NHS Vale of York CCG and NHS North Yorkshire CCG
Service commencing from December 2021
Community Eyecare Service
The service will provide assessment and treatment of a range of minor eye conditions
for patients aged 2 years and above who are the commissioning responsibility of the
commissioned CCG areas.
The service will also provide a Glaucoma repeat testing - repeat IOP and fields.
Patients can self-present to the service or attend following signposting from other
healthcare professionals.
The Referral Support Service will also deflect any ophthalmology referrals back into the
service where appropriate.
Service details
01/12/2021 in Vale of York, Scarborough and Ryedale.
01/02/2022 in Harrogate and Rural and Hambleton, Richmondshire
and Whitby.
Service Launch Dates…
GP colleagues will be provided with regular updates of participating
local practices.
However, the most accurate listing will be via our website which
hosts an active practice finder tool for the service.
Using a postcode the nearest provider practices can be easily
located:
Find a Practice - Search for your nearest participating optical
practice (primaryeyecare.co.uk)
Provider Practices
• Loss of vision, including transient loss
• Red eye, or other sore eyes, where symptoms have not improved with
pharmacist advised management or the pharmacist advises more urgent
optician review
• Flashes and floaters
• Blurred vision
• Monocular diplopia
• Ocular pain and irritation
• Dry eye, where symptoms have not improved following self-management
advice either from a community optometrist or a pharmacist or self-
management advice is not deemed clinically appropriate
Minor Eye Conditions –
appropriate presenting
symptoms…
• Non-penetrating foreign body, and emergency contact lens
removal
• Corneal foreign body sensation
• Eye infections that have not responded to treatment
• Epiphora (watery eye), where symptoms have not improved with
pharmacist advised management or the pharmacist advises more
urgent optician review.
• Trichiasis (in growing eyelashes). To include epilation of the lash
and repeated treatment if the patient is not willing or fit for
hospital referral to the oculoplastic clinic for more definitive
treatment.
Continued…
• Differential diagnosis of lumps and bumps in the vicinity of the
eye.
• Retinal lesions. Should include photography of the lesion, if
possible, (i.e. within range of the camera) to be shared with the
patient in case of future concerns.
• Field defects.
• Lid disease i.e. blepharitis, entropion, Meibomian gland
dysfunction. Where necessary follow up after 2/3 weeks from the
time of assessment to consider alternative treatment advice if no
improvement.
Continued…
• People under the age of 2 years
• Diabetic retinal screening and diabetic retinopathy
• Squints, long standing diplopia
• Cataracts (which should be managed via the existing Direct
Cataract Referral Scheme)
• Basic refraction
• Meibomian cysts needing excision
• Penetrating trauma*
• Orbital cellulitis*
Exclusions from the service
• Temporal arteritis*
• Ischaemic optic neuropathy*
• Suspected retinal vessel occlusion*
• Suspected cancer 2WW referrals*
• Suspect retinal detachment*
• Sudden total loss of vision*
• Significant trauma*
• Chemical burns*
• Ongoing Contact Lens complications
*In these cases, the patient should be asked to attend the Hospital Eye
Service or Accident and Emergency department (please note this may also
be after an initial face to face assessment if not diagnosed at triage).
Exclusions continued…
• Patient self referrals
• GPs
• GP practice staff
• Pharmacy
• A&E
• MIUs
• Referral management services
• NHS 111
• Other Optometrists in non participating practices
Source of referral into the service
Patients will be signposted into the service by GP’s or GP staff.
These patients should be advised to contact their chosen optical practice via
telephone.
It is essential that patients are advised to telephone the practice and do not
present to practice expecting to be seen immediately. This is a service with
appointment provision based on triage assessment and is not a walk in service.
Patients may not be given an appointment within the service if deemed
inappropriate for the service. Patients maybe advised to self care, attend a
pharmacy or to attend A&E.
Referral
A patient will be triaged within 24 hours of of patient contact.
Patients presenting with URGENT symptoms should have a clinical assessment
within 24 hours.
