Eye health care placing avoidable pressure on GPs in London

CREDIT: This story was first seen in OnMedica

OnMedica reports that clinical commissioning groups (CCGs) and local authorities in London need to have a better understanding of the eye health needs of their local populations, and the organisation and delivery of local services, according to a new report.

The report reveals that although eye health problems are generating significant and avoidable pressure on GP services and hospitals, none of London’s five sustainability and transformation partnerships (STPs) specifically mention eye health in their plans – and London CCGs spend a smaller fraction of their budgets on eye health than the average for England.

The London Assembly Health Committee conducted an investigation into eye health for all Londoners, during which it spoke to experts from Moorfields Eye Hospital, The Royal National Institute for Blind People (RNIB), the Thomas Pocklington Trust, the London Eye Health Network (LHEN) and Vision UK. It found that London CCGs spend on average 2.3% of their budgets on eye health, compared with the England mean of 2.6%; and this varied substantially, from a per-capita low of £17 in Ealing and Hammersmith and Fulham CCGs up to £36 in Redbridge and Havering.

The committee warned that demand for eye health care “is placing avoidable pressure on GPs and hospitals”. It said that because many eye health conditions are symptomless in the early stages, people tend to wait until they experience vision problems before seeking medical attention, which leads not only to late diagnosis but also to increased visits to GPs: an issue compounded by low awareness of community optometry services. It added that a recent survey found that eye health is an area where GPs feel low confidence and tend to over-refer to hospitals, as they do not always have the specialist knowledge and equipment to accurately diagnose eye problems.

Furthermore, LEHN found that eye health plans are not shared widely between commissioners when they were often dealing with the same trust; only a third of London CCGs commission glaucoma repeat measures (NICE Quality standard); and several London CCGs are reviewing cataract pathways, but are doing so separately from each other.

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The committee argued that there are opportunities to make better use of the existing network of community-based eye service providers to reduce pressure on GP and hospital services, and called for up-front investment to avoid the need for expensive treatment later, such as through the development of primary eye care services and more multidisciplinary community ophthalmology-led services.

The report’s authors commented: “Eye health appears to be viewed as a lower health priority in comparison to more ‘serious’ conditions such as dementia or cancer, even though research shows that people rank sight loss alongside these conditions in terms of impact on quality of life. For example, all of London’s five STPs address dementia and cancer, but none specifically mentions eye health in their plans. This is an area the Mayor should encourage STP leadership to address in their developing plans.”

The committee concluded: “CCGs and local authorities need to have a better understanding of the eye health needs of their local populations, and the organisation and delivery of local services. The Mayor, through the London Health Board, should urge local authorities to consider eye health more explicitly in joint strategic needs assessments.”

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