Investing in Eye Care Services Could Bring £98M Net Benefits for the NHS per Year, New Findings Show
29 November 2024
New report reveals the untapped clinical and socio-economic impact of primary eye care, reducing waiting lists and moving care from hospitals to communities.
Investment directed into primary eye care has the potential to deliver £98m in net benefits for the NHS and help the government fulfil its objectives set out in the Darzi review to reduce the waiting lists and move care closer to home, a new report finds.
The Association of Optometrists (AOP), Fight for Sight, Primary Eyecare Services and Roche Products Ltd provided financial support, editorial input and reviewed all associated outputs of the report produced by PA consulting.
The research from PA Consulting explores the role of High Street optometry in end-to-end eye care and eye health in the UK that will achieve both cost savings to the NHS and directly benefit patients, clinical staff and the wider economy.
The report, Key Interventions to Transform Eye Care & Eye Health, identifies four system-wide changes that could release nearly two million appointments per year within overstretched hospital eye services, A&E and General Practice – the equivalent of 9,600 appointments per year for each Acute Trust in England.
The government has pledged to reform the NHS following the publication of the Darzi review in September. The reform announced focuses on three big shifts: moving more care from hospitals into the community; changing from an analogue to a digital NHS; and being bolder on a sickness to prevention healthcare model.
The analysis examined the current value of primary eye care provision and found that NHS services delivered in High Street optometry offer over c£1.5 billion of value from correcting sight in children and young people and nearly half a billion in adults, most notably from early detection of glaucoma and age-related macular degeneration (AMD) in older people. PA Consulting findings equates this to a return of£3.98 for every £1 spent.
The Darzi review revealed that spend on acute care as a percentage of the NHS budget has risen from 47% in 2002 to 58% in 2022, while primary care’s share of NHS spending has fallen from 27% to 18%.
Data in the PA report highlights that the NHS faces high and rising demand for eye care and eye health services, alongside an increasing mismatch between patient demand and the NHS’s capacity:
- The most prevalent eye conditions are predicted to increase between now and 2032. Prevalence of some major eye conditions is expected to grow by 25% over the next decade – around seven times faster than overall population growth
- Hospital Eye Services (HES) cannot meet current demand. Waiting lists and times for hospital eye care have been growing for more than a decade, were significantly worsened by Covid, and even now remain close to their peak
- Demand for HES is growing faster than ophthalmology workforce capacity. Only 24% of eye units believe they have enough consultants to meet current demand
- There is significant variation in both eye care activity and outcomes. Some areas refer patients to HES three times more than others, and there is a 26-fold difference between areas in the rate of people registered blind or partially-sighted
The four system-wide changes identified in the report for national government and NHS England to commit to are:
- A 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
- A national roll-out of the Integrated Glaucoma Pathway – including ongoing monitoring to prevent the development or exacerbation of glaucoma for patients at risk
- A national roll-out of the Integrated Cataract Pathway – primary care optometrists confirm patient eligibility for surgery. After surgery they check for and treat post-operative complications and monitor patient outcomes
- To transforming the potential of Optical Coherence Tomography – including in community settings and harnessing its continued technological advance
The overall net gain in benefit for the NHS from implementing the four tailored system-wide changes breaks down as follows:
- Community Urgent Eye Care Services: £30 million pa
- Integrated Glaucoma Pathway: £13 million pa
- Integrated Cataract Pathway: £34 million pa
- Optical Coherence Tomography (OCT): £21 million pa
To read the recommendations of the report Key Interventions to Transform Eye Care & Eye Health in full visit aop.org.uk/transformingeyecare
Adam Sampson, Chief Executive of the AOP, said: “All too often, healthcare reports tell a story about how broken the NHS is, and the challenges around the corner that could make the situation worse. This report from PA Consulting’s report is different – and offers real cause for optimism.
“Yes, the report highlights that the NHS faces ever-increasing demand for eye care and eye health services. But the data shows that the existing service delivered by optometrists on High Streets across the UK delivers outstanding value. And it further signals four simple ways in which the role of High Street optometry in end-to-end eye care and eye health in the UK can be extended, which will cut waiting lists, achieve cost savings to the NHS, and support the drive for growth in the economy.
“The eye health sector is committed to the government’s plans to shift more care out of hospitals and into the community as part of its 10-year plan for health. Now we need NHS England to support this step-change, and invest in the services that empower primary care to really deliver for patients.”
Keith Valentine, Chief Executive of Fight for Sight said: “We are delighted to have been part of this piece of work, and need to see the recommendations taken seriously and implemented urgently.
“Whilst this report focuses on the economic argument and the sustainability of our health systems, at the heart of this is the desperate need for improved patient outcomes. For the last several years ophthalmology has accounted for almost 10% of all NHS backlogs leading to avoidable and irreversible sight loss. Proper investment and design of our primary care services as this report demonstrates will be transformational in the delivery of eye care in this country.”
Dharmesh Patel, Chief Executive of Primary Eyecare Services said: “This report emphasises the critical need to expand eye care services within primary care optometry settings to alleviate the burden on GPs, A&E and hospital ophthalmology, enhancing patient care and supporting NHS sustainability.
“With major eye conditions projected to increase by 25% by 2032, this report highlights interventions based on existing innovative delivery models utilising primary and community optometry practices. Along with partners, we stand ready to scale up delivery of eye care in the community at a local, regional and national level at pace.”
Eelke Roos, Ophthalmology Lead, Roche Products Limited said: “It is vital that we free up NHS capacity to treat more patients, faster. This research supports the mounting body of evidence that shows that more eye care needs to be delivered in primary care to meet rising demand. Optometrists are on the frontline of eye care, and their experiences and insights are essential in identifying sustainable solutions to the crisis in eye care for ophthalmology patients.”
The AOP’s Sight Won’t Wait Campaign has been calling for a national approach for eye care services to utilise the existing optometry workforce to cut hospital waiting lists, reduce sight loss and improve patient outcomes.
For more information, visit aop.org.uk/sight-wont-wait