Primary care ophthalmology

There was once a time when “primary care” was synonymous with general practice, “secondary care” with district general hospitals, “tertiary care” with teaching hospitals, and everyone who worked in the National Health Service knew their place. Now everything seems so confusing. Is the teaching hospital consultant who conducts an outreach clinic in a general practice providing primary, secondary, or tertiary care? What about the general practitioner (GP) with a specialist interest who performs argon laser photocoagulation for diabetic retinopathy in his own practice premises? And what of mobile cataract surgical teams?

The truth is that the nomenclature of primary, secondary, and tertiary care has never served ophthalmology particularly well. Most GPs learn little ophthalmology as undergraduates or during GP vocational training and few practices have more than the most basic equipment for ophthalmic examination. Although eye problems present commonly in general practice and many GPs are willing to treat a limited range of minor eye disorders, most hospital eye departments continue to be major providers of first-line ophthalmic care for the simplest to the most complex eye conditions.1 Ophthalmology therefore does not separate out cleanly into primary, secondary, and tertiary sectors on the basis of the environment in which care takes place or on the basis of the professional groups contributing to the service. Blach,2 in a commentary in the BJO in 2001, argued for the creation of multiprofessional “community ophthalmic teams” and suggested that the concept should be tested in a pilot study in a defined community. …