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Improving glaucoma referrals in Scotland: developing a national data set for referral from community optometry to the Hospital Eye Service (HES)

Eye (2026)Cite this article

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Ophthalmology, like many other specialities, faces the challenge of an ever-increasing demand for care. NHS Scotland’s approach to this challenge is to manage as many ophthalmic patients within a primary care setting as possible, utilising community optometrists and providing patients with care closer to home. This policy reduces referrals in to the hospital, and discharges patients out whenever possible.

Glaucoma can be a difficult disease to identify. In Scotland, the 2006 GOS regulations, SIGN 144 guidance (glaucoma referral and safe discharge) [1] and instigation of electronic referrals have supported community optometrists nationally in enhanced case finding and referral management, evidencing a reduction in false positive referrals [2, 3]. However, variation in referral quality still exists [3], and reducing false positive referrals is essential to ensuring adequate HES capacity. Therefore, a national standardised glaucoma referral data set has been developed to help further reduce unwarranted variation and avoidable HES referrals, led by the Centre for Sustainable Delivery, NHS Scotland.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Scottish Intercollegiate Guidelines Network (SIGN). Glaucoma referral and safe discharge. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network; March 2015. SIGN publication no. 144. ISBN 978-1-905813-36-8

  2. El-Assal K, Foulds J, Dobson S, Sanders R. A comparative study of glaucoma referrals in Southeast Scotland: effect of the new general ophthalmic service contract, Eyecare integration pilot programme and NICE guidelines. BMC Ophthalmol. 2015;15:172. https://doi.org/10.1186/s12886-015-0161-5.

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  3. Sii S, Nasser A, Loo CY, Croghan C, Rotchford A, Agarwal PK. The impact of SIGN glaucoma guidelines on false-positive referrals from community optometrists in Central Scotland. Br J Ophthalmol. 2019;103:369–73. https://doi.org/10.1136/bjophthalmol-2017-311429.

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  4. Scottish Government, 2008. PCA(O)(2008)3 (link).

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Author information

Authors and Affiliations

  1. Centre for Sustainable Delivery, Planned Care Team, NHS Golden Jubilee, Agamemnon St, Clydebank, UK

    Helen Court, Jacquie Dougall & Janet Pooley

Authors
  1. Helen Court
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  2. Jacquie Dougall
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  3. Janet Pooley
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Contributions

HC led the design of the work, analysis of data and writing the paper. JP and JD contributed to the conceptualisation and design of the work and writing the paper.

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Correspondence to Helen Court.

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The authors declare no competing interests.

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Court, H., Dougall, J. & Pooley, J. Improving glaucoma referrals in Scotland: developing a national data set for referral from community optometry to the Hospital Eye Service (HES). Eye (2026). https://doi.org/10.1038/s41433-026-04347-x

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