The NHS faces a growing challenge in meeting demand for eye care. Ophthalmology is now the largest outpatient specialty in England, with almost 9 million appointments delivered in 2023-24 alone.
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Demand continues to rise, costs are increasing, and although cataract waiting times have improved, long waits remain across many other eye care specialties. At the same time, more than 5,000 optometry practices operate across England, providing an established workforce, clinical expertise, equipment and local facilities embedded within communities.
Recognising this opportunity, Lancashire and South Cumbria Integrated Care Board (ICB) set out to redesign eye care services around patients and communities. The ambition was to reduce pressure on hospital services, improve access and equity, address historic variation in provision and deliver more care closer to home. This approach aligned with wider NHS ambitions to shift care from hospitals into neighbourhood settings, while supporting sustainability goals and creating a more joined-up experience for patients.
Working closely with Primary Eyecare Services, local optometrists, hospital teams, commissioners and voluntary sector partners, the ICB commissioned a range of community-based services, including urgent eye care, post-operative cataract care, glaucoma services and support for people living with sight loss. The programme was designed to ensure that patients receive the right care, in the right place, at the right time.
The results have been impressive. In 2025-26, one service alone generated savings of more than £1.26m, while preventing more than 11,400 accident and emergency department attendances, 21,500 GP appointments and almost 6,800 hospital appointments. By making better use of community-based optometry services, the system has released valuable hospital capacity while improving access for patients.
A key success has been the shift of routine care from hospitals into local community settings. Between April and December 2025, more than 7,100 post-operative cataract appointments were delivered outside hospital. The vast majority of patients were managed successfully within the community pathway, with more than half discharged directly following first-eye surgery and many others progressing to planned second-eye surgery. Only around 10 per cent required referral back to hospital because of post-operative complications. Community urgent eye care services have also reduced unnecessary referrals into hospital and GP services, helping patients access faster support closer to home.
The programme has gone beyond clinical services. New support pathways, including the Royal National Institute of Blind People Waiting Well programme, eye care liaison officers and the eye care navigation service, are helping patients navigate their care and access practical and emotional support throughout their journey. Early results from the eye care navigation service show how a single point of access can direct people to the most appropriate service, reducing unnecessary hospital demand and improving system flow.
Most importantly, Lancashire and South Cumbria demonstrates exactly how neighbourhood health can become a reality. The model supports GP access by diverting eye care activity away from general practice, reduces avoidable emergency department attendances, lowers demand on hospital outpatient services, supports prevention and early intervention, and provides patients with convenient care closer to where they live.
The key lesson is that transformation is possible when organisations work together around the needs of local people. Through strong collaboration between primary care, secondary care, commissioners, voluntary organisations, and patients, Lancashire and South Cumbria has created a scalable model that improves outcomes, tackles inequalities, and makes better use of NHS resources. As neighbourhood health becomes the future direction of the NHS, this programme offers a practical blueprint that other systems can follow.
Primary Eyecare Services is a not-for-profit provider of primary eye care services at scale, working across more than 800 neighbourhoods in partnership with NHS commissioners, trusts and local optical committees (LOCs). By coordinating and supporting community optometry services, Primary Eyecare Services helps local systems make better use of existing eye care capacity, enabling more patients to access high-quality care closer to home.
