Enhancing primary eye care services in the UK
Research by City’s Professor John Lawrenson and colleagues demonstrates effectiveness of community-based Enhanced Eye Care Service Schemes
Optometry researchers in the UK have shown that eye care provided by Enhanced Eye Care Service Schemes (ESS) and community optometrists are safe, clinically effective and also provide good value for money.
Led by Professors John Lawrenson and Dave Edgar at City, University of London together with Dr Robert Harper from the Manchester University NHS Foundation Trust, the research has been influential in providing an evidence base for the development of enhanced primary care services provided by community optometrists.
Launched in 2012, the Enhanced Scheme Evaluation Project (ESEP) was funded by the College of Optometrists with the aim of evaluating community-based eye care service models in order to better understand the impact of the organisation of services on clinical effectiveness; cost effectiveness; and patient safety.
Conducting a systematic review and looking specifically at the effectiveness of examples of enhanced eye care services schemes (ESS) including a Minor Eye Conditions Scheme (MECS) in South East London and a Glaucoma Referral Refinement Scheme (GRRS) in Greater Manchester, across five peer-reviewed publications, the researchers evaluated the three most common types of eye care service schemes (glaucoma, primary eye care and cataract).
The research found that:
- ESSs are safe - Good evidence exists for cataract, glaucoma, and primary care ESS that with appropriate training, accredited optometrists manage patients with usual care standards; genuine partnerships can exist between community and hospital providers for cataract and glaucoma ESS; and patient satisfaction with all three types is high;
- ESSs are clinically effective – the evaluation demonstrated clinical effectiveness, reduction in hospital attendances and high patient satisfaction and represents a successful collaboration between commissioners, local hospital eye service (HES) units and primary healthcare providers. The realist review concluded that the ESS reviewed are clinically effective;
- ESSs are potentially cost-effective - A health economics evaluation of the wider health system effects of the introduction of MECS in Lambeth and Lewisham concluded that intermediate-tier services based in the community could potentially reduce volumes of patients referred to hospitals by GPs and provide replacement services at lower unit costs.
The researchers are planning further publications from the project and hope that the work will continue to provide evidence of good practice in service delivery and inform the design, review and development of future schemes.
Professor John Lawrenson, Joint Principle Investigator of the project and a Professor of Clinical Visual Science at City, University of London, said:
“Our research into ESSs has shown that they can be effective in delivering safe, clinically and cost-effective care to patients with a variety of eye conditions, including cataracts, glaucoma and also primary care. We hope that this work can help influence policy development and building the evidence needed to make commissioning decisions, as we’ve clearly shown the benefits of such schemes and community optometrists.”