Jag Singh, Specsavers' head of new clinical services pathway development
Nearly one million A&E patients could be diverted to primary care optometry, says a new report published by Specsavers.
The multiple’s Access to Care report outlined the benefits of eye and hearing care in the community and how pressure on the NHS could be eased.
Giles Edmonds, Specsavers clinical director of optics, said: ‘Community optometry and audiology are an integral yet often overlooked part of primary and community care, providing a range of ear and eye health services.
‘Using this highly qualified workforce to its full extent will free up capacity within the health service in return for very little cost to the taxpayer and an overwhelming improvement in patient health outcomes and quality of life.
‘Lack of accessible eye health care in England is causing patients to use up valuable GP time for referral to hospital.
'The resources, facilities and governance mechanisms are already in place in NHS primary care optometry to deliver Community Urgent Eyecare Services (Cues) to all NHS patients in England, with no additional investment from the NHS. This is a commissioning policy decision for each Integrated Commissioning Board (ICB) to make.’
England lags behind
The report highlighted that of the 42 ICBs, only 23 commissioned Cues. Edmonds added that a consistent commissioning and funding approach to community-based treatment by optometrists was vital and highlighted a detrimental ‘postcode lottery’ in England unlike commissioning in the other UK nations.
‘Variations in the involvement of optometrists in community-based treatment, caused by regionalised financing arrangements, are resulting in poor standards of care with a few pockets of excellence.
‘With no additional investment from the NHS and simply making this a requirement for all commissioning areas, up to a million A&E attendances each year could be diverted to accessible local NHS primary care services that already have the facilities, technology, training and resources to provide this care,’ Edmonds said.
Specsavers’ report highlighted how governments in Wales and Scotland were improving access and outcomes for patients by
effectively using the skills and resources available in primary care optometry.
David O’Sullivan, chief optometric adviser for the Welsh Government, said: ‘The Welsh Government recognised that a whole system change with seamless working between ophthalmology and optometry is the only way we can reduce long waiting lists and prevent irreversible sight loss.
‘While hospitals lack capacity to meet clinical targets, recruiting more ophthalmologists is a challenge and space within hospitals is limited. To stop the capacity-demand mismatch growing even wider, a different approach is being taken to prevent irreversible sight loss.’
Specsavers noted how the Scottish Government initially funded independent prescribing studies for optometrists to release capacity in secondary care. It cited Optometry Scotland’s estimation of 350,000 hospital attendances being prevented each year as a result.
Hope in Hampshire
The report noted that people with eye related conditions accounted for five million GP consultations per year, which Specsavers said could be dealt with by community optometrists using existing infrastructure.
It highlighted that the annual cost of sight loss, blindness and untreated hearing loss to the UK economy was £63 billion.
At least 50% of all sight loss is preventable or correctable, yet one in four people do not get their eyes tested regularly, Specsavers noted.
The report highlighted a best practice case study of how three glaucoma care services in Hampshire were preventing patients from going to hospital unnecessarily and freeing up capacity in secondary care.
Low-risk patients were moved from hospital to be managed in the community by primary care optometrists, who were funded to repeat abnormal pressure measures or visual field tests to ensure accurate referrals.
Optometrists who had additional glaucoma qualifications reviewed referrals of suspect glaucoma patients from other community optometrists. They were able to safely determine which patients could be monitored in the community, so that only those who required treatment were seen in hospital.
Repeat measures and referral refinement services have reduced referrals to the local hospital by more than two-thirds in the last year, with 1,100 patients managed in the community.
A monitoring service has meant that more than 90% of patients were now managed entirely within the community, without the need to go to hospital.
Jag Singh, head of new clinical services pathway development at Specsavers, said glaucoma services in England were under huge pressure.
‘There are delays for patients waiting to be seen in hospital for their glaucoma appointments. This is where community optometry plays a really important role, doing more to support access to eye care for patients and supporting the NHS.
‘Between 75% and 92% of patients seen in glaucoma monitoring services throughout England are kept in the community for ongoing review. A nationally commissioned eye care pathway would allow more patients to be seen in the community and help alleviate the increasing pressure on ophthalmology services,’ Singh said.