Investing in community-based eye care and technology could help to save around £98 million, according to a new report.
The research, commissioned by Primary Eyecare Services and the Association of Optometrists (AOP), suggested that the total cost of visual impairment is anticipated to rise by one quarter over the next decade, to £33.5 billion.
It suggested there were ‘clear opportunities’ to do things differently, including increasing the use of community-based eye care and advancing technology to allow more care to be provided in community settings.
The report suggested four ‘high-impact’, system-wide changes, including rolling out community urgent eye services, an integrated glaucoma pathway, an integrated cataract pathway and community-based optical coherence tomography (OCT) (see box for more detail).
Introducing these could help to release around 1.9 million appointments per year across hospital eye services (HES), A&E and GP practices, the report said. It would also help to save an estimated £98m per year in England.
Four ‘high-impact’ changes
- National roll out of community urgent eye services
Using the skills of primary eye care practitioners to triage, manage and prioritise patients presenting with urgent and/or minor eye conditions. This allows patients to be seen faster and in a more convenient setting when compared to A&E and GP surgeries – reducing waiting and resulting anxiety. It also minimises unwarranted onward referral to HES.
- National roll out of the integrated glaucoma pathway
Including avoiding ‘false positive’ hospital referrals for patients with suspected glaucoma and ongoing monitoring to prevent the development or exacerbation of glaucoma for patients at risk.
- National roll out of the integrated cataract pathway
Primary care optometrists confirm eligibility and patient willingness for surgery. After surgery they then check for and treat post-operative complications and monitor patient outcomes. Patients receive more accessible and convenient care both before and after surgery, fewer change their minds after committing to surgery (saving time, cost, inconvenience), and hospital eye specialists can devote themselves entirely to the part of the pathway which only they can perform.
- Transforming the potential of Optical Coherence Tomography (“OCT”) in community settings and harnessing its continued technological advance.
Community-based OCT allows patients to receive more advanced eye care closer to home and more quickly, reducing the need for hospital visits and easing the burden on secondary care services. Community-based OCT is not currently integrated into NHS pathways, even though the quality of technology and optometrists’ capabilities are high and advancing rapidly. It would be easy to integrate community OCT into end-to-end NHS workflows.
The report suggested a national plan for eye care and eye health may ‘have a role to play’ in articulating and delivering the changes.
It said: ‘The commissioning partners for this report (AOP, Fight for Sight, Primary Eyecare Services and Roche) are clear in calling for a national commitment towards such a plan, as well as taking an ongoing role to encourage and support partnership-based working with Government, national and local NHS leaders, professional associations, patient representative groups and others.’
Ruth Rankine, primary care director at the NHS Confederation, said the report provided more evidence supporting the shift out of hospitals and into the community.
‘It estimates that more than 750,000 appointments a year could be shifted from hospital eye services to community optometry, easing the pressure on hospitals and potentially reducing waits for patients,’ she said.
‘The case for prevention and early detection is clear – it is better for patients and cheaper for the NHS. The fact that teams across primary care are managing record demand and hospital waiting lists remain stubbornly high highlights the need to make sure patients are seen by the right person at the right time.
‘Our analysis with CF (Carnall Farrar) found that for every £1 invested in community or primary care, there is up to a £14 return back into the local economy through gross value added (GVA). This new report adds to this evidence by suggesting that investing in high street opticians could deliver £98m in annual savings for the NHS.
‘We look forward to working with the government on its 10-year strategy to help it achieve its ambitions of moving more care into the community and moving from treating sickness to preventing ill health.’
Last month it was announced that diabetes patients are to be offered OTC scans in the community as part of NHS England’s plans to reduce hospital appointments.
