Community Glaucoma Service (CGS): island communities impact assessment

Policy Objectives

The policy involves Scottish Ministers directing Health Boards to deliver a national CGS for eligible patients.

The CGS involves the Hospital Eye Service (HES) discharging lower risk glaucoma and treated ocular hypertension patients into the community. These patients will then register with accredited providers and be managed by accredited clinicians (Independent Prescriber (IP) community optometrists) who have attained appropriate accreditation in the treatment and management of glaucoma and ocular hypertension.

The CGS provides patients with more timely access to treatment, often closer to home, whilst significantly reducing hospital waiting lists. It is not possible to provide the CGS from a person’s place of residence for clinical reasons, which relate to the equipment required to deliver the service.

This ICIA specifically assesses the impact of the policy on island communities in so far as it is relevant to the legislation for CGS, which form Ministerial Directions^[1]. It sets out the approach to assessing the potential impacts on island communities of the CGS and considers how the actions could have both positive and negative impacts. It also includes the unique challenges of providing these services in rural areas.

The responsibility for determining whether an ICIA is required with regards to the local implementation of this policy at Health Board level is a matter for each territorial Health Board to consider.

Island identification

The 2011 Census (Inhabited Islands Analytical Report^[2]) has been used to identify relevant island communities. By territorial Health Board, these are categorised as follows:

• NHS Shetland
• NHS Western Isles
• NHS Ayrshire & Arran – Arran, Great Cumbrae
• NHS Highland – Bute, Skye, Raasay, Seil, Easdale, Kerrera, Lismore, Luing, Gigha, Islay, Jura, Mull, Iona, Tiree, Coll, Colonsay, Eigg
• NHS Orkney

Intended impact and outcomes for the islands

The intended impact of the service is to deliver a national community-based service regardless of where the patient lives. The service will be provided by accredited clinicians based in a network of accredited community optometry practices.

Introducing CGS will have the potential to significantly impact island communities in receiving quicker and more sustainable access to eyecare services. This will have the added benefit of reducing hospital waiting times for other patients awaiting eyecare treatment.

However, it should be noted that due to the low number of community optometry practices in some of these locations, and the corresponding low number of optometrists who are qualified to deliver the service, there are some challenges in ensuring consistency of CGS provision across the islands.

In addition, the size of the island may impact on the capacity to support CGS provision. As this is a practice-based service, population size will largely determine whether it is viable for an optometry practice to be established on a particular island. There can often be other factors (such as housing, transport, education) which determine whether optometrists choose to practice on a particular island.

Introducing CGS

The CGS is a new policy. To date, CGS eligible patients have been mostly managed by the NHS in a hospital setting.

Although provision of the CGS is new, the Scottish Government has already started to address disparities between services provided on the islands compared to that on the mainland. This includes the provision of targeted financial support for eligible visiting and peripatetic services in rural and island areas.