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Essex LOC successfully implements new children’s pathway

30 August 2019

Being told your young child has failed vision screening and needs further assessment is an anxious time for any parent or caregiver. Waiting for appointments in a hospital setting can add to this anxiety and delay the start of treatment, if it is needed. Essex LOC has been working hard to address this issue and reduce the burden on hospital ophthalmology departments by implementing a pathway based on LOCSU’s Children’s Pathway, with remarkable success.

Children's eye test


Previously, all children who failed the vision screening offered during the first year of school were referred to a clinic at Southend Hospital. Eighteen months ago, pressures on the hospital ophthalmology department meant that waiting times for children’s appointments in the region had reached up to 18 weeks; it became clear that a service innovation was needed.

Essex LOC began working closely with the hospital to implement a system that means patients are seen in primary care optical practices. This approach utilises the advanced skills of Optometrists and Dispensing Opticians, with the clinical work-up including a cycloplegic refraction and a fundus assessment, in line with RCOphth recommendations. The service initially went live in South Essex and has since rolled out across five CCG areas across Essex.

There are several major advantages to this approach for young patients. They can be seen at a time and in a place convenient to the family, with no need to take time out of school or work. If glasses are prescribed, these can be dispensed in the same setting so the child benefits sooner and follow-up appointments are easier to schedule. Optical practices are also a more familiar and less stressful environment than a hospital setting for young people and their families. By implementing a structured set of requirements, all children have the same detailed assessments and are prescribed spectacles before any referral to hospital, if still deemed necessary.

Thanks to this shift in approach children who fail vision screening at school are now seen within two weeks in a local optical practice. This also has the welcome effect of releasing capacity in the hospital ophthalmology department for any children requiring specialist intervention, meaning their waiting time is also reduced. Any child seen within the hospital eye department now needs fewer appointments, as they have already received a comprehensive initial assessment.

Sheila Purser, Chairman at the Essex LOC explains the scale of the success and the outcomes they have achieved implementing the children’s pathway: “The waiting time for appointments has been reduced to just two weeks and, since the pathway has been in place, 857 children have been fully managed in primary care [figures up to the end of July 2019]. These children would previously have automatically been referred into the hospital eye service. This has restored much-needed capacity to hospital ophthalmology departments.

“Achieving such a successful outcome is testament to the commitment and hard work of all the stakeholders, from Southend Hospital Eye Department, Essex LOC, the Mid/South Essex STP and Optical Practitioners who were determined to improve the process for young patients and their families. We are now making the best use of the skills and capabilities of primary eyecare practitioners to provide a much better, more efficient pathway for children’s eyecare.”

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