Eyecare in the UK has seen significant changes in recent years, with new models of care, technological advancements and an increased emphasis on primary eyecare in some UK nations. Crucially, an ageing population demographic is set to escalate further both the volume of cases and complexity of clinical needs.
There are currently around 18,000 registered optometrists in the UK who provide crucial eye health services for patients in both hospital and primary care settings. In addition to delivering over 23 million routine sight tests each year [1], primary care optometrists prescribe spectacles, contact lenses and other optical devices, and independently manage a range of common eye conditions, referring patients for additional specialist care where required. Many primary eyecare practices provide urgent and acute eyecare services, therapeutic prescribing and undertake essential pre- and post-cataract operative care and glaucoma referral refinement services. The profession is also playing an increasingly important role in the early detection of systemic diseases, such as high blood pressure and diabetes.
As first contact practitioners, optometrists are well placed to help relieve the growing eye health crisis in secondary care. Although only 3–5% of eye examinations require onward referral [2], pressure on ophthalmology is huge – and growing. In England during 2023–24, ophthalmology has the highest number of outpatient appointments, accounting for nearly 9% of all NHS outpatient appointments [3]. Population demographics will exacerbate the number of patients developing sight-threatening ocular conditions. At the time of writing, one third of patients in England have been waiting more than the 18-week target [3], and nearly half of patients in Wales have waited over 36 weeks for eyecare treatment [4]. Long hospital waiting times risks further irremediable decline in vision, resulting in permanent sight loss and reduced patient quality of life.
Similarly, acute eye problems are increasingly burdening A&E departments, with ocular emergencies accounting for up to 6% of all A&E attendances [5]. Up to 70% of eye-related A&E cases could be managed in primary care by optometrists. In fact, measurable decreases in hospital attendance and improved patient outcomes have been observed where primary care optometry services of this kind have been commissioned.
Delivering timely and accessible eyecare
Optometrists are qualified to deliver urgent and minor eyecare services, as well as managing some stable chronic conditions, via their core competencies and scope of practice at initial registration. In addition to the central role that hospital optometrists already play in the hospital eye service, there are clear opportunities to expand the scope of commissioned primary care optometry services to ensure consistency of access to timely and localised eyecare across the UK.
The number of patients with eye symptoms who turn first to optometrists, rather than GPs, has increased in the past decade, yet a quarter of the UK public still say they would go to a GP first with an eye problem: 53% of those living in Scotland and Wales would visit an optometrist first, but only 33% in England [6]. GPs are already overloaded and lack the specialist ophthalmic training and equipment needed to handle most eye conditions. The consequence of the status quo – overloaded hospitals and GPs – is delayed care and avoidable sight loss. With an ageing population and restricted health service budgets, it is imperative to adopt new models of care that improve access and outcomes.
Delivering the workforce of tomorrow
For the last 20 years, optometrists have typically qualified to practise in the UK by completing a General Optical Council (GOC)-approved degree followed by The College of Optometrists’ Scheme for Registration (SfR) placement and assessments. Once qualified, as with other health professions, optometrists must maintain and update their clinical expertise through regular, documented CPD, and may take practical courses to enable confident execution of new techniques. Many also develop specialisms, via College Higher Qualifications, increasing the range of conditions and patients that they can safely manage autonomously, and qualify to be added to the specialist register as independent therapeutic prescribers.
Over this period, several degree providers have worked with the College to develop four-year master’s qualifications that integrate the SfR. Increasingly, such courses have incorporated the first level of College Higher Qualifications alongside other academic support during the placement period, allowing these new registrants to qualify with additional specialist knowledge and skills that help meet the growing demand for enhanced primary eyecare.
Since 2023, providers of optometry degrees have been required by the GOC to adopt this integrated model. The College has partnered with GOC-approved universities to facilitate, support and assess 44 of the 48 weeks of the patient-facing experience required by the new education and training requirements (ETR). The College’s newly-developed Clinical Learning in Practice Programme (CLiP) delivers an integrated ETR placement experience, building on 20 years’ experience of delivering the SfR. The College has invested in developing the online CLiP portal to address many of the infrastructural challenges of placement delivery, such as progression monitoring, and offer a student clinical learning experience underpinned by a partnership of employers, universities and the College. A significantly enhanced programme of College support is also now on offer to supervisors on both the SfR and CLiP.
