South-west London (Moorfields Croydon) community glaucoma service

The challenge

Glaucoma outpatient services in south-west London were under increasing pressure from high volumes of routine follow-up activity. A large proportion of patients were clinically stable but required ongoing monitoring, limiting hospital capacity to prioritise higher-risk individuals. This contributed to delays, reduced efficiency and increasing clinical risk across the pathway.

The approach

The system developed a community glaucoma service (CGS) delivered by primary care optometrists focused on synchronous management of low-risk and stable patients outside hospital settings. The aim was to shift appropriate demand into community settings while maintaining consultant oversight, improving access and preserving hospital capacity for complex care.

The model was deliberately designed to combine clear clinical standards, structured workforce capability and strong governance, ensuring community delivery could be trusted and scaled.

How it was delivered

• Defined clinical cohorts: Clear inclusion and exclusion criteria (e.g. stable ocular hypertension and glaucoma suspects) ensured patients entering the pathway were appropriate.
• Standardised capability: Minimum training requirements (e.g. College of Optometrists higher qualifications in glaucoma ) ensured consistency in clinical practice.
• Equipment standards: Community providers were required to have appropriate diagnostics (OCT, visual fields, applanation tonometry).
• Digital integration: Electronic referral, discharge and data-sharing mechanisms enabled continuity of care and  consultant oversight.
• Governance framework: Shared SOPs, escalation processes and monthly audit reviews ensured quality and safety across settings.

Impact

• 88 per cent of patients were safely managed in the community, with 66 per cent retained within the CGS for monitoring, and 22 per cent discharged back their GP avoiding ongoing hospital follow-up.
• Only 12 per cent required escalation back to hospital care, demonstrating appropriate cohort selection and clinical decision-making.
• Patient satisfaction was 98 per cent positive, with feedback highlighting improved convenience and accessibility.
• Clinical safety was maintained, with no evidence of harm even in cases where delays occurred.
• Clinical audit demonstrated good concordance in decision making between primary-care optometrists and hospital clinicians demonstrating safe patient care.

Key learning

• Clarity and standardisation drive confidence, well-defined cohorts, protocols and competencies enabled safe decentralisation.
• Governance and connectivity are critical: shared SOPs, audit and digital and data flows allowed hospital teams to trust community-delivered care.
• Integration matters as much as capability, honorary contracts and shared governance created a single system model rather than parallel services.