NHS sight tests lead to waste

Michael Clarke, Consultant Ophthalmologist at Newcastle Eye Centre, says that apart from trauma and orthopaedics, ophthalmology receives more NHS outpatient referrals than any other speciality.

He says that opticians are constrained by legislation to refer patients to a medical practitioner if abnormalities are found at an NHS sight test. However, the testing done at NHS sight tests has become more complex and many patients are now referred with clinically insignificant abnormalities, leading to wastage of appointments in Hospital Eye Services.

So called 'Eye Health Checks' now increasingly done as part of NHS sight tests are effectively screening tests which have never been subject to the scrutiny of the UK National Screening Committee". Clarke says these checks represent a form of screening limited to people who access NHS sight tests and consent has not been sought, either from individuals or "society as a whole".

He says there are many false positive referrals, causing unnecessary anxiety and waste of resource – which account for "up to 30% of all new ophthalmology referrals".

Clarke suggests that GPs may feel pressured to refer patients with identified minor abnormalities to hospitals, which may then affect the care of patients with serious eye disease. He says that the solution will involve a greater engagement of general practitioners with referrals for eye disease, as optometrists have no incentives to reduce demand on hospital services.

He says that if such solutions are not found then "the future for may lie in a mixture of NHS and private care such as now exists in dentistry" and that the NHS "must find a solution to the waste generated by unnecessary referrals".

Clarke concludes that "it's time for ophthalmologists to step into the light, engage with general practitioners and commissioners, and demand that is subject to the same evidential requirements as other medical specialities."

More information: www.bmj.com/cgi/doi/10.1136/bmj.g2084

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