Patients face postcode lottery in NHS eyecare as new report calls for better use of available capacity

Independent Healthcare Providers Network calls for more consistent patient choice, better planning and common quality standards across NHS eyecare services

Patients risk facing longer waits for NHS eyecare because of local differences in how services are commissioned and referrals managed, according to a new report from the Independent Healthcare Providers Network (IHPN).

The report, Protecting sight, expanding capacity: The independent sector’s role in building a sustainable NHS eyecare service, warns that patients’ access to timely treatment can increasingly depend on where they live, with some areas making full use of available NHS and independent sector capacity while others operate more restrictive referral and commissioning arrangements.

The report comes as demand for eyecare is expected to rise significantly over the next decade, driven by an ageing population and increasing prevalence of chronic eye conditions. The College of Optometrists estimates that the number of people living with age-related macular degeneration could increase by almost 25% over the next ten years, while demand associated with glaucoma and vision-impairing cataracts is expected to rise by 16%.

Ophthalmology has been one of the few bright spots in efforts to tackle NHS waiting lists, with both waiting lists and average waiting times falling since the pandemic. Independent providers have played a significant role in supporting this progress, now delivering around one in five NHS ophthalmology appointments and more than half of NHS cataract procedures in England.

New figures highlighted in the report show that:

• Independent providers are delivering more than 140,000 NHS ophthalmology appointments every month.
• More than 400,000 NHS ophthalmology patients were treated by IHPN members during 2025.
• Independent providers have helped remove more than two million patients from NHS ophthalmology waiting lists since April 2021.
• IHPN members operate more than 150 ophthalmology sites across England, alongside over 1,300 community optometry practices and home visit teams.

However, the report highlights ongoing challenges in how eyecare is organised, including inconsistent access to patient choice, short-term contracting arrangements and referral pathways that can make it harder for patients to access available service

It also calls for greater consistency in clinical quality, transparency and data sharing across NHS and independent providers, including participation in national clinical audits and outcomes reporting.

The report also raises concerns about the growing use of Single Points of Access (SPOAs) to manage NHS eyecare referrals. While these can help ensure patients are directed to the most appropriate services and reduce unnecessary appointments, IHPN warns that poorly designed systems risk adding delays, restricting patient choice and leaving available treatment capacity unused.

IHPN is calling for these systems to be designed around patients’ clinical needs, with clear safeguards to ensure people retain their right to choose from the full range of qualified NHS-funded providers.

David Hare, Chief Executive of the Independent Healthcare Providers Network, said:

“Real progress has been made in reducing NHS eyecare waiting times, with independent providers playing an important role. But with demand set to grow significantly, we cannot afford to be complacent.

“Patients should not face longer waits simply because of where they live, particularly when there is capacity available to treat them. Changes to referral pathways, including Single Points of Access, must improve access to care rather than restrict patient choice.

“We need a more joined-up approach across NHS and independent providers, with consistent standards of quality and care, to ensure patients get the treatment they need and avoid preventable sight loss.”
The report makes four recommendations to improve NHS eyecare services:

1. Protect patient choice – ensuring patients can access the full range of qualified NHS-funded providers, including through Single Points of Access, with safeguards against unnecessary restrictions on referrals.
2. Improve demand and capacity planning, giving commissioners a clearer picture of where patients need treatment and where capacity is available.
3. Provide more stable contracting arrangements, enabling providers to maintain clinical capacity, invest in services and support workforce development.
4. Strengthen common standards for quality and data, ensuring consistent clinical audit, outcomes reporting and information sharing across NHS and independent services.

The report also highlights the importance of better integration between community optometry and hospital eyecare, including more streamlined referral routes and carefully designed Single Points of Access, to ensure patients reach the right service without unnecessary delays.

Closer collaboration, consistent standards and more effective use of capacity across the whole health system will be essential to ensuring patients can continue to access timely, high-quality care.