According to ISD Scotland, since the inception of the free NHS eye examination for all, the numbers of examinations performed has increased by 22.5% from 1.57m in 2007 to 1.92m in 2013.17% of eye examinations are supplementary.  

Transferring care out of hospitals and into the community has enabled optometrists to manage a greater range of eye conditions, as well as 'freeing up' GP appointments and reducing  the pressure on the hospital eye service. Optometrists can also refer patients to hospital eye services where they deem necessary. 90% of optometry referrals to secondary care are now directly referred.

The GOS contract in Scotland has a tiered fee structure. There is funding to support the training of independent prescribing (IP) optometrists, and the issuing of NHS prescribing pads to optometrists at the end of 2013 has ensured that the optometrist can manage ocular conditions within primary care at no cost to the patient.

Further information can be found at GOS Optometry Scotland.

In 2013, Wales Eye Health Examination (WEHE) and the Primary Eye Care Acute Referral Scheme (PEARS) developed into Eye Health Examination Wales (EHEW) to deliver Wales Eye Care Services (WECS).  These are free enhanced eye health services for selected groups of patients using a three band structure.

• Band 1 enables patients with acute eye conditions, those in at-risk categories for developing eye disease (eg black and minority ethnic groups), or those who would find losing their sight particularly difficult (eg those with a hearing impairment), to obtain an extended eye examination.
• Band 2 enables optometrists to do further investigations / examinations to inform their referral, investigate clinical findings or determine management after a sight test (GOS or private).
• Band 3 examinations enable patients to be followed-up.

WECS enable more people to be managed in the community, preserve sight through the early detection of eye disease and provide help to those who have visual impairment for which further treatment is not appropriate. Almost every practice in Wales offers WECS. All participating optometrists refer directly to the hospital eye service.  

In 2013, as part of the ‘Connecting primary care’ initiative, funding was made available to develop e-referrals. In addition, in 2015, a significant amount of funding was made available to health boards in Wales to offer funded courses to up to 15 optometrists in each of the seven health boards to undertake College of Optometrists Diplomas and Certificates in medical retina, glaucoma and independent prescribing. 

Strategically, the optics sector in Wales is guided by the publication of the Welsh Assembly’s Together for Health: Eye Health Care delivery plan 2013 – 2018. In total, 73 actions have been identified in the plan and now health boards and the Welsh Government share the responsibility for delivering on these actions.