UK Vision Strategy
RCGP – Royal College of General Practitioners
The Royal College of General Practitioners clinical
priority on eye health: summary analysis of UK data
Table of Contents
1
2
3
Introduction .......................................................................... 1
Methods ............................................................................... 2
Results ................................................................................. 2
3.1 Key findings ................................................................... 2
3.2 Summary of results ........................................................ 3
4 Statistical reporting and accuracy......................................... 6
Introduction
The Royal College of General Practitioners (RCGP) has selected eye health with
a focus on ageing and sight loss as one of their clinical priorities until March 2016.
The aims of the eye health clinical priority programme include reducing
preventable sight loss amongst patients aged 65 plus to help improve their quality
of life; and to provide more effective management of patients with eye conditions.
The RCGP has appointed a Clinical Champion, Dr Waqaar Shah, to lead this
programme in partnership with the RCGP and the UK Vision Strategy.
The purpose of this survey was to establish levels of awareness of General
Practitioners (GPs) and their Practice Teams in regards to managing the eye
health of their patients and the needs of their patients with sight loss.
The information gained from the survey will help to inform the RCGP clinical
priority for eye health programme and to assess the programme’s impact in
general practice and across primary care.
Methods
An online survey of General Practitioners (GPs) and primary care practice staff
was conducted between November 2013 and January 2014. Participants were
invited to complete the survey via an email sent to all the Royal College of GPs
50,000 members and via a targeted marketing and public relations programme
including RCGP blogs, GP internet sites and media coverage in primary care
trade magazines and networks.
The survey was administered in SurveyMonkey. Voluntary sampling was used to
generate the sample. Survey data were exported into SPSS (version 20), cleaned,
duplicates removed and descriptive analyses applied to the data.
This report presents analysis of the UK-wide data. Separate country reports will
be presented in future releases of the data. Throughout the report percentages
are given when the base sample is greater than 20. For samples sizes smaller
than 20, whole numbers are reported.
Results
Key findings
 Only twenty per cent of GPs and ten per cent of nurses were aware of the
RCGP clinical priority for eye health with a focus on ageing and sight loss.
 Fewer than half of respondents said their practice made information regarding
bookings and appointments, or information about the practice available in
accessible formats.
 GPs' confidence in their ability to spot the symptoms or signs of eye conditions
was dependent on the condition. Confidence in spotting the signs or symptoms
of cataract was high, but low for age related macular degeneration.
 Confidence in the ability to spot the symptoms or signs of different eye
conditions was lower among nursing staff, compared with GPs.
 There was limited awareness of the eye conditions that are more prevalent in
minority ethnic groups or the prevalence and eye care needs of people with
learning disabilities.
 The majority of patients presenting with concerns about sight problems or eye
conditions are referred to either an optometrist or ophthalmologist, according to
the diagnosis and severity of the condition.
 Nurses are more likely to refer patients presenting with concerns about sight
problems or eye conditions to a GP colleague rather than an optometrist or
ophthalmologist.
www.rcgp.org.uk/eyehealth
circ@rcgp.org.uk
020 7391 2177
 The majority of respondents believe that talking to patients about their sight
and educating patients about sight loss; supporting patients to comply with their
eye health medication; and incorporating eye health into wider work around
obesity, falls, diabetes and smoking, are important facets of their role.
 The majority of respondents support guidance for patients on the management
of eye conditions; information/literature and guidance for patients regarding
sight loss; training for practice staff to support patients with sight impairment;
and better working with other local health and social care services as a means
of improving the management of patients' eye health.
Summary of results
Respondent characteristics
In total, 296 people responded to the survey. Of these, 194 were based in
England (65.5 per cent), 78 in Scotland (26.4 per cent), 19 in Wales (6.4 per cent)
and 5 in Northern Ireland (1.7 per cent).
Of the 296 respondents, 205 were GPs (69.3 per cent) and 45 were nurses (15.2
per cent). There were 10 GPs with a special interest in ophthalmology (3.4 per
cent). The GP sample represents less than 1 per cent of the GP population.
Of the 205 GPs, 133 were based in England (64.9 per cent), 50 were based in
Scotland (24.4 per cent), 18 in Wales (8.8 per cent) and 4 in Northern Ireland.
Number of years in current profession
A third of respondents (34.1 per cent) had been practicing for more than 20 years,
representing the largest group in terms of the number of year practicing. A quarter
(24.3 per cent) had been practicing for less than 5 years.
Among GPs, 36.6 per cent had been practising for more than 20 years; although
the proportion was substantially higher in Scotland (48.0 per cent). 7 out of 18
GPs in Wales had been practicing for more than 20 years and 1 GP in Northern
Ireland.
Among nursing staff, 36.6 per cent had been practising for more than 20 years,
compared with 8.9 per cent for less than 5 years. In general, nurses had been
practicing for more years than their GP colleagues.
Knowledge of RCGP priority
A fifth of GPs (19.5 per cent) was aware of the RCGP clinical priority for eye
health with a focus on ageing and sight loss.
www.rcgp.org.uk/eyehealth
circ@rcgp.org.uk
020 7391 2177
Overall, 8.9 per cent of nurses were aware of the clinical priority for eye health.