The College developed this approach collaboratively to enable the optical sector to shift from assessing ‘competencies’ that focused on specific techniques and skills to ‘outcomes’ which describe the attributes and behaviours expected of future registrants. The CLiP programme future-proofs new registrants by overtly requiring them to demonstrate overarching leadership, personal and service development capabilities alongside the more technical clinical decision-making, knowledge and skills. This, combined with a fully integrated route to registration, secures and emphasises the capabilities and qualities of the registrants as ophthalmic healthcare practitioners who join the eyecare workforce ready to meet current and future demand for high-quality care.
However, this transition is not without cost. In addition to the regulatory burden of developing new models of course delivery, and validating wholly redeveloped qualifications, there is an ongoing unfunded cost of facilitating, delivering and assuring the quality of clinical learning. Whilst other healthcare professions benefit from funding for employers, students and education providers, outside of Scotland optometry funding is restricted to a small fraction of the costs for practices to provide pre-registration supervisors.
Equally, the placements required to undertake specialist clinical learning for therapeutic prescribing and higher qualifications do not currently benefit from nationwide funding in England, other than through charity and commercial support, for optometrists working outside the hospital eye service. Trainees regularly report waiting six months or more and paying thousands of pounds for access to clinical experience. Funded specialist and prescribing optometric qualification routes are essential, underpinning the shift to managing more complex eye conditions, such as glaucoma and macular disease, in primary care settings, promptly and locally.
Capitalising on capabilities
As the professional body for optometry, The College of Optometrists supports and encourages optometrists to expand their scope of practice to provide both core and enhanced eyecare services. The College’s guidance on safely managing their scope of practice enables optometrists to determine which qualifications and competencies are required to provide different therapeutics and services [7]. However, without universal commissioning and funding for clinical education, consistent engagement from the whole profession with meeting enhanced eye health needs is undermined. Equally, without access to shared electronic patient records and agreed standards to enable universal digital image sharing, the contribution of optometry to the wider healthcare ecosystem is unnecessarily impeded.
We’re already seeing successful expansions of optometry services in primary care in some parts of the UK, showcasing how optometrists are poised to provide timely and accessible patient care, and improve patient outcomes. For example, 75–97% of acute eye cases are managed by optometrists in primary care without need for referral where there are locally commissioned community urgent and emergency eyecare services in England. In Wales, Cardiff and Vale University Health Board are reducing waiting times and improving outcomes for patients with urgent eye conditions by integrating primary and secondary care and maximising the use of digital advancements [8].
These pockets of excellence demonstrate that small changes in systems and policy to integrate and utilise the healthcare capabilities of optometrists can deliver huge improvements in patient outcomes. With modest funding and universal commissioning of enhanced services across the UK, we could look forward to a future eyecare landscape that meets patients’ needs promptly and locally and puts an end to avoidable sight loss.
References
1. www.fodo.com/downloads/managed/
Principles_and_priorities/13351_FODO
_Strategy_Document_Full_Layout_-_Print-at-Home.pdf
2. www.college-optometrists.org/news/
2025/may/lack-of-funding-threatens
-urgent-care-in-england
3. https://digital.nhs.uk/data-and-information/
publications/statistical/hospital-outpatient-activity/2023-24
4. https://statswales.gov.wales/Catalogue/
Health-and-Social-Care/NHS-Hospital
-Waiting-Times/Referral-to-Treatment/
rttkeymeasures-by-treatmentfunction
5. Rehan SM, Morris DS, Pedlar L, et al. Ophthalmic emergencies presenting to the emergency department at the University Hospital of Wales, Cardiff, UK. Clin Exp Optom 2020;103(6):895–901.
6. https://optical.org/resource/
public-perceptions-research-2025.html
7. www.college-optometrists.org/
clinical-guidance/supplementary-guidance/
expanding-scope-of-practice-optometrists
8. https://lshubwales.com/case-studies/
working-collaboratively-improve
-eye-care-patients-across-wales
[All links last accessed August 2025]
