Colleges develop joint vision for future of eyecare

Colin Davison, College of Optometrists president

The College of Optometrists and the Royal College of Ophthalmologists (RCOphth) have developed a Joint Vision for the two professions to continue to work together to support the delivery of safe and sustainable eyecare services in England.

The vision sets out three key principles and recommendations for the development and governance of high quality eyecare service that involve other key policy and commissioning organisations, including NHS England and NHS Improvement.

The three key principles are: balancing visual loss due to delays in appointments against the risk of acquiring Covid-19 infection; decision making about the most effective patient care being made by the appropriate clinician, supported by senior decision makers in optometry and; all pathways are underpinned by the highest standards of joint optometry and ophthalmology clinical governance.

The vision will ensure that the eye sector will take forward the new ways of working, developed during the restrictions placed on services during the Covid-19 pandemic, as a framework for the future delivery of primary and secondary eye care services in England, said the colleges in a joint statement.

The vision ensures integrated eyecare pathways between secondary, community and primary care optometry and builds on the established Covid-19 urgent eyecare services (CUES). Coordinated services for more eye health conditions will see extended collaboration between the hospital eye service and primary care, enabling a greater role for IP and HQ qualified optometrists. The wider multidisciplinary team, including ophthalmologists, nurses and orthoptists, dispensing opticians, contact lens opticians, service managers, GPs, patients, working with commissioners, Local Eye Health Networks, Local Optical Committees and the Hospital Eye Services (HES) are key to delivering the vision.

The vision makes a series of recommendations, including integrated pathways and services at STP or ICS level, with long-term commissioning plans put in place; agreed risk stratification models across primary and secondary care and optometrists with IP and other higher qualifications able to work with a greater degree of autonomy. Importantly, funding models and pricing should not lead to any perverse incentives or inconsistent payments for the same work and resource use across organisations.

The vision is initially for England only, with the aim to develop joint frameworks, pathways and guidance for all UK nations by both colleges.

Colin Davidson, president of the College of Optometrists, said: “In the grip of the pandemic, we worked very quickly with the RCOphth to develop joint management principles and pathways that minimise the risk of vision loss. Having established CUES, we – working with NHSE and key sector bodies – need to build on these advances and go much further, in the interests of both of our professions and patients. We see this as the start of the conversation that will allow optometrists to be recognised and enabled to do more, in line with their skills so that optometrists can routinely provide services including minor eye conditions services (MECS), CUES, glaucoma triage and pre- and post-operative cataract assessments. While this vision is for England as a starting point, our aim is to establish similar frameworks for the other nations.”

Bernard Chang, president of the Royal College of Ophthalmologists, said: “Crucially from the start of the Covid-19 pandemic, both colleges responded by developing a joint strategy agreeing principles and pathways. Significantly, this collaboration will continue to lead the development of eye services in the community and secondary care settings as we enter the restoration and recovery phase.

“We must continue to do more to increase capacity to help prevent avoidable sight loss. This vision for England will be a start of more collaborative work across all four nations in the future. Our Colleges are focusing on urgent care, cataract, glaucoma, AMD and diabetic eye disease pathways initially. The emphasis will be on delivering safe, high quality care in the right setting by the most appropriate trained professional, ensuring patients are confident in accessing the joined-up care they deserve.”

Both colleges are involved in the Eye Care Restoration and Transformation Steering Group, as part of NHS England and Improvement’s National Outpatient Transformation Programme, which brings together key stakeholders to develop and support the delivery of a shared vision and plan for the delivery of eyecare services across the entire patient pathway.

It will work across organisational boundaries to develop practical guidance, tools and resources; remove long-standing barriers to change; and work directly with systems to implement change by building on the pathway redesign principles of CUES and the colleges’ new Joint Vision.