This retrospective, GM-wide analysis evaluated all CUES encounters across Greater Manchester in 2024 (N=54,994), assessing patient pathways, case mix, socioeconomic access (IMD deciles), and outcomes of an embedded Independent Prescribing (IP) optometrist pathway, including a sub-sample of referrals to Manchester Royal Eye Hospital compared against Eye Emergency Department clinician diagnoses.
78.2% of patients were discharged without referral; 83.4% were retained in primary care overall. IP optometrist episodes had a significantly higher discharge rate (87.5%) vs. non-IP episodes (78.1%; p=0.000001). Diagnostic agreement with secondary care EED clinicians was 75.0%, and 40.0% of referred cases could potentially have been managed in primary care with IP capacity. Corticosteroids (43.7%), antibiotics (14.3%), and antimuscarinics (12.4%) were the most prescribed drug classes via NHS FP10 prescriptions.
Retrospective single-year design limits causal inference. The secondary care sub-sample size is not fully specified, which may affect the reliability of the 75% diagnostic agreement and 40% manageable-in-primary-care estimates. IP optometrist availability was unequal across sites, potentially confounding IP vs. non-IP comparisons.
Community urgent eyecare led by optometrists can keep more than 4 in 5 patients out of hospital eye departments and GP surgeries. Expanding Independent Prescribing capacity within CUES — especially for corticosteroids and antibiotics — could meaningfully reduce secondary care demand further.
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