Patients presenting with ROUTINE symptoms should have a clinical assessment
within 5 working days.
Where a practice is unable to see the patient within this timeframe the patient will
be referred to another CECS practice where possible. Where this is not possible,
a clinical judgement will be made if it is safe for the patient to be seen out with
the usual timeframe, or if referral to GP out of hours service or HES is indicated.
Triage
Patients will be assessed for their presenting condition and the
outcome will be one of the following:
Discharge (with advice)
Follow up within the service
Referral to GP for other health care needs
Referral to HES (routine)
Referral to HES (Urgent/Emergency)
Assessment
Urgent/Emergency referrals
These will be processed directly by Opera to the appropriate email
within the Trust.
Routine referrals
All routine referrals will be directed via the Referral Support Service
where patient choice will be offered.
Onward referral
Discharge will occur when the patient’s ophthalmic issue has been
resolved or an appropriate shared or self-care programme has been
fully implemented.
When transferring a patient to their GP, a copy of the discharge letter
including the management plan will be sent to the patient.
Discharge
Patients with suspected glaucoma following a GOS or private sight test due to
visual field and nerve head indications can access the service; unless:
They are identified as having other signs of glaucoma and should be referred to
secondary care (via their GP or using locally agreed referral protocol as
appropriate) without further refinement
This service is not for patients presenting with signs of suspect glaucoma that
the Practitioner would normally refer to secondary care on the basis of the initial
readings e.g. high IOP and obviously cupped discs. If the discs alone are
suspicious then the patient should be referred to hospital regardless of any other
parameters
Glaucoma repeat testing
1. If a patients IOP is found to be between 24-30mmHG it should be
rechecked on a separate occasion, (i.e. a different day) using an
applanation method (Goldmann or Perkins type) tonometry.
2. If there is a field defect present, the practitioner should repeat the
visual fields full or supra threshold technique – not Frequency
Doubling Technique (although this can be done as the ‘first’
fields). Repeat fields should be done on a separate day.
Glaucoma repeat testing
Patients under the age of 18
Patients who are not the commissioning responsibility of Vale of York
CCG and North Yorkshire CCG.
Exclusion
The following would not be eligible for the service and should be
referred urgently via the locally agreed protocol.
1. Acute glaucoma (angle-closure or rubeotic) – such cases should
be referred as an emergency via the accepted emergency referral
method.
2. Patients with new IOPs of 45mmHg and over should be referred as
an emergency. Please note IOP>31mmHG should be discussed
with acute service triage and have same day emergency review.
3. Patients with pressures over 35mmHg (and less than 45mmHg) or
raised pressure in the presence of active uveitis should also be
considered urgent.
Urgent referrals
Patients should be offered the initial repeat reading on the same day
as their sight test.
Second repeat tests should be completed within 14 working days of
the initial repeat.
Time frame for repeats
1. Should a patient fail to arrive for an appointment, the ophthalmic
practitioner must contact the patient or parent/carer within one
working day, informing them that they have missed their
appointment, and asking them to arrange a further appointment.
2. Should a patient or parent/carer fail to re-arrange an appointment
within 7 working days of contact being made (or fail to attend or
be brought to their re-arranged appointment) then the ophthalmic
practitioner will discharge the patient to the care of their GP.
Failed to attend - FTA
GP’s and GP practice staff will sign post patients into the service
using the “find a practice tool” Find a Practice - Search for your
nearest participating optical practice (primaryeyecare.co.uk)
Please ensure that the patient is advised to telephone the practice for
initial triage. An appointment will be made based on this triage
assessed need.
If a patient is not appropriate for the service, they will be directed to
the more appropriate service – Self care, Pharmacy or A&E.
Referrals from GP into the service
If any GP practice would like further training for their front of house
staff this can be arranged with the support of Primary Eyecare
Services.
Please contact Naomi or Angela to register your interest.
Support from Primary Eyecare
Patient information leaflet
Primary Eyecare Services Website
Supporting documents