Patient attendance due to problems of vision
The majority (63.6 per cent) of clinical staff (i.e. GPs and nursing staff) reported
that fewer than 5 per cent of patients presenting at the surgery each week did so
because of problems of vision.
Professionals ability to recognise the symptoms or signs of eye conditions
A third of GPs (34.1 per cent) were confident (ie responded 'somewhat confident'
or 'very confident') they could spot the symptoms or signs of age related macular
degeneration (AMD).
A large majority of GPs (89.8 per cent) were confident they could spot the
symptoms or signs of cataract. Approximately half of GPs were confident they
could spot the symptoms or signs of diabetic retinopathy (48.8 per cent),
glaucoma (51.2 per cent), or refractive error (49.3 per cent).
Confidence in the ability to spot the symptoms or signs of different eye conditions
was lower among nursing staff, compared with GPs. Only 4.5 per cent of nursing
staff were confident they could spot the symptoms or signs of AMD; the majority
(81 per cent) were 'not at all confident'.
A quarter of nurses (22.7 per cent) were confident they could spot the symptoms
or signs of cataract; 13.6 per cent were confident they could spot the symptoms or
signs of diabetic eye disease; 9.1 per cent were confident they could spot the
symptoms or signs of glaucoma; and 6.8 per cent were confident they could spot
the symptoms or signs of refractive error.
Management of eye conditions and the role of health professionals in
supporting patients
The majority of GPs supported (ie either 'agree' or 'agree strongly') the
statements:
 I think it is important that I ask my patients about their sight (75.6 per cent);
 Eye health promotion and education to prevent avoidable sight loss is an
important part of my role (63.4 per cent);
 Supporting (through guiding, educating, encouraging compliance) my patients
to comply with their eye health medication is a vital part of my role (75.6 per
cent);
 Eye Health is addressed as part of my work around obesity, falls, diabetes and
smoking (59.8 per cent).
www.rcgp.org.uk/eyehealth
circ@rcgp.org.uk
020 7391 2177
However, only a small minority GPs supported the statements:
 I am well informed on the eye conditions that are more prevalent in some
minority ethnic groups (9.2 per cent).
 I am well informed about prevalence and eye care needs of people with
learning disabilities (12.6 per cent).
Only 6 GPs with a special interest in ophthalmology were well informed about eye
conditions prevalent in ethnic minority groups. Four were well informed about eye
conditions prevalent in people with learning disabilities.
A slightly higher proportion of nurses supported the statements:
 'I think it is important I ask my patients about their sight (80.0 per cent); and
 'Eye Health is addressed as part of my work around obesity, falls, diabetes and
smoking' (68.9 per cent).
However, nurses were less informed on the eye conditions that are more
prevalent in minority ethnic groups (2.2 per cent) and the prevalence and eye care
needs of people with learning disabilities (4.5 per cent).
Referral routes for patients presenting with concerns about sight problems
or eye conditions
Asked where they would refer patients presenting with concerns about sight
problems or eye conditions, 90.2 per cent of GPs indicated they would refer to
either an optometrist or ophthalmologist, according to the diagnosis and severity
of the condition.
Conversely, only 22.2 per cent of nursing staff would refer a patient direct to
optometry or ophthalmology. The most common direct route of referral would be
to a GP colleague (46.7 per cent).
The provision of accessible information by practices
Fewer than half of respondents (43.2 per cent) said their practice made
information regarding bookings and attending appointments available in
accessible formats. 40.5 per cent said general information about the practice
(signage, newsletter, reception information) was available in accessible formats.
A large majority of respondents (80.4 per cent) said they would be interested in
finding out how they can provide information in accessible formats.
www.rcgp.org.uk/eyehealth
circ@rcgp.org.uk
020 7391 2177
The extent of training offered to practice staff to support patients who were
blind and partially sighted
A quarter of respondents (26.1 per cent) had been offered training on how to
support patients who were blind and partially sighted. For GPs it was 25.6 per
cent. The proportion of nurses offered training was markedly lower (18.2 per cent);
only 1 GP in training had received guidance.
81.1 per cent of respondents said they would be interested in receiving training or
guidance on how to support patients who were blind and partially sighted.
Suggestions for improving services
Respondents were provided with a series of statements and asked to select which
they thought would improve the management of patients' eye health. The majority
of respondents supported each of the following statements:
 Training and guidance on the management of eye conditions 71.3 per cent);
 Information/literature and guidance for patients regarding…' (72.6 per cent);
 Training for practice staff to support patients with sight impairment (77.4 per
cent) and
 Joined up working with other local health and social care services (60.8 per
cent)
A higher proportion of nursing staff supported each statement, compared with
overall respondents (80.0 per cent, 88.9 per cent, 82.2 per cent and 62.2 per cent,
respectively).
Statistical reporting and accuracy
Voluntary sampling was used to generate the survey sample. As such, the
findings are applicable only to the survey respondents. Inferences about UK or
country representativeness are not applicable and should not be drawn.
www.rcgp.org.uk/eyehealth
circ@rcgp.org.uk
020 7391 2177