Evaluation of the Community Urgent Eyecare Service in Greater Manchester, Including the Impact of Independent Prescribing.

PURPOSE: Community Urgent Eyecare Services (CUES) utilises primary care optometrists to reduce urgent eyecare demand within ophthalmology and general practice (GP). This large-scale study evaluated CUES in Greater Manchester (GM), including assessing the embedded Independent Prescribing (IP) pathway.

METHODS

This retrospective, GM-wide analysis evaluated CUES data from 1st January to 31st December 2024. Primary care data included patient pathways, case mix and IP outcomes. Index of Multiple Deprivation (IMD) deciles were assigned to explore socioeconomic associations with CUES access. Secondary care data included sampling CUES referrals to Manchester Royal Eye Hospital (MREH), assessing diagnostic agreement with Eye Emergency Department (EED) clinicians and determining the proportion of cases potentially manageable by IP optometrists in primary care.

RESULTS

In 2024, GM CUES managed 54,994 patients; 69.9% were self-presenting, and 78.2% were assessed, managed and discharged without referral. Furthermore, 5.2% of cases were referred to General Medical Practitioners (GPs), resulting in 83.4% overall being retained in primary care. Patients in the most deprived IMD decile attended more frequently. IP-episode discharge rate was significantly higher (87.5%, p = 0.000001) than non-IP episodes (78.1%). In the referred sub-sample, diagnostic agreement with EED clinicians was 75.0%, with 40.0% of these cases being potentially manageable within primary care had IP capacity been available. Primary care National Health Service prescriptions (FP10 prescriptions) were issued for 73.0% (N = 362) of IP cases with corticosteroids (43.7%, N = 190), antibiotics (14.3%, N = 62) and antimuscarinics (12.4%, N = 54) being the most common.

CONCLUSION

GM CUES managed and discharged most cases in primary care, reducing GP and EED demands. Greater IP optometrist availability could broaden CUES' scope and increase effectiveness.