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NHS England – Eye Care Planning & Implementation Guidance 2021-2022

27 April 2021

NHS England has published Eyecare Planning & Implementation guidance for NHS Regions, commissioners (CCGs moving to ICSs*) and NHS Trusts (hospital eye services) for the new financial year (2021-2022). Eye-Care-Planning-Implementation-Guidance-2021-22-Summary-Annexe This is now an official annexe to NHS England’s main 2021/22 priorities and operational planning guidance published on 25 March 2021.  

The overarching NHS guidance already requires ‘systems’ (i.e. CCGs merging and operating alongside NHS hospital Trusts within ICSs) to reduce variation in access and outcomes by implementing whole pathway transformations and performance in three specialties: Cardiac, Musculoskeletal (MSK) and Eye Care supported by the National Pathway Improvement Programme.  The new annexe sets out NHS England’s further requirements for eye care.

None of these affects General Ophthalmic Services (GOS) other than to require direct referrals to HES (rather than via GPs).  However, the guidance contains very positive messages about the role of primary eye care and should lead to wider roll out of extended services and the early implementation of EeRS across some systems.

The key in-year planning aims/deliverables for primary eye care, together with target delivery dates, are summarised below.  For the full text see the Summary Annexe hyper-linked above.  

At the same time NHS Trusts (HES) will be implementing hospital-specific deliverables set out in the guidance including the recommendations made by the National Eye Care Recovery and Transformation programme (NECRT). This may result in more patients attending their local optical practice for support/advice under locally commissioned services as ICSs roll out the recommendations in local areas.

Further Information

LOCs will no doubt have questions relating to this document.  Please liaise with your local LOCSU Optical Lead who will be able to work with you to engage with this process and to identify opportunities locally. LOCSU will also be working alongside the national bodies to address any issues and problems as well as to map progress. 

Zoe Richmond
Nizz Sabir
Tom Mackley
Richard Rawlinson
Max Halford
Amar Shah
Helen Haslett 


Q1 April – June 2021

NHS England regional teams should 

  • set up a strategic Eye Care Board and an Eye Care Improvement Programme with appointed regional senior responsible officer (SRO), clinical leads from ophthalmology and primary care optometry**, NHS Trust management and project management within a clear governance and escalation framework 
  • send representation to a national Eye Care Board (to be established) and share learning with other regions

ICSs should  

  • complete a scoping exercise of current provision and performance of locally commissioned extended primary care services across their area (including variation and coverage) for as a minimum

Glaucoma referral
Cataract referral and post-operative care
Urgent eyecare (MECS, PEARS and CUES)
Medical retina referral filtering (AMD and diabetic macular oedema)

plus all other non-hospital provision e.g. glaucoma long term monitoring/management, children’s eye services, low vision, medical retina long term monitoring.

NHS Trusts (HES) should 

  • put in place a Standard Operating Procedure to risk stratify all patients on the inpatient IP waiting list together with appropriate harm review processes.

Q2 July – September 2021

ICSs should 

  • establish delivery boards reporting to the regional board 
  • have in place a direct referral pathway from primary care optometry to the hospital eye service for urgent wet age-related macular degeneration
  • ensure optometrist referrals can be made direct to hospital eye services (not routinely redirected via GPs) 
  • demonstrate an increase in number of extended primary care episodes (where these services are already in place) with a corresponding reduction in traditional hospital appointments
  • undertake gap analysis for national primary care optometry and diabetic macular oedema monitoring pathways for low-risk patients and identify suitable patients

NHS Trusts (HES) should

  • ensure that correspondence with patients is copied routinely to referring optometrist as well as the patient’s GP 

Q3 October – December 2021

Regions and ICSs should 

  • complete local roll-out plans of the EeRS solutions procured with NHSX 2020/21 funding
  • set a timeline for introducing eyecare specific electronic patient records (EPRs) within their digital strategies
  • ensure all registered IP optometrists working in an urgent eyecare service (MECS or CUES) have access to FP10

NHS Trusts (HES) should

  • implement remote (telephone and video) consultations for all appointments where appropriate, possible, and safe

Q4 January 2022 – March 2022

Regions and ICSs should 

  • complete the benefits realisation analysis of the EeRS solutions procured with NHSX 2020/21 funding


  • have in place urgent eye care services in primary care optometry with ‘optometry first’ approach for all urgent (non-emergency) eye care
  • demonstrate an increase in activity for glaucoma, medical retina or diabetic eye screening (OCT monitoring) in primary eye care (where these services are in place) with a linked reduction in hospital face to face consultations
  • where they do not exist, develop a plan to implement these
  • have developed a plan for an optimal ‘optometry first’ ‘first contact practitioner’ (FCP) service for eye care

ICSs and NHS Trusts (HES) should have in place 

  • an integrated cataract referral and post-op pathway and report a decrease in post-op cataract appointments delivered in hospital (aiming for 50% cataract post-op across each system and achieving top decile cataract first appointment conversion to surgery rate of 85%)
  • glaucoma referral filtering pathways which can reduce avoidable hospital face-to-face consultations
  • medical retina referral filtering pathways which can reduce hospital face-to-face consultations

* ICSs (integrated care systems) are the new organisations which will replace merged CCGs under new NHS legislation for England to be brought before Parliament this summer.  ICSs are generally referred to as ‘system’ level in the reformed NHS as opposed to ‘place’ level which means Primary Care Networks (PCNs)

** which we interpret as the whole ‘GOS contractors, optometrists and dispensing/contact lens opticians’ community,

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