CUES in the Community: Life Beyond COVID

As COVID-19 began to take its inexorable toll on the UK health sector in early 2020, the Local Optical Committee Support Unit (LOCSU), NHSE-I, and the Clinical Council for Eye Health Commissioning established the COVID-19 Urgent Eyecare Service (CUES) to help ensure “timely access to urgent and emergency eye care in a ‘COVID-safe’ way, without the need to travel to a hospital or, in some cases, even leave home.”

The service requires collaboration across the system, with primary and secondary care clinicians “working together to support each patient in the most appropriate way” and allows optometrists to offer a broader range of eye treatment than they could previously provide.

With a need to mobilize CUES quickly, LOCSU supported LOCs and Primary Eyecare Companies (PECs) in their discussions with Clinical Commissioning Groups to implement a service in areas where no extended services were currently available – and to move up to CUES in areas already offering a Minor Eye Conditions Service (MECS).

Fionnuala Kidd, optometrist and LOCSU’s Optical Lead for the North West, tells The New Optometrist about the progress and success of CUES in her region – and how the now-rebranded service will help to reshape UK eye care as we begin to move beyond COVID-19.

What were the main successes of the CUES initiative from a LOCSU perspective?

As LOCSU optical lead for the North West, I feel qualified to say that Greater Manchester is very progressive and forward-thinking in its approach to optometry. Before COVID, Greater Manchester had already started to build some of the infrastructure that became very useful when the pandemic hit. There was already some funding, for example, for the development and progression of IP optoms. Manchester Eye Hospital was already very engaged in working with primary care optometrists. And optometrists were referring to other optometrists for enhanced glaucoma services. So, CUES was able to hit the ground running in Greater Manchester and has been hugely successful in the area. Out of almost 39,000 CUES episodes in the region in the 12 months from April 2021, for example, more than 75 percent of patients were kept in or discharged from primary care. A recent study also shows that emergency eye care department attendances in Manchester were reduced by 37.7 percent per month between April and December 2020, compared with the same months in 2019 (1).

Across the country, CUES can make use of OCT if the patients’ presenting symptoms indicate this is clinically necessary. In recent years, more and more practices have invested in OCT to offer the best care to patients. Through CUES, we’ve seen the benefits of sharing OCT images, which has led to further service enhancements. LOCSU, for example, has developed an end-to-end macular pathway to improve case-finding by both filtering patients presenting with possible wet AMD symptoms and monitoring patients with late-stable disease. Several areas are now working on implementing this service. I had a conversation with an ophthalmologist recently who mentioned that around 30–40 percent of patients in her wet AMD clinic do not actually have this condition but another macular condition with reduced urgency. She’s supporting the roll-out of this service in her region, as the benefits are clear. Wet AMD patients need to be seen and treated quickly to prevent sight loss; by filtering patients in primary care, we can help ease some of the capacity challenges faced in secondary care.

But CUES is not available everywhere… 

Yes, that’s true. It can be challenging in areas where there hasn’t been a MECS and where commissioners perhaps haven’t recognized or seen the need to expand the service. For example, in another area I oversee – Cheshire and Mersey – urgent eye care services are fairly widespread, but not across the whole region, which leaves an inequitable or two-tier service – and that’s not acceptable. However, the formation of Integrated Care Systems (ICS) and the move towards collaborative, joined-up care – with primary care at the heart of delivering care closer to home – is a huge step in the right direction. Things are changing for the better.

What is the future of CUES? The service is, by definition, time-limited. Does that mean it is winding down?

Ophthalmology is the country’s biggest outpatient specialty and services like CUES allow secondary care to release some of that pressure. So, even though CUES began as a COVID-19 response service, there is definitely an ongoing need for it. It has been rebranded as the Community Urgent Eye Care Service, and some areas that didn’t commission it initially are now looking to take it up. Optometrists have been influencing each other, saying how they fit CUES into their day, and that kind of peer-to-peer communication and support will lead more practices to come on board. There’s a growing acceptance that we need to embrace these enhanced services, particularly as we return to face-to-face treatment. It makes business sense and it’s certainly in the patient’s interest.

How does CUES feed into Optometry First, which is positioned as a comprehensive, end-to-end service extending those collaborative practices that COVID-19 necessitated?

The three proof-of-concept Optometry First areas – Bassetlaw (North East & Yorkshire), Isle of Wight (South East), and Sefton (North West) – all offered CUES before they took on the Optometry First initiative. We’re finding that CUES offers a good starting point from which to build relationships and networks – where a consultant, for example, can feel confident discharging patients safely to primary care. These networks mean we don’t need to follow the traditional model, where a patient can find a certain service only in one place. Building on those relationships forged during CUES, Optometry First is ambitious and exciting and will see an overhaul of our whole eye care model – but it’s not going to happen overnight!