Creating a community of care on eye health

The chief operating officer with the Local Optical Committee Support Unit (LOCSU) explains how local optical practices can play a significant role providing patient-centred, preventative health:

Sight is the sense we fear losing most and a growing elderly population is more likely to suffer sight issues.

There are almost two million people in the UK living with sight loss – this is expected to double by 2050.

Many people think that a sight test is just about checking whether your vision needs correcting with glasses or contact lenses. But checking a patient’s sight could transform their health and wellbeing through the identification of other health issues.

In some potentially life-saving cases, a check-up can spot cancer or identify high blood pressure, moving the sight test towards a much more medical examination. Building eye health into a wider, preventative health model has widespread benefits, including reducing isolation and depression; preventing falls and fractures; providing low-vision aids to improve everyday tasks; and giving people a better quality of life.

Optical professionals are often neglected – regarded mere spectacle sellers – and face an ongoing battle for recognition as front-line health professionals. Yet optical practices can act as high-street health hubs. Open over extended hours in the morning and evening and seven days a week, optical practices are highly accessible and convenient for patients.

Generally based in the centre of local communities, they could be part of the delivery mechanism for a range of lifestyle checks, similar to pharmacies – from smoking cessation, to weight management potentially and alcohol control, to conditions such as high blood pressure, raised cholesterol, diabetes and increased risk of stroke. An initiative in the West Midlands, the Healthy Living Optician, is doing just this.

Optometrists, and the wider primary care team, including dispensing opticians and optical assistants, also often see a demographic that might not necessarily visit the GP or hospital.

Part of the solution is for the health workforce in the widest sense to think about visual health in their daily interaction with patients. This creates a powerful team. A collaborative, multi-disciplinary, patient-centred team from primary care and domiciliary care, through community care to the acute sector and voluntary organisations.

With new treatments and technologies preventing and even reversing sight loss, eye health should be a strong story of success for the NHS. Yet while spending on eye health has almost doubled in the last 10 years, from £1.2 billion to £2.3 billion, hospital eye clinics are bursting at the seams.

Ophthalmology is now the largest specialty when looking at outpatient appointments. Attendance at eye clinics has rocketed and, with an ageing population and rising levels of obesity and diabetes, the demand on services and the levels of sight loss show no signs of relenting.

The key to transformation is to ensure that patients access care from the most appropriate and qualified eye health professional, irrespective of location.

Often primary care can offer the most appropriate and timely care. Peer-reviewed studies show that the introduction of a Minor Eye Conditions Service (MECS) can deflect significant numbers from both GP surgeries and A&E.

One study in Lambeth shows a reduction in GP referrals by more than a quarter. And optometrists, in line with the national position, managed and discharged more than 80 per cent of MECS patients from within the optical practice after one intervention.

Care navigation services can also help to guide patients to the most appropriate care. In a pilot in West Wakefield, of 6,000 calls more than 5,800 were directed to a more appropriate local service. Within the study, around one quarter were directed to the optical practice for eye-related treatment, saving more than 185 hours of GP appointments.

Routine monitoring of long-term conditions offers similar results. There are around 600,000 people with glaucoma – the second biggest cause of blindness – in the UK today. Early diagnosis and treatment is vital to prevent irreversible sight loss. 80% of all glaucoma cases annually originate from primary care, but a significant number of patients with glaucoma remain undiagnosed as some patients do not routinely have their sight checked – the principle route for spotting potential glaucoma.

Post-diagnosis, nearly all patients receive follow-up care in hospital. In fact, it is recognised that around half of glaucoma patients can be managed by a suitably-qualified optometrist in a local practice, providing care much closer to patients’ homes.

Cataract is the most commonly performed surgical procedure in the NHS. Pre- and post-operative care can be delivered via a community optical practice; up to 90% of post-cataract patients can be managed in the community.

Across England, our 75 Local Optical Committees are making connections to show why eye health needs to be on every health professionals’ radar.

There is a willingness and a passion from optical professionals to be recognised as front-line health professionals and play a bigger part in delivering better health for the NHS and for patients.

Richard Whittington

Richard Whittington joined LOCSU as assistant director, commissioning, in June 2016 from the NHS and was appointed as chief operating officer in November 2016.

He is an experienced CCG director and acute trust director with extensive commissioning and service redesign experience. He led the initial commissioning of primary care ophthalmic service across a range of South East London primary care trusts and clinical commissioning groups.

Richard has worked in and across all healthcare and care sectors and has expertise in service change, organisational change and commissioning service delivery. Throughout his career, Richard has delivered real service change with measurable patient benefits and, as such, has a proven record of delivery across QIPP programmes.