Community Glaucoma Service (CGS): island communities impact assessment

Assessment

Our assessment has not identified any unique impacts in island communities. Challenges in implementing CGS in an equitable way across the country are also applicable to rural areas on the mainland of Scotland.

Potential barriers and wider impacts

As mentioned previously in the document, it is not currently possible to provide the CGS in all the islands referenced as they do not all have optometry practices, and where there are practices not all have an IP optometrist.

In addition to these supply side challenges, the demographics of island communities may mean that there is a higher proportion of eligible CGS patients than in the general population as the islands have a higher proportion of elderly residents. As mentioned earlier, age^[10] is the greatest risk factor for developing sight-threatening conditions including glaucoma, presbyopia, cataract and age-related macular degeneration.

There may also be a financial disparity between island and mainland communities, as well as between larger and smaller islands. This may mean that some island residents may be unable to afford the cost of travel to CGS practices.

Steps taken to address barriers To expand the number of IP optometrists, the Scottish Government provides funding to NHS Education for Scotland to support optometrists to obtain the IP qualification. In addition, the Scottish Government is supporting the rollout of a new Master’s Optometry degree which will enable all students to graduate with the IP qualification (the only country in the UK where this will be the case).

The Scottish Government is also considering the possible introduction of a scheme for the reimbursement of travelling expenses applicable to some CGS patients.

As mentioned previously, registration with the CGS is voluntary. Should the patient be unable to access the CGS where they reside, they can continue their treatment at their HES location.

Conclusion

In conclusion, the Scottish Government does not consider it is required to complete a full ICIA for the CGS, on the basis that there are no unique impacts on the island community. 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.

The requirements for the CGS are such that it must be delivered in a practice-based setting and therefore it is not possible to deliver the service in areas where there are no optometry practices.

Where sufficient community optometry capacity is present, the CGS will give all eligible island residents access to the same service as that received on the mainland.

Ongoing evaluation and monitoring

NHS National Services Scotland will be undertaking service evaluation and will ensure that aspects specific to island communities are included within this as part of the evaluation process.

It will be the responsibility of the relevant territorial Health Board to identify any specific indicators or targets that require monitoring. The relevant territorial Health Board will also be responsible for measuring the outcomes on the islands.

Future policy decisions

In terms of future policy making and service delivery, the ICIA process has highlighted that in order to deliver enhanced community-based eyecare services there must first be sufficient capacity for the provision of NHS eye examinations under GOS. In addition, specifically with regards CGS there must also be a sufficient number of IP community optometrists working across Scotland.