Norfolk and Waveney Integrated Care Board

5. Mr and Mrs A say:

• while on holiday in Norfolk, Mrs A could not access primary eye care when she had a bloodshot eye. They believe that due to the way the CUES contract has been drawn up, holidaymakers in the Norfolk and Waveney area are potentially excluded from being able to access primary care for eye problems.

• as a result, Mr and Mrs A say they suffered considerable distress and inconvenience.

6. By bringing this complaint to us, Mr and Mrs A are seeking:

• for the ICB to check its policy and make sure that it covers anyone who needs medical attention regarding an eye problem • if the ICB haven’t resolved the CUES contract issue, for GP practices in the area to change their pathway so that non-residents can get an appointment or get referred for appropriate care.

7. In June 2024, while on holiday in Norfolk, Mrs A woke up with a bloodshot eye. Mr and Mrs A called a GP practice in the area.

8. The GP practice mistakenly signposted Mrs A to CUES. CUES is not available to holidaymakers or temporarily registered patients unless they live in an area where CUES is also provided. As CUES is not provided in the area where Mrs A lives, she was not able to access primary eye care through this route.

9. PES advised Mrs A of the emergency eye clinic at a local hospital. When Mr and Mrs A rang the hospital, it had no appointments available, but suggested they contact a different hospital. The emergency eye clinic at the second hospital advised it could only treat Mrs A if she was referred by an optician. Mr and Mrs A contacted four local opticians, but none had any emergency appointments available.

10. This meant that Mrs A was unable to access primary eyecare in the Norfolk and Waveney area for her eye problem.

14. To decide if we should conduct a detailed investigation, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that the ICB got anything wrong.

15. The ICB commission PES who deliver CUES to patients registered with a GP in the Norfolk and Waveney area. For non-residents, access to urgent eyecare is available via referral from NHS111, a MIU, or Accident and Emergency. It is not the case that non-residents to the Norfolk and Waveney area are excluded from accessing emergency eyecare. We are sorry Mrs A was not signposted to the correct places to receive urgent eyecare.

16. We are unable to criticise the ICB for not commissioning services specifically for non-residents. The ICB’s role is to commission services for people who live in the area. An alternative route is available to non-residents. We are therefore not able to achieve the outcome that Mr and Mrs A are seeking in terms of commissioning of services.

17. In its response letter to Mr and Mrs A, the ICB explained that following their complaint it had taken the following steps:

• PES requested all local GP Practices be willing to collaborate with the ICB to support the arrangement of alternative provisions for out-of-area patients • ensured all local GP Practices were reminded they can only refer patients living in the Norfolk and Waveney area to the CUES service • the ICB would consider the option of including out-of-area patients into the CUES contract for the future • the Associate Director of the new Commissioning and Performance team asked for Mr and Mrs A’s concerns to be followed up via their Multi-Disciplinary Team meeting.

18. The ICB continue to review service models and is awaiting feedback to inform future approaches to delivering urgent eyecare to non-residents. The ICB has also informed us of a potential rollout of the CUES service across England. This would mean any resident of England would be able to access CUES when visiting other parts of England.

19. On instruction from the ICB, the GP Practice Mr and Mrs A contacted has updated its process to ensure people are correctly signposted to NHS111 or a MIU.

20. We have advised the ICB that two local hospitals also incorrectly signposted Mr and Mrs A, and we have asked that they take some learning from this.

21. Although we cannot see any indications the ICB did anything wrong, we recognise Mr and Mrs A had a distressing experience and were inconvenienced by not being signposted to the correct services during their holiday. We can see the ICB has taken appropriate action to ensure GPs in the area are aware of the correct route for non-residents to obtain urgent eyecare. By sharing learning about the local hospitals, the ICB can consider whether it should do anything differently in terms of communication to ensure people are directed to the right services in future.

22. We hope this statement reassures Mr and Mrs A that urgent eyecare services are available for holidaymakers in the Norfolk and Waveney area.

1. We have carefully considered Mr and Mrs A’s complaint about the commissioning of services by Norfolk and Waveney Integrated Care Board (the ICB).We recognise Mr and Mrs A suffered distress and inconvenience whilst trying to find medical help for Mrs A’s eye problem during their holiday.

2. We have not seen any indications of failing by the ICB when commissioning eyecare services in the Norfolk and Waveney area.

3. It is the role of the ICB to plan and deliver healthcare for people who live in their area. The ICB has done this through the commissioning of Primary Eyecare Services (PES) via the delivery of Community Urgent Eyecare Services (CUES). For non-residents to the area, urgent eyecare can be accessed via referral from NHS111, a minor injuries unit (MIU) or Accident and Emergency.

4. We did see that Mr and Mrs A were incorrectly signposted to access care by multiple organisations in the local area and we have informed the ICB of this and asked it to take some learning. We would like to reassure Mr and Mrs A that emergency eye services are available to out of area patients in the Norfolk and Waveney area.