Technician-led eye clinics could lead to more timely NHS care

Innovative virtual eye clinics in shopping centres could significantly reduce waiting times for routine eye appointments, UCL-led research suggests in a first-of-its-kind study.

The research, published in the journal BMJ Open, evaluates the impact of a community-based ‘pop-up’ eye clinic set up in Brent Cross shopping centre in north London in September 2021, at the height of the pandemic, on reducing the post-COVID-19 appointment backlog.

The researchers looked at data from 69,257 appointments attended by 39,357 patients with stable glaucoma and medical retinal conditions at sites across the Moorfields Eye Hospital network in London between June 2018 and April 2023.

During the pandemic, waits for NHS ophthalmology appointments rose sharply. By March 2023, 628,502 people in England were waiting for appointments, with 27,260 of those patients waiting for a year or more, according to the Association of Optometrists.¹

The researchers found that patients seen in the hospital network hosting the London virtual clinic bucked the national trend – for each week that passed, the delay they were expected to face fell by more than a week (eight days) for the first five months the clinic was operating.

For example, in November 2021 on average patients with stable chronic conditions across the Moorfields Eye Hospital network were being seen six months later than intended, and by April 2022, following the introduction of the clinic, appointments were happening only two months late.

Previous research has suggested so-called virtual clinics, where technicians perform routine scans during patients’ regular check-up appointments that are examined later on by a clinician, can reduce waits for outpatient appointments. In this innovative clinic, technicians without prior healthcare experience were trained on how to perform the scans, with ongoing support from senior clinicians, saving clinical specialists' face-to-face time for urgent and complex cases.²

But this is the first study to quantify how much delays for NHS outpatient ophthalmology appointments can be reduced by the impact of a COVID 19-era service innovation.

Lead author Siyabonga Ndwandwe (UCL Research Department of Primary Care and Population Health) said: “Our findings suggest that community-based, technician-led virtual review clinics could play a significant role in reducing wait times for patients with stable chronic eye conditions.

“This is especially relevant given current NHS challenges, including chronic workforce shortages – particularly among eye specialists – and limited hospital estate capacity.

“This is the first study to quantify the impact of a COVID 19-era service innovation on outpatient ophthalmology delays and the findings highlight a scalable model that could be adopted more widely to improve access and efficiency across the whole of the NHS.

“This is very much in line with the ambitious plans to reform the NHS announced by the Prime Minister and Health Secretary only weeks ago.”

The virtual clinic, led by technicians rather than specialists, was designed to monitor low-risk patients outside traditional NHS estates.

The research showed it led to a significant reduction in weekly average appointment delay days (delays reducing by an average of 8.1 days per week) following its launch.

This slowed to a reduction by 0.3 days per week after the initial backlog had been cleared at around five months after opening. Pre-pandemic appointment delays had been increasing on average by 0.9 days per week.  This rate increased sharply to 2.0 days per week due to service delivery interruptions associated with COVID-19 lockdowns. 

The researchers measured attendance delays by counting how many days passed between when a patient actually attended and the date they were supposed to attend, based on the appointment date set during their previous visit.

They excluded some patients from the analysis, such as patients with non-stable conditions which they defined as people who were required to be seen less than six months after their previous attendance. They also excluded those where the appointment could have been an emergency, indicated by it taking place more than four weeks earlier than required.

Joint first author Dr Dun Jack Fu (NIHR Moorfields Biomedical Research Centre) said:

“Our report draws on data from one the world’s largest specialist eye centres – Moorfields Eye Hospital NHS Foundation Trust - providing care at over 25 sites across London.”

“Our findings are highly relevant to the post-COVID era with millions of people facing long waits for routine NHS appointments.

“They are in the spirit of the government’s 2024 Change NHS campaign, which emphasises three key shifts for a future-ready health service: moving care from hospitals into communities, harnessing technology (the virtual review part), and focusing on prevention over treatment (preventing eyesight loss by timely monitoring). 

“We believe that pop-up virtual eye clinics in locations such as shopping centres could be a game-changer.”

The study was part of the Healthcare Exemplar for Recovery from COVID 19 Using Linear Examination Systems (HERCULES) project.³

Study limitations

The study has some limitations, including that no external control group was available, limiting comparison to national or regional trends.

