Is Optometry Missing from Your Neighbourhood Health Discussions?

Many of us forget that primary care is actually four disciplines: general practice, community pharmacy, dentistry, and optometry.

And one of those disciplines is sitting right there on your high street, often within 10 minutes of where you live, with the capacity and capability to take significant pressure off both GP practices and A&E departments: optometry.

In a recent episode of The Business of Healthcare podcast, I spoke with Dharmesh Patel, Chief Executive of Primary Eye Care Services.

We discussed why optometry so often gets left out of neighbourhood planning, the practical barriers they face, and what it would actually take to properly include them in integrated care discussions.

If you're leading a neighbourhood team or planning integrated services, this conversation might change how you think about who needs to be in the room.

Let's jump in!

Optometry: The Opportunity We're Missing

In a recent episode of The Business of Healthcare Podcast, I spoke with Dharmesh Patel, Chief Executive of Primary Eye Care Services and an optometrist by background.

Dharmesh leads an organisation working with over 3,000 optometry practices across 30 Integrated Care Boards, delivering both private and NHS services.

And what he shared was both exciting and frustrating in equal measure.

Ophthalmology is one of the biggest causes of hospital outpatient attendance in the UK. Yet optometry, the community-based service that's already embedded in neighbourhoods across the country, is often left out of the planning conversations.

It's exactly the same challenge we've had in general practice for years: being expected to deliver more, whilst not being properly included in the strategic discussions about how that happens.

What Could Be Possible?

When people wake up with a red, sticky eye, where do they go? To their GP. But why? Because that's what we've always done. It's behavioural, it's habitual, and it's putting unnecessary pressure on general practice.

Your optician can manage that red eye. They can assess it, treat it if appropriate, or refer it onwards if needed. They can also manage a wide range of other eye-related issues that currently clog up GP appointments and A&E waiting rooms.

The infrastructure is already in place, as optometry doesn't face the same workforce challenges as general practice. They have the capacity, the capability, and the willingness to be involved in a more intergrated way.

The Same Barriers, Different Discipline

Whilst workforce issues are not on the same scale as general practice, optometry does face many of the same barriers we've been wrestling with in general practice:

Funding - The money doesn't always follow the policy intent. Enhanced services are commissioned with the expectation of delivery, but without the resources to make it viable.

Digital infrastructure - If we're serious about integrated care, we need systems that actually talk to each other. However, outside of general practice, there's limited support for digital infrastructure across the wider primary care sector.

Estates - There's no funding or support for optometry premises in the way there is for general practice. Conversations about co-location in community health centres often fall apart on the financial case.

Behavioural change - This is perhaps the biggest challenge of all. How do you shift decades of patient behaviour? How do you change the ingrained habit of "go to the GP for all health problems"?

These are the exact conversations we've been having in PCN meetings for years.

Starting with Everyone at the Table

Dharmesh's message to those of us leading integrated neighbourhood teams was simple and clear: be inclusive from the beginning.

Don't start with a few disciplines and then expand. That "we'll add them later" approach? It rarely happens in practice. Start by having everyone at the table and work out what each discipline can contribute, then build from there.

During our conversation, I raised the practical challenge. We've all been to meetings that felt like a waste of time. And organising a meeting with 10 or 15 people when everyone has completely different schedules is genuinely difficult. It does need careful crafting.

My view is you need a bit of a disclaimer when you're bringing these groups together: this may not be perfect, it may not be relevant to everyone, but we want to understand what the challenges are, what the patient journey looks like, and what it could look like if it were better or different.

We're still learning and developing who the right people are that need to be in these meetings. But you have to start somewhere.

Bring the four primary care disciplines together first, and explore whether we're missing something.

Otherwise, we're going to get the same answers to the same questions again and again.

And Dharmesh made an excellent point about primary care provider collaboratives. If we can get the four contractor groups working together at a system level – ensuring the strongest possible voice for primary care – that's really powerful. It means you can have those enabler conversations: "This is happening over here on diabetes, is optometry relevant?" And you make sure the right people are involved.

It comes down to trust and relationship building. The maturity to say, "I'm not in that room, but it's okay because if there's something relevant to optometry, they'll come and speak to me." But you can only get to that point if you've done the groundwork at the beginning.

And his message to patients was equally straightforward: your optician should be your first port of call for your eye care needs.

Not your GP. Not A&E. Your local optician.

Why This Matters

The 10 Year Plan talks about shifting care from hospitals to communities. It discusses ways to make better use of our existing workforce. It talks about reducing pressure on overstretched services.

Optometry can deliver on all of those things. Right now. Today.

But only if we actually include them in the planning conversations.

Only if we fund services appropriately.

Only if we build the digital infrastructure that makes integrated care possible. And only if we help patients understand where to go for what.

It's not revolutionary. It's not complicated. It's just about recognising that when we say "primary care," we need to mean all four disciplines – not just the one we're most familiar with.

If you found this useful, we would love it if you shared it with colleagues who might benefit. And if you want to hear the full conversation with Dharmesh, you can find it on The Business of Healthcare Podcast wherever you listen to podcasts.

About Us

THC Primary Care is an award-winning healthcare consultancy specialising in Primary Care Network Management and the creator of the Business of Healthcare Podcast. With over 20 years in the industry, we've supported more than 200 PCNs through interim management, training, and consultancy.

Our expertise spans project management and business development across both private and public sectors. Our work has been published in the London Journal of Primary Care, and we've authored over 250 blogs sharing insights about primary care networks.