Delivering eye care closer to home: enabling it at scale from acute to community
8 July 2026
Across England, ophthalmology is one of the largest and fastest-growing outpatient specialties. Demand continues to rise, driven by an ageing population, improved detection and the long-term management of chronic eye conditions. At the same time, capacity within hospital eye services remains under sustained pressure. Long waits, delayed follow-up and unwarranted variation in access are no longer isolated operational challenges:
The ambition to deliver eye care closer to home through community-based services supported by integrated pathways is now widely accepted as essential for improving access, safety and sustainability:
Many systems have demonstrated pockets of success but these approaches are not yet consistently embedded or spread across whole pathways.
This publication draws on the insights of an eight-month national programme from the NHS Alliance, delivered in partnership with Primary Eyecare Services, which supported systems to create plans and explore redesign of eyecare pathways so that care can be safely delivered in community settings. The programme involved over 100 participants ranging from commissioners, operational and finance leaders to consultant ophthalmologist, optometrists and local optical committee leads. These participants spanned seven systems in England, incorporating acute trusts, community providers, primary care, integrated care boards and national stakeholders. A consistent message emerged throughout the programme: the barrier is no longer knowing what good looks like, it is enabling it to happen reliably and consistently across whole systems.
This guidance, aimed at system and commissioning leaders, acute and community provider leaders, clinicians involved in managing eyecare and transformation leaders, highlights core enablers for shifting eye care closer to home and the practical actions local systems can take to translate them into tangible steps. While some of the challenges described also require national action, this guidance outlines where local leadership, collaboration and pathway redesign can drive meaningful progress. Our separate national policy briefing outlines the system-level changes required to support and accelerate this shift at scale.
“We don’t have a knowledge problem anymore, we have an execution problem. The question is how we make this work consistently across the system, not whether it works.”