Gloucestershire: creating an integrated digital eyecare pathway

The challenge

Patients in Gloucestershire experienced fragmented care across primary and secondary eye care services. Clinical information was held in separate systems, limiting the ability of community optometrists and hospital teams to access and share information effectively. This resulted in duplication of diagnostics, delays in clinical decision-making, unnecessary hospital appointments and barriers to delivering care closer to home.

The approach

Gloucestershire collaboratively developed a digitally enabled integrated eyecare pathway that connected all community optometrists and hospital clinicians through a shared clinical platform. The aim was to move from fragmented, organisation-based care to a single connected pathway, enabling a shared source of clinical information, real-time access to diagnostics and imaging, virtual clinical review and faster decision-making. The approach aligned digital infrastructure directly with pathway redesign, supporting community and hospital providers to work as a single clinical network.

How it was delivered

• A shared vendor-neutral digital platform: Introduction of the community ophthalmic link (COL) system, enabling real-time access to patient records and clinical information across settings.
• Image and data sharing: Community optometrists able to upload full imaging and datasets (including the full OCT) and access complete hospital imaging and clinical records, providing visibility of ophthalmology history dating back to 1996.
• Integrated workflows: Referral, triage, virtual review, advice and feedback processes aligned through a single digital platform.
• Access across sectors: Community optometrists given secure access to relevant hospital ophthalmology data and diagnostics.
• System-wide adoption: Countywide implementation across all of community optometry and hospital services, connecting over 250 clinicians within a unified digital network.
• Cross-border sharing: Extension of the platform across neighbouring counties, enabling clinicians to securely access and share patient information across organisational and geographical boundaries.

Impact 

• Reduction in unnecessary referrals: Over 4,000 hospital referrals and 1,100 GP referrals avoided through shared access to clinical data and improved decision-making.
• Reduced referral demand: A 41 per cent reduction in monthly ophthalmology electronic referrals, decreasing from an average of 497 to 293 referrals per month following countywide rollout.
• Reduced waiting lists: A 37 per cent reduction in the new patient ophthalmology waiting list, reducing from 5,529 to 3,476 patients and supporting faster access to specialist care.
• Improved clinical decision-making and pathway flow: More than 1,400 referrals were better informed, with clinicians able to make faster and more confident decisions through real-time access to imaging and clinical records.
• Increased community management: Over 13,000 patients were appropriately managed within community eye care settings, reducing demand on hospital services while maintaining clinical oversight.
• Enhanced patient understanding and self-management: Nearly 20,000 patient interactions benefited from improved education and understanding, supporting better patient engagement and outcomes.
• System-wide adoption: The pathway achieved countywide participation, connecting all practices and over 250 clinicians through a shared digital network and enabling consistent delivery of integrated care at scale.

Key learning

• Seamless and accessible digital connectivity is foundational: without shared visibility, pathways remain fragmented.
• Vendor-neutral integration is a critical enabler: Achieving a single shared clinical view across community and hospital eyecare requires a platform that connects imaging, clinical data and workflows across disparate systems. Traditional PACS and image-sharing solutions alone are unlikely to deliver the end-to-end pathway integration required for system-wide transformation.
• Value comes from connecting critical points in the pathway rather than waiting for full system integration.
• Image sharing, virtual review and remote clinical collaboration are high-impact enablers, reducing duplication and unlocking capacity.
• Adoption at scale is essential: consistent use across providers creates true system transformation.
• Digital platforms alone do not deliver integration; success depends on strong clinical leadership, shared governance and trust between community and hospital providers.