Eye Care Services in the United Kingdom(1)

Healthcare in England is provided to all permanent residents by the National Health Service.  Health care is free at the point of need and paid for from general taxation.  Although the public system dominates healthcare provision in England, private and supplementary care is available for those willing to pay.

In January 2007, the British government announced the results of the General Ophthalmic Services Review.(2)  This review concluded that the United Kingdom had a successful sight testing service that should be built upon rather than changed. The review recognized the potential to develop more accessible, tailored eye care services for patients by making greater use of the skills that exist among eye care professionals to diagnose and manage a range of eye conditions. The review also recognized the potential for collaboration between the National Health Service, social care (education, primary health care) and the third sector (charities, non for profit, social enterprise) in providing integrated services for patients with low vision.  

The main outcome of the review was a commissioning toolkit (3)which provides practical advice for Primary Care Trusts (PCTs) on the commissioning of community based eye care services.  The commissioning of eye care services in the UK is complex.  Local government-run PCTs must contract with medical practitioners to provide services. A key feature of eye health services is the number of different professionals who may potentially be involved in service delivery.  Thus it is important to work across sectors to best meet patient need.  

The Health Act 2006 introduced a three-tiered framework for commissioning primary ophthalmic services. This framework includes(3):

Mandatory Services – NHS funded sight testing

Mandatory services are the traditional sight testing services offered by optical businesses with a General Ophthalmic Services contract with their local PCT.  All PCTs must contract for these services and any eligible contractor may provide them subject to local decision on matters such as quality of service (e.g. inspection of premises and equipment, etc). The NHS funded sight test is subject to the same regulations as privately funded sight tests and may only be carried out by an ophthalmic practitioner on a PCT performers list.

When glasses or contact lenses are needed to correct vision, the sight tester is required to prescribe them and to give the patient a copy of their optical prescription. The sight tester is also required to issue an NHS optical voucher to all eligible patients at the time that the sight test is carried out unless a patient’s circumstances change, in which case a voucher can be issued later. If signs of injury, disease or abnormality are identified then the practitioner will refer the patient to a general practitioner or directly to the hospital as appropriate.

Patients may take their prescriptions and their NHS optical vouchers to any supplier of optical appliances who will accept them. Recipients of income support are entitled to NHS funded sight tests and optical vouchers. All those receiving income-related employment and support allowance, who would previously have received income support, will continue to receive the same entitlement once the benefit is introduced.  Patients who are under 16, blind or partially sighted must take their prescriptions to be dispensed by an optometrist, a dispensing optician or a registered medical practitioner.

Additional Services

Additional services are those prescribed in regulations which Primary Care Trusts must contract to provide. All PCTs must contract for these services but not all contractors are obliged to provide them. Optical providers may have a mandatory services contract, an additional services contract or both. I n order to receive additional services at home, at a care home or at a day center, certain eligibilities apply:

• At home: the patient must be eligible and must be unable to leave home unaccompanied because of physical or mental illness or disability.
At a residential or care home: the patient must be eligible and must normally live there and be unable to leave the home unaccompanied because of physical or mental illness or disability.
At a day center: the patient must be eligible and must have difficulty in obtaining sight testing services from practice premises because of physical or mental illness or disability or because of difficulties in communicating health needs.

Enhanced Services

There is also a wide range of eye care services available to patients, which span different sectors of the NHS as well as social care. Whereas sight testing is restricted under the Opticians Act to registered optometrists or medical practitioners, these restrictions do not apply to enhanced services if the service is for something other than a sight test.

UK Vision Strategy

The World Health Organization’s Vision 2020 program to eliminate preventable blindness by 2020 provides a strategic context for service development.  In the UK, stakeholders have developed a UK Vision Strategy inspired by the WHO’s initiative. The Department of Health is committed to supporting the aims of the UK Vision Strategy within the context of a locally commissioned service.  The UK Vision Strategy aims to:

Footnotes

(1) Department of Health, 2007. Accessed 21 October 2009.

(2) Department of Health, 2007. Accessed 21 October 2009.

(3) Department of Health, 2007. Accessed 21 October 2009.