The NCP for Ophthalmology recommends the integration of hospital and community care, with clinicians and care providers working in teams, as the best approach to deliver care for patients and to address the structural deﬁcits in the current system. The eﬃcient operation of the integrated eye team is critical to the delivery of primary eye care. The eye team must have the staff, support structures and electronic patient records (EPRs) in place to address the current challenges. Challenges which include long waiting lists for patients to be seen in the hospital when they could be diagnosed and managed safely and efficiently in the community. Implementing a more community based model will improve access to care and will help address the current adult and paediatric waiting list crisis. A clear governance structure for the eye teams, with clinical audits, will ensure that the standards of clinical care are maintained.
Ophthalmology is currently the number one specialty by volume of patients waiting for procedures. The two connected reasons for this are over-commitment of ophthalmic surgeons to outpatient clinics and lack of access to theatre operating time. The ﬁrst cause feeds into the latter, once a patient is diagnosed with a chronic eye condition, they remain within the acute service for their ongoing monitoring and treatment. This situation results in burgeoning outpatient clinics requiring long hours of the hospital doctors input. Better developed community based service with eye teams working in fully staffed and resourced clinics will facilitate the movement of a signiﬁcant cohort of patients back to the primary care setting for their ongoing management, freeing the hospital ophthalmologists to put more time into the surgical and procedural waiting lists.