Out of Hours position statement: February 2025

In 2024, the Welsh Government approached the Welsh Optometric Committee (WOC) to ask for an opinion and position on “Out of Hours” healthcare provision within optometry. In tandem with more services and clinical responsibility migrating to primary care from secondary care services (progressively since October 2023), there was consideration of the limit to these services in terms of reasonable service hours.

A patient who experiences an acute eye problem must be triaged appropriately and signposted to an appropriate service. Prior to Wales General Ophthalmic Service (WGOS), these options consisted of the patients’ general practitioner (GP), community pharmacist, hospital eye services or A&E, or the patient’s optometrist or accredited contact lens optician providing Wales Eye Care Service (WECS) appointments.

Since the implementation of WGOS in October 2023, all seven health boards have launched their “WGOS5 Urgent” pathways. This pathway allows a patient who is seen by a WGOS practitioner to be referred to a geographically local Optometrist who is an Independent Prescriber (IP). The legislation and the GOC Rules (General Ophthalmic Council rules) limits the scope of practice of an IP optometrist to "the treatment of ocular conditions affecting the eye or adnexa" and drugs which are not controlled drugs or for parenteral administration. In addition, it is now compulsory for all practitioners wishing to offer NHS WGOS services to also be qualified and able to offer WGOS2 appointments within a clinically appropriate timescale.

Both WGOS2 and WGOS5 work to provide a holistic primary care service covering triage, examination and management the vast majority acute ophthalmic presentations.

The WOC has debated the definition of “Out of Hours” and believes this to mean any presentation outside of the traditional hours of 9am to 5pm, Monday to Friday. This is in line with other healthcare professionals, both in primary and secondary settings. Optometry practices are dual retail and healthcare, by this nature often opening on weekends and some early evenings, at individual discretion. Data compiled across all 7 health boards show there is IP Optometrist cover within each health board working across all “regular” clinical hours, with additional availability on Saturdays in all seven health boards, and Sundays in four health boards.

WOC also discussed “true” ophthalmic emergencies, those being presentations which were sight-threatening and required immediate medical intervention. From an A&E standpoint it was noted that there are very few of these presentations, all of which are particularly rare. A patient who presented to an A&E department “out of hours” could be appropriately signposted to an optometrist within “regular” clinical hours, for which there is availability within 24 hours of a given presentation time. For those patients with urgent post-operative concerns, it would be appropriate to refer to the secondary care hospital unit where the surgery was performed, where out-of-hours triage systems already exist.

The WOC agree primary care optometry offers a holistic service within WGOS 1 to 5 and meets or exceeds regular clinical hours across all health boards in terms of service availability. Providing additional out of hours services would diminish the capacity of the profession to deliver consistent, high quality core services during regular hours.

Optometrist independent prescribers should be able to prescribe any licensed medicine for ocular conditions, affecting the eye and adnexa, within their recognised area of expertise.

WOC also discussed the best way to encourage the public to use the services provided by primary care optometry, in particular to convey that optometry is the most appropriate profession for all eye conditions.

WOC will meet with the Welsh Medical Committee to discuss best practice for interprofessional communication, and possible additional awareness and training for GP’s around WGOS services on an all-Wales basis.

Health Board held lists of IP service availability are to be circulated to all Primary care optometry practices, all local community pharmacies and GP surgeries, as well as with all other allied health professions who provide primary care services.

Optometrists will become familiar with the use of signed orders and their ability to issue appropriate medications without reliance on CAS, IPs or GPs.

Optometry Wales to meet with Community Pharmacy Wales to ensure all pharmacists are aware of service changes within the optometric profession.