Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

Deprivation and the location of primary care optometry services in England

Eye volume 38, pages 656–658 (2024)Cite this article

Subjects

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.

Our analyses reveal substantial variations in the crude rate of optometric practices per 100,000 of population, with this rate being much lower in more deprived versus more affluent areas, with some evidence for increased practice closures in the most deprived areas. These data deserve flagging within the narrative of existing research on deprivation and eyecare, but moreover in relation to plans to transform ophthalmology, with more services being proposed for delivery within primary care. Arguably of necessity, likely driven by the economics of the NHS’s funding models for primary care optometry, i.e., a requirement for businesses to use cross-subsidisation from spectacles sales versus income derived from eyecare provision (for GOS sight test/community ophthalmology schemes), optometric practices are more prevalent in the more affluent areas. While uptake of services is multifactorial and beyond the matter of accessibility alone, including for example previously raised concerns about lack of awareness and perceptions of costs [11], there is a pressing need for services to be located more evenly, minimising variations in accessibility as the kernel for uptake of services. While it might be argued that regardless of these findings, for many patients, optometric practices may still be more accessible than traditional secondary care ophthalmology services, local Health and Wellbeing Boards and those responsible for commissioning must create NHS contracts in England permitting optometry practices to be economically viable within the most deprived areas or alternatively develop outreach services in such areas [11]. Legge et al’s analysis in Scotland [7] provides some evidence to suggest that the funding model in Scotland has enabled optometry practices to function in all socio-economic areas. Our analysis of NHS data here appears to show this scenario is far from so in England.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

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

References

  1. Joint statement on our vision for safe and sustainable patient eye care services - College of Optometrists. 2021. www.college-optometrists.org. Accessed 31 August 2023.

  2. Sukumar S, Spencer A, Fenerty C, Harper R, Henson DB. The influence of socioeconomic and clinical factors upon the presenting visual field status of patients with glaucoma. Eye. 2009;23:1038–44.

    Article  CAS  PubMed  Google Scholar 

  3. Wong TL, Ang JL, Deol S, Buckmaster F, McTrusty AD, Tatham AJ. The relationship between multiple deprivation and severity of glaucoma at diagnosis. Eye. 2023. https://doi.org/10.1038/s41433-023-02508-w.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Rathore M, Shweikh Y, Kelly SR, Crabb DP. Measures of multiple deprivation and visual field loss in glaucoma clinics in England: lessons from big data. Eye. 2023. https://doi.org/10.1038/s41433-023-02567-z.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Shickle D, Farragher TM, Davey CJ, Slade SV, Syrett J. Geographical inequalities in uptake of NHS funded eye examinations: poisson modelling of small-area data for Essex, UK. J Public Health. 2017;40:171–9.

    Article  Google Scholar 

  6. Swystun AG, Davey CJ. Exploring the effect of optometrist practice type on NHS funded sight test outcome. J Optom. 2021;14:69–77.

    Article  PubMed  Google Scholar 

  7. Legge R, Strang NC, Loffler G. Distribution of optometric practices relative to deprivation index in Scotland. J Public Health. 2017;40:389–96.

    Article  Google Scholar 

  8. Jonuscheit S, Loffler G, Strang NC. General ophthalmic services in Scotland: value for (public) money? Ophthalmic Physiol Opt. 2019;39:225–31.

    Article  PubMed  Google Scholar 

  9. NHS England ODS - Optical HQ and Optical Site. 2023. https://nhsenglandfilestore.s3.amazonaws.com/ods/eoptsite.csv. Accessed 31st August 2023.

  10. IMD2019 Dept Levelling Up, Communities & local Government. English indices of deprivation. GOV.UK, 2019. www.gov.uk.

  11. Day F, Buchan JC, Cassells-Brown A, Fear J, Dixon R, Wood F. A glaucoma equity profile: correlating disease distribution with service provision and uptake in a population in Northern England, UK. Eye. 2010;24:1478–85.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

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

Authors
  1. Robert A. Harper
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeremy Hooper
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cecilia H. Fenerty
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James Roach
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Bowen
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Corresponding author

Correspondence to Robert A. Harper.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harper, R.A., Hooper, J., Fenerty, C.H. et al. Deprivation and the location of primary care optometry services in England. Eye 38, 656–658 (2024). https://doi.org/10.1038/s41433-023-02774-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41433-023-02774-8

This article is cited by

Search

Advanced search

Quick links