“Get people the treatment they need faster,” said Scotland’s public health minister Jenni Minto, setting out why community optometrists will treat more urgent eye problems close to home. Ministers say the shift could free up around 20,000 hospital appointments a year.

The legal change is now on the books. Signed on 5 November 2025, laid before Holyrood on 7 November and coming into force on 1 January 2026, the amendment tightens how patients with suspected anterior eye conditions are referred and treated within NHS community optometry in Scotland.

Here’s what changes on the ground. Where a patient shows signs of an anterior eye condition, non‑specialist clinicians in primary eye care must refer only to a Board‑approved “specialist” - either a specialist ophthalmic medical practitioner or a specialist optometrist independent prescriber - and only once that clinician has agreed to accept the case. Referrers are told to take into account where the patient normally lives. Health Boards can formally contract these specialists, using standard forms supplied by “the Agency” (the Common Services Agency for the Scottish Health Service).

The regulations define “anterior eye condition” and the government has already spelled out the starter list: anterior uveitis; anterior/posterior blepharitis; episcleritis; herpes simplex keratitis; herpes zoster ophthalmicus; infective conjunctivitis; marginal keratitis; ocular allergy; and ocular rosacea - with corneal foreign body removal joining from January 2026.

This builds on the new GOS Specialist Supplementary (GOS SS) service and fee that began in August 2025. The Scottish Government’s operations plan aims for most Health Boards to be fully up and running by the end of March 2026, estimating the service could remove around 40,000 hospital appointments each year once mature.

Optometry Scotland has backed the move, arguing it will keep more patients in community care and relieve pressure on GPs and hospitals. As chair Eilidh Thomson put it, the step is “driven by the growing demand on hospital eye services,” and will mean “keeping more patients within the community.”

The numbers suggest Scotland’s high‑street optometry is already carrying a big share of clinical work. Public Health Scotland recorded around 2.44 million NHS eye examinations in 2024/25, with 93.4% of patients not needing a referral - evidence that most problems are managed safely in primary care.

Capacity should be there to deliver. Research published this year shows Scotland’s pool of independent prescribing (IP) optometrists grew from 350 to 396 between 2022 and 2023, with roughly one in four optometrists now IP‑qualified - a critical workforce for the specialist service.

Why this matters beyond the Central Belt: commissioners across the North of England are grappling with the same pressures. England’s community urgent eye care (CUES/MECS) offer still isn’t universal - the College of Optometrists says coverage sits at about 73% - despite evidence the service can fully manage most cases and avoid thousands of GP, A&E and hospital appointments.

For Northern practices and ICS leaders watching Scotland’s approach, the direction is clear: formalise referral routes into named community “specialists”, line up acceptance protocols in advance, and pay for the complexity being handled outside hospital. Scotland’s model is backed by ministers who also remind patients that the country remains the only part of the UK offering free, universal NHS‑funded eye examinations - an incentive to seek help early.