Scotland's NHS eye-care changes start 1 January 2026

You know that moment when your eye is red, gritty or suddenly sore and you’re not sure who to see first? Scotland is about to make that decision clearer. From 1 January 2026, the rules for NHS eye care change to give you a more direct route to the right professional, closer to home. This update arrives via Scottish Statutory Instrument 2025/337, made on 5 November and laid before the Scottish Parliament on 7 November 2025. We’ve read the legal text so you don’t have to, and this explainer translates it into everyday steps for patients, students and teachers.

Here’s the simple version. The law adds a precise definition of “anterior eye condition”, formally names two specialist roles in community eye care, and tightens how referrals are made when these conditions are suspected. The aim is practical: you should be seen by someone trained to manage the issue, in a place that makes sense for where you live. Think of it as tidying up the pathway. Your first contact in the community still matters, but the next step is now more clearly signposted.

So, what counts as an anterior eye condition under the new rules? The law lists ten: anterior uveitis, blepharitis, a corneal foreign body, episcleritis, herpes simplex keratitis, herpes zoster ophthalmicus, infective conjunctivitis, marginal keratitis, ocular allergy and ocular rosacea. All of these affect the front of the eye or eyelids - the cornea, conjunctiva or surrounding tissues. Conditions at the back of the eye, such as retinal tears, aren’t covered by this definition and follow different pathways.

Two specialist roles are created for this pathway. A “specialist ophthalmic medical practitioner” is a doctor providing general ophthalmic services under a Health Board arrangement for specified anterior eye conditions. A “specialist optometrist independent prescriber” is an optometrist with the independent prescribing qualification working under the same type of Board arrangement. Here, “specialist” is a legal label. It means the professional has a formal agreement with the local Health Board, appears on the Board’s List, and the arrangement is recorded on a national form supplied by the Agency. It does not turn every optometrist or every doctor into a specialist - it’s about those contracted for these specific services.

The referral rules tighten in an important way. If, during an NHS eye examination, you show signs of an anterior eye condition, the professional examining you can only refer you to a specialist ophthalmic medical practitioner or a specialist optometrist independent prescriber - and only if that specialist has agreed to accept the referral. The referrer must take into account where you normally live when deciding where to send you. The receiving specialist can accept if they reasonably expect that they, or another specialist working at the same practice premises, will be able to carry out any necessary eye examination. In short: agreed referrals, realistic capacity, and a focus on local care.

What this means for your appointment is straightforward. More of the listed front‑of‑the‑eye problems can now be assessed and treated in community optometry settings by trained independent prescribers, rather than defaulting to hospital clinics. You should still be referred to hospital if your case is complex or sight‑threatening, but for these ten conditions the first port of call will often be your local practice. You can expect clearer information about who will see you, where, and roughly when - because acceptance happens before the referral is sent.

If you need urgent help, the basics remain the same. For sudden loss of vision, severe eye pain, a chemical injury or major trauma, seek emergency care immediately. For non‑emergency issues like suspected conjunctivitis, blepharitis or a foreign body sensation, book an NHS eye examination with a community optometrist. If one of the defined anterior conditions is suspected, you may be treated there and then or referred to a named local specialist who has agreed to see you. This explainer supports your health decisions, but it isn’t medical advice. If you’re worried about your sight, please seek professional care promptly.

Health Boards now have a clear job to do. They can enter into arrangements with doctors and independent prescribing optometrists to provide general ophthalmic services for specified anterior eye conditions. “Specified” means the exact conditions are listed in each local agreement, so the precise scope may vary by Board. The “specialist” title applies for the purposes of those agreements. For you, that means services may be organised slightly differently in different areas, but the legal framework aims to keep care closer to where you live.

Dates help you plan. The regulations were signed by Jenni Minto on 5 November 2025, placed before the Scottish Parliament on 7 November 2025, and come into force on 1 January 2026. If your appointment is before 1 January, current routes apply; from New Year’s Day, the new referral rules switch on. Teachers: this is a neat civics moment. “Made”, “laid” and “in force” are three stages that show how rules move from ministerial sign‑off to parliamentary scrutiny to real‑world change.

A quick learning corner for students. “Anterior” simply means “front”. Herpes zoster ophthalmicus is shingles affecting the eye area; herpes simplex keratitis is a corneal infection caused by the cold‑sore virus. A corneal foreign body might be as small as a speck of metal or grit. Even “mild” problems can threaten vision if ignored - that’s why fast assessment matters. Knowing these terms helps you describe symptoms clearly, which speeds up the right care.

When you next see your optometrist, it’s reasonable to ask whether your problem falls under the new anterior eye rules, whether they are an independent prescriber, and if a referral is needed, whether you’ll be seen locally by a designated specialist. Clear questions lead to clear plans, and that’s the whole point of this reform.

One last note on fairness. The law tells referrers to consider where you normally live. That’s a practical equity check for people in rural or island communities: the default should be appropriate care as close to home as is safe. If you’re offered a referral that seems far away, it’s okay to ask if there is a nearer specialist within the Board’s arrangements. This is your care, and you deserve it to be accessible.