It may be years before the full effects of the reforms are clear, but in eye health the new flexibility brings an opportunity for more accessible services at lower cost.
Across the NHS, commissioners and health professionals are increasingly expected to deliver more on a shrinking budget. The expectation that this can be achieved, particularly at the same time as adapting to structural reforms, is often controversial.
Innovative services costing less
But in eye health, the reforms are helping practitioners to provide innovative services that are more accessible for patients and cost less for the NHS. The increased involvement of clinicians in commissioning and growing use of innovative approaches are changing the way eye-health services are provided.
Local Optical Committees, which represent optometrists and dispensing opticians, now cover all of England. Practices in more than 90% of these areas have been commissioned by the NHS to provide more flexible community eye health services.
GPs can refer their patients to accredited eye care practitioners based on high streets and in town centres where pathways are in place – rather than referring directly to hospitals.
When this happens patients can be diagnosed and treated locally with more emphasis on convenience and choice. It means patients are triaged more efficiently, allowing hospitals to focus their resources on the people who need the skills and expertise of a hospital consultant.
Across the country a series of patient-centred eye health pathways are now in place. A learning disabilities service has been developed by LOCSU with Mencap and SeeAbility in consultation with commissioners. It offers enhanced sight tests in the community, giving optometrists more time to familiarise patients with new procedures and equipment.
Low vision pathway valuable for older patients
These new pathways which include a low vision pathway are particularly valuable for older, frail patients, for whom the prospect of travelling to a large, out-of-town hospital can be daunting. Better access to eye health services helps older people with diminishing vision to avoid falls, so bringing wider benefits in terms of increased independence, better wellbeing and reduced costs. Other pathways are addressing particular eye health conditions, like glaucoma and cataracts.
Where these new approaches to eye health services have been adopted, they show encouraging results and begin to address some of the funding and demographic challenges facing the NHS. But much more can be done to ensure these services are available to everyone in England who needs them, so the benefits of greater flexibility and efficiency can be spread more widely.
- Katrina Venerus is a qualified optometrist and managing director of LOCSU.
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