Community Glaucoma Service (CGS): island communities impact assessment

Data and Stakeholder Identification

Background data

Island populations and eye examination data

Data from the 2022 Census is unavailable at the time of publication, however data from the 2011 Census recorded 93 inhabited island communities in Scotland, totalling a population of 103,700 (2% of Scotland’s population)^[3]. Fluctuations in population growth have been experienced since 1991-2011, with the 4% increase from 2001-2011 reversing the 3% decrease between 1991-2001^[4]. Island communities have an ageing population compared to Scotland as a whole. The median age of 45 sits above the national average of 41 and 21% of residents are aged 65+ compared to 17% in Scotland, while the islands population of under 16’s decreased to 17% in 2011 from 20% in 2001.

The volume of NHS General Ophthalmic Services (GOS) eye examinations undertaken by population size in each Health Board in Scotland is available. The most recent data available is from 2022/23 and is published by Public Health^[5] Scotland. The data is available at Health Board level only.

Island Optometry Practices

The location of CGS practices, and details of journeys to those practices, have been mapped out for the islands previously referenced.

There are currently eleven GOS practices on the islands, and of these four have been approved to provide CGS. It is not currently possible to increase this to all eleven practices as the seven who are not approved do not have an IP optometrist. In order to undertake the CGS training accreditation course, and thus provide CGS, an optometrist must first be IP qualified.

CGS patient forecast and age as a glaucoma risk factor The service is designed to have capacity for 20,000 patients (0.36% of the Scottish population) to be registered under the CGS. Using data from the 2011 Census, there are 103,571 patients in the islands previously referenced. This would suggest that there are approximately 327 patients who could be eligible for the CGS. It is, however, suspected that this will be higher as the islands have a higher proportion of elderly residents.

Age is the greatest risk factor for developing sight-threatening conditions. The prevalence of glaucoma, presbyopia, cataract and age-related macular degeneration increase sharply with age^[6], although glaucoma and ocular hypertension can also affect members of the working population.

CGS locations and travel

The situation for CGS provision in each relevant Health Board, including travel, is as follows:

• NHS Shetland – a CGS practice is located in Lerwick, which is on the mainland of Shetland. This will deliver an improvement for patients in terms of appointment access and flexibility.

Inhabitants of the following islands will have more significant travel than those on the mainland of Shetland or other islands in Shetland: East Burra; Muckle Roe; Tondra; West Burra. The following nearby islands can reach the mainland of Shetland via ferry and road: Bressay; Fair Isle; Fetlar; Housay; Unst; Whalsay; Yell.

• NHS Western Isles – CGS practices are located in Stornoway, Benbecula and Barra. In addition to appointment access and flexibility, patients residing in this Health Board area will benefit from treatment closer to home.

These locations will provide care to residents of Barra; Benbecula; Berneray; Erisky; Great Bernera; Grimsay (North); Lewis & Harris; North Uist; Scalpay; South Uist; Vattersay. Inhabitants of these islands are able to access this service by relatively short road travel.

• NHS Ayrshire & Arran – CGS practices are located on the mainland. This will deliver an improvement for patients residing on Arran and Great Cumbrae as they will be required to travel a shorter distance than they do currently to receive treatment. Arran residents would travel to Irvine via a ferry to Ardrossan and a 6 mile journey by road, whilst Great Cumbrae residents would travel by ferry to Largs.
• NHS Highland – as CGS practices are located on the mainland, the impact is limited in terms of benefits, and islanders therefore have longer distances to travel to CGS practices than those on the mainland.

The islanders of Seil and Skye have to travel over 90 miles by road to access their closest CGS practice. Residents of Bute, Coll, Colonsay, Easdale, Eigg, Gigha, Iona, Islay, Jura, Kerrera, Lismore, Luing, Mull, Raasay and Tiree need to travel to their closest CGS practice by both ferry and road. These journeys vary in ferry time and road distances that range between 6 and 105 miles.

• NHS Orkney – there are currently no CGS practices in this Health Board area and patients will remain under the care of the HES.

Data differences between islands

Although tools such as the Scottish Index of Multiple Deprivation^[7] provide some localised information, little data is available which differentiates specifically between each island. As stated in the National Islands Plan^[8] ‘currently, there is a lack of robust disaggregated socio-economic data at the island level, particularly publishable data’.

ICIA mitigations

Registration with the CGS is voluntary. Should the patient decide that they do not wish to be treated in a community setting then they can continue their treatment at their HES location.

Currently patients who travel to HES, and who meet certain criteria, are entitled to reimbursement of expenses incurred when travelling to their hospital appointments. Consideration will be given to ensuring that CGS patients continue to benefit in some way regarding appropriate reimbursement of travelling expenses.

The University of the Highlands and Islands is forecast to significantly increase the student intake for their optometry undergraduate degree course in the forthcoming years. This should have a positive impact on optometry services in the Scottish islands, including with regards to the capacity to provide CGS.