Informal consultation on Ophthalmology services: joint report by Healthwatch City of London and Healthwatch Hackney

Healthwatch City of London and Healthwatch Hackney were asked by the local CCG to carry out surveys and focus group with users who have experience of using services for visually impaired people to understand the need for a community based ophthalmology service.  They spoke to 51 people.

Overall, participants were supportive of the idea of delivering more eye care services closer to home in community settings, rather than in hospitals. This reflected wider NHS aims to improve accessibility, reduce pressure on hospital services such as Moorfields Eye Hospital, and ensure patients receive care in the most appropriate setting. 

Patients generally rated the quality of care at Moorfields Eye Hospital as excellent, highlighting staff expertise and confidence in diagnosis and treatment. However, long waiting times and overcrowding were common concerns, with many patients reporting that visits could take most of the day. 

A key theme across the consultation was the importance of high-quality clinical expertise. Participants wanted assurance that any community-based services would be delivered by skilled professionals, with strong links to specialist hospital services for more complex conditions. They emphasised that Moorfields should remain the “gold standard” for specialist care, particularly for rare or serious eye conditions. 

Patients also highlighted inconsistencies in current referral pathways, particularly through GPs, noting that some GPs lacked specialist knowledge of eye conditions and were slow to refer patients. In contrast, optometrists were viewed as highly skilled and better equipped to detect early eye problems, leading many participants to support stronger integration of optometrists into care pathways and allowing them to refer directly to hospital specialists. 

However, there were concerns about regulation, as optometrists are not always overseen by the Care Quality Commission (CQC). Patients consistently stated that all providers in any new service should be subject to the same regulatory standards to ensure quality and safety. 

Accessibility and convenience were also major considerations. Participants valued services that were easy to reach, well signposted, clean, and comfortable. They supported faster access to appointments, including same‑day or next‑day assessments for urgent but non-emergency conditions, which are currently often seen in hospital A&E due to lack of alternatives. 

While most participants supported community-based care, some raised concerns about potential risks, including reduced expertise, lack of access to full patient records, and possible fragmentation of services. There was a strong preference for new services to be fully integrated with existing hospital pathways and to maintain clear links to specialist care. 

The report concludes that community ophthalmology services could be beneficial if designed carefully. Recommended features include building on existing networks such as Moorfields’ satellite services, ensuring high clinical standards and consistent regulation, improving referral pathways, enabling direct referrals from optometrists, and locating services in accessible areas. Outreach work to underserved communities and long-term commissioning arrangements were also identified as important for success. 

In summary, patients were broadly positive about shifting some eye care into community settings, but stressed that this must not compromise quality, expertise, or integration with specialist hospital services.