In 2021, NHS Shropshire, Telford and Wrekin began a four-year project to improve local eye care services, working with health and care partners from across the area. 

This work was guided by a 2019 report called the Eye Health Needs Assessment, which showed that more people are being affected by common eye conditions like cataracts, glaucoma, and age-related macular degeneration (AMD).  

Using this and other local information, the team looked at how best to plan for the growing need for eye care. The goal was to create eye care services that are safe, easy to access, joined up, and fit for the future. 

The reasons for change, and the scope of the programme, included the need to: 

• Anticipate and plan for the increasing demand on services. 

• Reduce unnecessary face-to-face outpatient appointments and trips to hospital. 

• Ensure earlier detection and prevention of certain eye conditions. 

• Provide more joined up services across primary, secondary and community care. 

• Provide more services closer to home, when and where they are needed. 

• Make better use of innovative technologies and developments in eye care. 

• Provide a more integrated service that is a lot easier to navigate for everyone. 

• Make better use of data and tracking people’s care. 

The approach 

The work started by gathering and analysing a range of different data sets including the needs of our local population, public health and health inequalities, and three years’ worth of complaints and compliments linked to eye care. 

To build on these findings, and to ensure people were informed and involved, a series of engagement events were held to bring together a wide range of individuals and organisations. These events aimed to gather feedback about current eye care services in the county to understand what worked well and what could be improved. 

The findings were used, along with nationally recommended new models of care and best practice in other areas, to develop more efficient ways of providing eye care outpatient services, and to start shape and design a new community optometry service. 

The outcomes 

New ways of providing outpatient eye care services have been developed including: 

• Virtual consultations, where appropriate.  

• Advice and guidance, where a referring optometrist or GP can send a scan to a hospital consultant for review and a recommended course of action without the need for a hospital appointment. 

• Patient-initiated follow ups, where people are empowered to play a bigger role in their own care and only seek a follow-up appointment where it is clinically necessary. 

In addition, work was also undertaken alongside system partners to design and develop a new improved integrated eye care system. This new approach brings together primary, community and secondary care services related to eye health, and includes a new model for both community optometry and ophthalmology services. 

The new community optometry service was designed to be more innovative, effective, efficient, easier to navigate and ensure people get seen by the right person in the right setting at the right time. It also supports the shift from hospital-based care to community-based care. A wider range of eye care services and tests will now be available closer to home, in local and high street optical practices instead of in hospitals. 

Supporting this new improved service, a range of improved clinical pathways were also redesigned and developed including: 

• Cataracts 

• Glaucoma 

• Medical retina 

• Urgent eye care 

• Children’s eye care 

An innovative digital Electronic Eye Care Referral System (EeRS) is also in place. This is a two-way communication tool between clinicians which allows scans to be uploaded. The new system improves the way referrals are managed and makes the entire process quicker and more direct, speeding up access to the right care, in the right place, at the right time. 

EeRS is now up and running in every optical practice across the county. As the first county in the Midlands region to make such innovative progress and improvements, we are leading the way in Shropshire, Telford and Wrekin.