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With so many acronyms, professions, services and organisations, eye care in the UK can be difficult to navigate. This overview provides key decision-makers like you with all you need to know about eye care and to ensure everybody in the UK has access to timely care.
At FODO we believe that working together to meet population needs will help us prevent avoidable sight loss and achieve better eye care for all in a sustainable way. If you are a policymaker, commissioner or researcher and have any questions or would like more detailed information, please get in touch: [email protected]
An overview of eye care in the UK
Opticians have provided eye care funded by the NHS since it was founded in 1948. Since 1998, healthcare planning has been increasingly devolved to each of the four nations which is why eligibility for NHS funded eye examinations and how much the NHS pays per patient now varies depending on where people live in the UK.
This also explains why, for example, everybody in Scotland is eligible for an NHS funded eye examination and benefits from a comprehensive primary eye care service, but people that live in England, Northern Ireland and Wales might have to pay because there is no universal access to an NHS funded primary eye care service.
The NHS in England, Scotland and Wales and the Health Service in Northern Ireland fund all eye care provided in secondary care but again, because of devolution, the organisations responsible for this are different in each nation.
People can also choose to access eye care from ophthalmologists, optometrists and other eye care professionals privately.
The sections below provide an overview of eye health professionals and eye care services and how they are regulated, commissioned and provided across the UK.
Regulated by the General Optical Council. Optometrists perform detailed eye examinations to detect defects in vision, ocular disease or other health issues. Many now also perform advanced diagnostic tests and co-manage patients with eye conditions. They form the single largest group of eye care professionals in the UK.
Dispensing opticians
Regulated by the General Optical Council. Dispensing opticians can fit and supply spectacles to children and adults and can advise on and dispense low vision aids. With additional specialist training they can also fit contact lenses and examine the anterior eye for defects and ocular disease.
Orthoptists
Regulated by the Health and Care Professions Council. Orthoptists specialise in diagnosing and treating visual problems involving eye movements. They might have other roles and responsibilities. They typically work in hospital eye clinics but can also work in community settings - for example, when screening in schools.
Ophthalmologists
Regulated by the General Medical Council. Ophthalmologists are medically trained doctors who specialise in eye health. They often do a mix of surgical and non-surgical work, and as they build more experience they typically specialise in a specific sub-speciality, with Health Education England noting eight subspecialty areas in 2019
- Cornea and anterior segment
- Medical retina
- Glaucoma
- Oculoplastic surgery (plastic surgery around the eye)
- Paediatric ophthalmology
- Surgical retina (vitreo-retinal surgeons)
- Primary care
- Medical and neuro-ophthalmology.
In England, the NHS sets out who is eligible for an NHS funded eye examination and help towards the cost of prescription glasses. This eye examination is provided based on a national contract for General Ophthalmic Services (GOS). The GOS fee is negotiated annually by the Optometric Fees Negotiating Committee (OFNC).
All other adults must pay for a private eye examination and do not get any help from the NHS towards the cost of prescription glasses.
NHS commissioners also work with Local Optical Committees (LOCs) and the LOC Support Unit (LOCSU) to commission enhanced services from community based practices. This allows people to access more timely care closer to home.
NHS commissioners fund the Hospital Eye Service (HES). This care is currently commissioned by Clinical Commissioning Groups (CCGs), with NHS England commissioning specialist services.
The Clinical Council for Eye Health Commissioning (CCEHC) is an advisory body to NHS England. It brings together experts in their field with the aim of providing evidence-based guidance to support NHS commissioners and achieve the best possible outcomes for patients and the wider NHS.
FODO has a seat on the CCEHC as a founding member of the Optical Confederation (OC). FODO is also a founding member of LOCSU and a member of the OFNC.In Northern Ireland, the Health Service (HS) sets out who is eligible for a HS funded eye examination. This eye examination is provided as part of General Ophthalmic Services (GOS).
All other adults must pay for a private eye examination and do not get any help from the NHS towards the cost of prescription glasses.
In addition to GOS-funded eye examinations, the Health & Social Care Board has commissioned a number of regional enhanced services aimed at improving access and outcomes and delivering care closer to home. Enhanced services include regional acute eye, glaucoma and cataract pathways. Glaucoma pathways can include repeat measure, enhanced case finding, and OHT monitoring. This has been made possible by eReferral, access to Electronic Care Record and Project ECHO. A NI Eyecare Network is also now constituted to make regional decisions, with a mandate to advise on prioritised investments across primary and secondary eye care.
Local Health and Social Care Trusts provide the HES and report to the HSCB.Scotland is the only country in the UK to currently provide NHS funded eye examinations to everybody ordinarily resident in the UK or otherwise exempt from NHS charges. The NHS provides universal access to this primary eye care service as part of General Ophthalmic Services (GOS) Scotland.
Optometrists in Scotland provide a range of NHS funded eye care, but these services fall into three main groups. The GOS primary eye examination (PEE), supplementary eye examination (SEE) and enhanced supplementary eye examination (ESEE). These eye examinations are available nationally and enable patients with routine, chronic or emergency eye conditions to access an NHS funded primary eye care service and be cared for locally and appropriately triaged.
Optometrists also provide locally commissioned services, learn more
By making the best use of the eye care workforce, the primary eye care service in Scotland saves 370,000 people from attending hospital each year, according to research by Optometry Scotland.
As well as primary care, 14 NHS Boards in NHS Scotland are responsible for the Hospital Eye Service (HES).In Wales, NHS Wales sets out who is eligible for an NHS funded eye examination and help towards the cost of prescription glasses. This eye examination is provided as part of General Ophthalmic Services (GOS).
NHS Wales has also improved access to eye care in primary care and community settings through the enhanced Wales Eye Care Service (WECS). This allows optometrists in primary care to offer enhanced services and care, and follow-up examinations and repeat tests. It means more people can be managed locally and they do not have to be referred to hospital unless they have to be. Eye Health Examination Wales (EHEW) is a fundamental part of WECS and nationally commissioned, taking administrative costs out of the system so more NHS resources can be spent on frontline services.
Seven Local Health Boards in Wales also provide a Hospital Eye Service (HES).
We will keep adding resources to help key decision makers like you understand the full breadth and depth of eye care services and what eye care professionals can do to meet population needs in a sustainable way.
In 2020 we will also be launching a data hub for members. If you are a policymaker, commissioner, or researcher you can apply for free access by emailing: [email protected]
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