Improving eye care delivery through community practice in the UK

In summary

Demographic changes, including an ageing population, are placing an increasing burden on Hospital Eye Services (HES) in the UK.

However, research conducted at City, University of London has demonstrated that community optometrists are able to provide specialist services, matching care in hospital eye departments and providing services that are clinically effective, cost-effective and associated with a high level of patient satisfaction.

The expansion of community-based care allows more patients to be managed closer to home and also relieves pressure on HES.

Through a process of qualitative and quantitative evidence synthesis, including gold standard Cochrane Reviews, City-based researchers have also developed the evidence base for the management of eye conditions presenting most frequently in primary care and authored clinical practice guidelines to support community optometrists working in extended roles.

The findings have informed commissioning guidance from NHS England, the College of Optometrists, the Royal College of Ophthalmologists and NHS Improvement, and influenced Clinical Commissioning Groups (CCGs) to adopt new service pathways.

What did we explore and how?

The research included enhanced syntheses of existing evidence and evaluations of the Glaucoma Referral Filtering Services (GRFS) and Minor Eye Conditions Services (MECS). It demonstrates that:

• MECS reduced GP referral to hospital ophthalmology services by between 40 to 75 per cent
• GRFS reduced the number of people referred to these services erroneously (testing false positive for glaucoma) by 53 per cent, whilst missing less than 1 per cent of those who needed to be referred (false negative for glaucoma).

In parallel with developing the evidence base for new services, the research has led to the publication of systematic reviews in priority areas of eye care to inform decision-making and explore major gaps in the clinical evidence base for eye care.

This has included ten Cochrane reviews and updates, and seven reviews published in ophthalmology and optometry journals.

Cochrane Reviews are recognized internationally as representing a gold standard for high-quality, trusted information, and are published in the Cochrane Database of Systematic Reviews, one of the databases within the Cochrane Library.

Benefits and influence of this research

The research has provided a solid evidence base for the clinical safety and cost-effectiveness of enhanced services provided by community optometrists. It has informed commissioning guidance from NHS England, the College of Optometrists and the Royal College of Ophthalmologists, and NHS Improvement.

As a result, these outputs have played a major role in building the business case for Local Optical Committees (LOCs) to influence the decisions of Clinical Commissioning Groups (CCGs) to adopt MECS and GRFS pathways.

The director of commissioning strategy for South East London CCG has commented:

The City team has led the development of Clinical Management Guidelines (CMGs), on behalf of the College of Optometrists. The CMGs are a key component of the clinical effectiveness of new models of community-based eye care.

They have been shown to address clinical uncertainties and support community optometrists in the diagnosis and management of eye conditions that present most frequently in primary care.

The quality of the guidelines has been recognised, and they inform the management of eye conditions by optometrists and other primary healthcare professionals. For example, CMGs are referenced in BMJ Evidence and NICE Clinical Knowledge Summaries for general practitioners (GPs).