Independent prescribing optometrists: Scotland pays, England varies

Since 19 January, an independent prescribing optometrist in Scotland who is approved by their health board can be paid by the NHS to treat ten anterior eye conditions, including anterior uveitis and herpes simplex keratitis. In England, community minor and urgent eye care is commissioned area by area. An evaluation published in July in Ophthalmic and Physiological Optics found that fewer than 1 in 100 urgent eyecare cases in Greater Manchester in 2024 were managed as prescribing cases.

In the same evaluation, eye emergency optometrists at Manchester Royal Eye Hospital went back through 120 urgent referrals, knowing the hospital's diagnosis. They judged that a prescribing optometrist might have managed 40% of them in practice. What a red eye can be given on the NHS depends on which side of the border it is on.

What an independent prescribing optometrist can do in Scotland

Any optometrist in Scotland can examine and treat a red or sore eye under the NHS. In Public Health Scotland's figures, anterior eye conditions were 30.0% of supplementary examinations in 2025/26. The General Ophthalmic Services (GOS) Specialist Supplementary service, which started on 1 August 2025, adds a second stage of treatment. Only a specialist independent prescribing (IP) optometrist or specialist ophthalmic medical practitioner, approved by their health board, can claim for it. Examples are a topical steroid and cycloplegic for anterior uveitis, or a sterile needle to remove a corneal foreign body and its rust ring. The first appointment pays £97.69, and each follow-up pays £47.80.

In 2025/26, Public Health Scotland counted 10,267 first-appointment claims and 10,880 follow-up claims. Access depends on an approved prescriber nearby: when the Scottish Government's impact assessment was written, no IP optometrist or ophthalmic medical practitioner provided GOS in Orkney, so the service could not run there. The assessment expects up to 20,000 unscheduled hospital appointments a year to move into the community once the service is fully rolled out. From summer 2029, optometrists graduating in Scotland, and nowhere else in the UK, will be able to qualify as independent prescribers.

What England commissions, and where

England's community minor and urgent eye care runs as the Community Urgent Eyecare Service (CUES) or the Minor Eye Conditions Service (MECS), depending on the area. The College of Optometrists said in May 2025 that these services, with or without prescribing, were available in 73% of England. In Scotland, Wales and Northern Ireland, it said, every patient had access.

Greater Manchester commissions the service in all ten of its localities. In 2024 it saw 54,994 cases, and 83.4% stayed in primary care. Only 496 cases, 0.9%, were prescribing cases, in which the practitioner used their prescribing qualification. An IP optometrist managed 460 of them, and an ophthalmologist the other 36. Prescribing was offered at 23 practices, 10.4% of those in the service. Of the prescribing cases an IP optometrist managed, 87.5% ended in discharge, against 78.1% of other cases. The prescribing cases had been triaged as suitable for a prescriber, so the two groups are not alike.

What registrants told the GOC

The General Optical Council's 2026 registrant survey counts dispensing opticians and students as well as optometrists, and had 310 replies from Scotland. Its figures for working registrants rest on 276 in Scotland and 2,252 in England. Those in Scotland were less likely to have felt under pressure to meet commercial targets at the expense of patient care (25% against 32%), or to be considering leaving the profession over the next 12 to 24 months (8% against 16%). They were more likely to have felt unable to cope with their workload in the last 12 months (66% against 58%).

Why it matters in practice

In England, the first step before a red eye goes to eye casualty is knowing whether the local CUES or MECS has a prescribing pathway, and which practice nearby runs it. The College says registered optometrists are already qualified for minor and urgent eye care. It wants the service commissioned everywhere, extra entry requirements dropped or minimised, and optometrists able to give treatments without involving the GP. Denmark's OCT pathway raised the same question for scans.

In Scotland, a practice without a prescriber still manages the first stage, and refers the patient for the second to a practice listed on NHS Inform. Whether the service is moving patients out of hospital is not yet visible. Scottish optometrists referred over 119,500 patients to hospital in 2025/26. Public Health Scotland calls this a stable trend, in line with the rise in eye examinations.

The caveats

• Greater Manchester is one region in one year, from routine records, and its discharge rates are not adjusted for case mix.
• The 40% rests on 120 referrals to one hospital, rated afterwards with the hospital's diagnosis known. Missed diagnoses among discharged patients, and cost, were not measured.
• Public Health Scotland counts claims paid since 1 August 2025, not patients treated, and no outcomes are published yet.
• The GOC survey is self-reported, with an 11% response rate. Scotland's 8% is 23 of 276 working registrants, and nothing in the survey ties a gap to scope of practice.

Sources

1. 1.Evaluation of the Community Urgent Eyecare Service in Greater Manchester, Including the Impact of Independent Prescribing · Ophthalmic and Physiological Optics, 21 July 2026
2. 2.General Ophthalmic Services (GOS) activity statistics: year ending March 2026 (report and data tables) · Public Health Scotland, 15 September 2026
3. 3.PCA(O)2026(01): GOS Specialist Supplementary service, full implementation (with the GOS Statement) · Scottish Government, 13 January 2026
4. 4.NHS (General Ophthalmic Services) (Scotland) Amendment Regulations 2025: business and regulatory impact assessment · Scottish Government, 15 December 2025
5. 5.Lack of funding threatens commissioning of urgent care eye services in England · College of Optometrists, 23 May 2025
6. 6.Registrant workforce and perceptions survey 2026 (research report, data tables and nation infographics) · General Optical Council, 2 September 2026