I was recently contacted by a Scottish optometrist who complained that he was unable to refer one of his patients to an well known NHS ophthalmology centre of excellence in England. There have been reports of English hospitals rejecting Scottish patients but in this case that wasn't the issue. Over the last few years it has become common practice for optometrists to refer directly to ophthalmology departments in Scotland. More than 90% of all referrals are now made direct so it this optometrist didn't even consider that an English hospital wouldn't accept direct referrals from any optometrist, regardless of location.

In England the referral system is still set up to work via the GP. There are exceptions of course, emergencies are usually referred straight to hospital. Private referrals are often made directly and there are now many referral refinement schemes and local referral protocols for common conditions such as cataract and glaucoma where patients follow a direct route to ophthalmology.

With so many direct referrals and referral schemes it begs the question; why do routine referrals still go through the GP? Very few GPs do any more than pass the referral on to the hospital, acting as more of a middle-man than a gatekeeper. Optometrists are more skilled than ever in the detection and management of eye disease, many are already participating in MECS or PEARS schemes and some even work with local health authorities to provide other primary care services such as smoking cessation, healthy eating and blood pressure monitoring.

The Optical Confederation Foresight report predicts that we will see more commissioning of community eye care services in the near future to meet the needs of an ageing population and predicts that optometrists' skills and training will increase. It looks likely that the working relationship between optometrists and ophthalmologists will continue to develop and grow. It is likely that we will see optometrists and ophthalmologists working collaboratively more often. Next January's Eyecare conference and exhibition in Glasgow will play host to optometrists and ophthalmologists, with collaborative sessions at the start and end of the day. Scotland has managed to change the landscape of primary eye care in the last 10 years. Is it now time that England to followed suit?