Scotland updates eye-care referrals from 1 Jan 2026

Scotland has updated how NHS general ophthalmic services work for front-of-eye problems. The Regulations were made on 5 November 2025, laid before the Scottish Parliament on 7 November, and come into force on 1 January 2026. Jenni Minto signed on behalf of the Scottish Ministers. We’ve pulled out what changes for you, why the wording matters, and how referrals will run from the new year.

First, a clear definition. The law now spells out what counts as an “anterior eye condition”. It includes ten conditions: anterior uveitis, blepharitis, corneal foreign body, episcleritis, herpes simplex keratitis, herpes zoster ophthalmicus, infective conjunctivitis, marginal keratitis, ocular allergy and ocular rosacea. When a clinician records one of these during an NHS eye examination, the new referral rules kick in.

Referrals tighten up for these cases. If you show signs of an anterior eye condition in an NHS eye examination, the examining practitioner may only refer you to a specialist ophthalmic medical practitioner or a specialist optometrist independent prescriber. Crucially, that specialist must have agreed to accept the referral before it is made. This is designed to send patients directly to someone with the right skills and prescribing authority.

Place matters as well as consent. The referring clinician is asked to consider where you normally live when choosing who to send you to, so care is arranged as near to home as practical within NHS systems. A specialist can accept a case when they reasonably expect that they, or another specialist working from the same practice premises, will be able to carry out any eye examination that follows.

So who is a “specialist” here? It is a service role created by your local NHS Board, not a new title on a professional register. A specialist ophthalmic medical practitioner or specialist optometrist independent prescriber is a clinician who has entered into an arrangement with their Board to provide general ophthalmic services for specified anterior eye conditions. The conditions covered are listed in that local agreement.

Two safeguards sit around those agreements. First, a Board may only make such an arrangement with someone on its Ophthalmic List, which keeps delivery inside the existing quality and vetting framework. Second, the agreement must be made on a form supplied by the Agency. In plain terms, that means the paperwork and data flows sit with the standard NHS processes you already use.

Independent prescriber, explained. An optometrist independent prescriber is an optometrist who has the required annotation on the register confirming they can prescribe medicines for eye conditions within their competence. Under these Regulations, an IP optometrist becomes a “specialist” only if they also have a Board agreement for the specified anterior eye conditions in their area.

What changes for you in clinic. If you are an optometrist or ophthalmic medical practitioner carrying out NHS eye examinations, you continue to follow the 2006 terms of service, but with a further step when you identify one of the ten anterior conditions. You line up a local specialist who has agreed to accept, you factor in the patient’s home location, you make the referral once acceptance is in place, and you give the patient written confirmation of what you’ve done.

What this means for patients. You should find that urgent front‑of‑eye problems are managed by clinicians with the right prescribing skills, often closer to home. You may still be referred to your GP or to hospital if that is appropriate, but the route into enhanced community optometry is clearer and faster because the receiving clinician confirms acceptance before the referral is made.

Study note for classrooms and clinics. Memorise the ten conditions, the acceptance rule, the ‘consider where the patient lives’ test, and the fact that “specialist” status comes from a Board arrangement, not a new professional badge. Keep the start date in view: 1 January 2026. When revising, practise mapping symptoms to the correct referral pathway and identifying which clinician can prescribe in that pathway.