Also, the study focused on glaucoma and medical retina patients but in 2022 the new clinic expanded the scope of its activities to include cataract patients and newly referred patients, so this analysis might underestimate the overall contribution to reducing ophthalmic appointment delays across the network.

Notes to Editors

For more information or to speak to the researchers involved, please contact Nick Hodgson, UCL Media Relations. T: 07769 240209, E: nick.hodgson@ucl.ac.uk

The pop-eye clinic was designed by a team of UCL architects and scientists led by Professor Paul Foster, based at UCL Institute of Ophthalmology and a consultant at Moorfields. More information about its launch and design can be found here: https://www.ucl.ac.uk/news/2021/dec/eye-care-clinic-future-launched-ucl-and-moorfields and here https://www.ucl.ac.uk/bartlett/ideas/bartlett-review/bartlett-review-2021/shopping-centre-pop-shows-way-forward-nhs

¹ Association of Optometrists. NHS patient backlogs are leading to life changing sight loss FOI request reveals, https://www.aop.org.uk/our-voice/media-centre/press-releases/2023/03/21/nhs-patient-backlogs-are-leading-to-life-changing-sight-loss-foi-request-reveals (2023, accessed 19 December 2023).

² All the Moorfield Eye Hospital network patients with chronic conditions were monitored regularly and had scans. In traditional NHS ophthalmology clinics, these scans are done by nurses and optometrists and the patient can see a consultant clinician after having all the scans if that turns out to be necessary as the scans are all looked at while the patient is there sitting in the waiting room. There were two key differences with the shopping centre clinic: the scans were performed by trained technicians who were not clinically trained (rather than clinical staff); and they were looked at ‘virtually’ by a clinical specialist using the hospital's electronic system, rather than on-site, and generally not straightaway. This meant patients didn’t have to wait for the scans to be examined, freed up senior clinical time and meant more appointments could be made available.

³ The HERCULES project is a collaboration between UCL and Moorfields Eye Hospital. It was made possible as a consequence of some visionary decisions around funding by the Moorfields Eye Hospital NHS Foundation Trust (via the NIHR Moorfields Biomedical Research Centre), Moorfields Eye Charity, The UCL Bartlett Faculty of the Built Environment, and Ubisense, with support in kind from Optos (now part of Nikon Medical Imaging). UCL departments involved in it include UCL Institute of Ophthalmology, the Research Department of Primary Care and Population Health and the UCL Research Department of Behavioural Science and Health. More information about the project can be found here: https://www.ucl.ac.uk/population-health-sciences/epidemiology-health-care/research/behavioural-science-and-health/research/health-care-organisation-and-management-group/hercules

Ndwandwe, Siyabonga; Fu, Dun Jack; Adesanya, Joy; Bazo-Alvarez, Juan Carlos; Ramsay, Angus I. G.; Fulop, Naomi, J.; Magnusson, Josefine; Napier, Steve; Cammack, Jocelyn; Baker, Helen; Kumpunen, Stephanie; Alarcón Garavito, Germán; Elphinstone, Holly; Mills, Grant; Scully, Peter; Symons, Anne; Webster, Paul; Wilson, Jonathan; Khaw, Peng Tee.; Sivaprasad, Sobha; Jayaram, Hari; Foster, Paul J.; Clarke, Caroline S., ‘Impact of a Community-Based Asynchronous-Review Clinic on Appointment Attendance Delays Across an Eye Hospital Network in London, UK: An Interrupted Time Series Analysis’ will be published in BMJ Open on Wednesday 16^th July 2025, 00:01 UK time.

The DOI of this paper will be: http://dx.doi.org/10.1136/bmjopen-2025-098820

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About NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology

NIHR Moorfields BRC is an internationally renowned partnership between Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, ranked number one in the world for ophthalmology research. The BRC was first established in April 2007 and is now in the fourth five-year term to support research designed to take advances in basic medical research from the laboratory to the clinic. The centre’s broad spectrum of research into eye disease enables patients to benefit more quickly from world-class scientific breakthroughs, treatments and diagnostics, and has demonstrated a wider reach into other health conditions through digital technology and advanced therapies. For further information, please visit www.moorfieldsbrc.nihr.ac.uk/  

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The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

• Funding high quality, timely research that benefits the NHS, public health and social care;
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