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Deprivation and the location of primary care optometry services in England

Eye (2023)Cite this article

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Primary care optometrists offer NHS sight tests under the General Ophthalmic Service (GOS), or private eye examinations, and increasingly in the past two decades also provide wider NHS services, typically as part of local commissioning in England, or, for example, within an enhanced GOS in Scotland. Plans for transformation in ophthalmology make recommendations for greater use of primary care, provided from either independent practices or chains of multiple optometric practices. The College of Optometrists and The Royal College of Ophthalmologists joint statement “our vision for safe and sustainable patient eye care services” recommends that integrated pathways should include optometrists as first contact practitioners for: urgent eye care; referral triage/advice and guidance; primary care-based management for new, low risk patients; and primary care-based management for follow up of patients with long term low risk conditions [1]. The statement notes the vision for the future is pathways that ensure patients are prioritised based on clinical need and that they receive care that is appropriate and accessible. Accessibility to services is, therefore, important for GOS sight testing, but also wider eyecare services, i.e., accessibility to the pathways currently provided or to those potentially feasible within primary care in the future. However, there is limited published information on the association between location of primary care optometry practices and deprivation in England. Socio-economic deprivation in the UK has been associated with presentation with more advanced eye disease [2,3,4] and lower uptake of services [5]. A previously published small-area analysis of GOS activity in Leeds found populations in the least deprived quintile were more likely to have NHS funded eye examinations than those in deprived areas [5]. Research elsewhere observed demonstrable inequalities in small-area data modelling in Essex [6], reinforcing the need to address inequalities. While there is some evidence that the distribution of optometry practices in Scotland, where the GOS is enhanced, may be more balanced [7, 8], and thus potential differences in eye examination uptake across social strata may not solely be related to their availability, accessibility to services remains a central tenet for NHS provision.

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Fig. 1: Optometric practice rates per Index of Multiple Deprivation decile.

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Authors and Affiliations

  1. Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust Manchester, Manchester, M13 9WL, UK

    Robert A. Harper & Cecilia H. Fenerty

  2. Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK

    Robert A. Harper & Cecilia H. Fenerty

  3. Conclusio, Ty Derw Lime Tree Court, Cardiff Gate Business Park, Cardiff, CF23 8AB, UK

    Jeremy Hooper & James Roach

  4. Division of Evolution and Genomic Sciences, School of Health Sciences, Faculty of Biology, Medicines and Health, University of Manchester, Manchester, M13 9PL, UK

    Cecilia H. Fenerty

  5. College of Optometrists, London, WC2N 5NG, UK

    Michael Bowen

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  1. Robert A. Harper
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Contributions

RAH, JH and CHF conceived and designed the study, supported by JR and MB. JH performed the analyses, supported by RAH and CHF; RAH wrote the manuscript; JH, CHF, JR and MB provided critical review of the manuscript.

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Correspondence to Robert A. Harper.

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Harper, R.A., Hooper, J., Fenerty, C.H. et al. Deprivation and the location of primary care optometry services in England. Eye (2023). https://doi.org/10.1038/s41433-023-02774-8

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