OS publishes LV services framework

New report sets out seven recommendations

Optometry Scotland (OS) has published seven evidence-based recommendations intended to inform the Scottish government as it resumes planning and development of a national Community Low Vision Service (CLVS).

Community Low Vision Service in Scotland: Considerations and Recommendations for Implementation sets out the workforce, funding, access, pathway and infrastructure required for a consistent national model. Is it suggested that the proposed CLVS could support around 10,000 people each year and enable substantially more low vision care to be delivered through community optometry.

The seven recommendations are:

1. Fund the service sustainably, reflecting the true cost of delivery
2. Build in local access, patient choice and flexible referral
3. Set a national timeline for community-based Certification of Visual Impairment (CVI)
4. Let optometrists and dispensing opticians (DOs) work to full scope
5. Get procurement, training and digital infrastructure ready before launch
6. Engage OS and stakeholders from the outset
7. Link community optometry, rehabilitation, social care, hospital eye services and the third sector in one coordinated pathway

Community optometry in Scotland already delivers an extensive and increasingly complex range of NHS-funded eyecare through General Ophthalmic Services and enhanced services including the Anterior Eye Service and Community Glaucoma Service. OS said the new service “should build on that experience and make full use of existing workforce skills”.

The paper recommends that optometrists and DOs form the core community clinical workforce. Optometrists would contribute their wider clinical expertise, while accredited DOs would have an integral and direct role, including undertaking low vision assessments within their competence, assessing functional needs, selecting and optimising low vision aids, and providing practical instruction and ongoing support. Clear service protocols should support collaboration, shared care and onward referral, alongside early workforce mapping to identify capacity, interest and training needs across both professions and all parts of Scotland.

Eilidh Thomson, OS chair, said: “Scotland already has a highly skilled community optometry workforce with the expertise and local reach to make this service work. Optometrists and dispensing opticians bring complementary skills and both must be recognised as direct providers. Protected consultation time, proportionate accreditation, straightforward claims and digital processes, timely access to low vision aids and clear referral routes must be built into the model from the outset.”

The proposed £150 fee reflects an initial or full assessment, including functional assessment, low vision aid selection, patient education, care planning, documentation and onward referral. A standard follow-up fee of £85 would cover a face-to-face appointment of up to 30 minutes with the full fee applying where a significant change requires comprehensive reassessment.

OS’s illustrative practice-cost model places the central full cost of maintaining one hour of available clinical capacity at approximately £169, meaning £150 is a pragmatic minimum rather than full cost recovery. Administration, low vision aids, equipment, training, digital infrastructure, non-attendance and domiciliary, mobile, remote and island delivery would need separate provision rather than being into the clinical fee. The proposed fees should be tested against actual activity and provider costs during early implementation, said OS.

OS recommends that the service not be operated as a standalone clinical intervention – and that national standards should define a key or link worker, or equivalent coordination function, to help patients navigate between clinical assessment, rehabilitation, social care and third sector support. It also recommends that community-based CVI should be planned alongside the service, with access to wider support based on need rather than delayed pending certification.

Frank Munro

Regarding national procurement, this should provide an appropriate range of optical, non-optical and electronic aids, with systems designed for timely provision at the point of assessment, said OS – adding that “digital infrastructure must support clinical delivery, ordering, referral, claims, data capture and monitoring without creating unnecessary administrative burden for practices”.

Frank Munro, chair of the CLVS Short Life Working Group, said: “These recommendations are intended to inform, rather than pre-empt, the formal development process. They bring together evidence, practitioner experience and learning from existing services to help ensure that the next phase produces a model that works for patients, practitioners and delivery partners across Scotland.”

Commenting on the recommendations, ABDO president, Brenda Rennie, said: “This framework represents a massive step forward in how we look at community-based low vision care. For dispensing opticians and optometrists across Scotland, the upcoming Community Low Vision Service is an unparalleled opportunity to extend our scope of practice, build advanced skills, and work collaboratively as direct low vision care providers. Our community workforce has the local reach and the specialist expertise required to make this service an absolute success.

“As the formal development phase begins, we look forward to ensuring that the practical realities of High Street practices, fair accreditation, clear referral paths, and protected clinic time are built straight into the core of the service,” Brenda added.

Implementation of the CLVS is not expected before late 2027, with timing dependent on coordinated progress across the service specification, procurement, accreditation, digital systems and payment processes.

OS said phased roll-out should be “governed by clear readiness criteria and early evaluation of service activity, patient experience and provider costs”.

The organisation said it had committed to continued engagement with Scottish government, Public Services Delivery Scotland, NHS boards, practitioners and wider health, social care and third sector partners as the model developed.

Read the report in full.