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The urgent eyecare pathway

Kamlesh Chauhan, president of the College of Optometrists, explains the need to set up a universal urgent community eyecare service across England and Northern Ireland.

It’s Saturday afternoon, you scratched your eye while gardening earlier and it’s getting increasingly painful. Just like any other kind of trauma, a minor eye injury can occur, or an existing condition can flare up, at any time – and expert care is required as soon as possible.

Outside of Scotland and Wales, most people in this kind of situation are faced with two choices: join the queue in A&E or soldier on until the GP opens on Monday. In either case, it is unlikely that you will see someone with access to the specialist equipment required to diagnose the problem, and where there is specialist emergency care, pressure on the service is growing at a worrying pace.
In London alone, demand for treatment at the two major eye casualty units increased by around 10% year-on-year between 2006 and 2011.

I, like many others working in the field, believe that we can reduce this burden and improve access to timely, effective diagnosis and treatment by making better use of our dedicated eye healthcare services. Promoting and supporting the high street optometrist as the first port of call for relatively minor injuries and conditions would mean that patients could be seen far more quickly by a local expert with the latest professional equipment. This would significantly reduce the worry and trauma for the patient, the queues in A&E and the strain on the already overburdened emergency services.

Optometrists have the expertise and specialist equipment to diagnose and treat most common urgent eye conditions. There are nearly 14,000 of them practising around the UK in accessible community locations, many working in the evenings and over the weekend in successful independent and multiple practices and within national chemists and supermarkets.

Growing numbers of optometrists can now prescribe medicines, and all are able to refer to ophthalmologists for further treatment, including surgery, where necessary. We should also make sure, however, that there are certain strategies and procedures in place within any primary-care focused system that we introduce. For example, to make the best use of our ophthalmologists and to alleviate overburdened hospital services, we need to ensure that primary care is only referring those people who really need to be seen by specialists and that, wherever possible, secondary care can confidently return patients for care and management in the community. This will allow us to create a truly patient-centred service.

This system is already up and running in Scotland and Wales, where activity is being shifted into the community to ease demand on A&E. This is proving effective on several levels. Patients in rural areas no longer have to travel long distances to the nearest hospital and those in urban areas have a great choice of providers on their doorstep. Patients in all settings are waiting significantly less time to be seen and NHS resources go further.

The success of this system has highlighted the need for a universal system of local community eye care, with the same type and level of service across clinical commissioning groups (CCGs) – and across the UK. CCGs in England and Northern Ireland should look to the successes of the initiatives in Scotland and Wales in their drive towards efficient use of limited resources and increased standards of patient care – and implement a comprehensive and universal UK-wide system.

For example, in England, NHS England commissions the core contract, which only covers eye examinations and some of the cost of corrective lenses. Then CCGs vary locally in the number of enhanced contracts they add on to enable optometrists to support patients with more serious eye diseases or urgent problems. We cannot continue with a service that varies not only from nation to nation, but from city to city. How can we expect someone to understand that they should make the optometrist their first port of call in Sheffield but not seven miles away in Rotherham?

A universal service for urgent community eye care services across England and Northern Ireland would improve the quality of care, cut waiting times, improve efficiency, and reduce pressure on A&E. And for you, currently worrying about the implications of that increasing painful gardening injury, you know that you will be treated in the community and can be confident of a speedy diagnosis, expert specialist care and peace of mind.