Scottish NHS anterior eye referrals change 1 Jan 2026

Scotland is updating how the NHS handles urgent problems at the front of the eye. From 1 January 2026, new rules set who can accept referrals and how those referrals are made under General Ophthalmic Services (GOS). This change sits in the National Health Service (General Ophthalmic Services) (Scotland) Amendment Regulations 2025, SSI 2025/337, laid before the Scottish Parliament on 7 November 2025 and published on legislation.gov.uk.

When clinicians talk about the “anterior eye”, they mean the eyelids, the conjunctiva, the clear cornea at the front of the eye and the front part of the uveal tract. The Regulations list ten conditions that count for this pathway: anterior uveitis; blepharitis; corneal foreign body; episcleritis; herpes simplex keratitis; herpes zoster ophthalmicus (shingles affecting the eye); infective conjunctivitis; marginal keratitis; ocular allergy; and ocular rosacea. The Scottish Government trailed the same set of conditions earlier in 2025, as reported by the Association of Optometrists.

Here is the core change you will notice in practice. If you present with signs of one of these anterior eye conditions, your community optometrist or an ophthalmic medical practitioner can only refer you to an approved specialist-either a specialist ophthalmic medical practitioner or a specialist optometrist who is an independent prescriber-and only if that specialist confirms they will take the case. The referrer must also consider where you normally live so care is offered as near to home as possible.

Once a specialist receives a request, they can agree to accept the referral when they reasonably expect that they, or another approved specialist working at the same premises, will be able to carry out any necessary eye examination. In simple terms, you should be booked with someone who can actually see you promptly, rather than being passed around.

The Regulations also spell out who counts as a “specialist”. A Health Board may enter into an arrangement with an ophthalmic medical practitioner or with an optometrist independent prescriber to provide GOS for specified anterior eye conditions in that Board area. Those who sign such an arrangement are treated as “specialists” for those specified conditions. They must already be on the Board’s Ophthalmic List, and the agreement is made on a form supplied by the Agency.

For patients, the aim is quicker care closer to home. The Scottish Government’s improvement plan-summarised by the Association of Optometrists-suggested the service could free up around 40,000 hospital eye appointments a year once most Boards are fully running it by March 2026. That means more hospital capacity for people who truly need secondary care, and faster treatment in community practices for red, painful or irritated eyes.

For students and early‑career clinicians, this is a live case study of how scope of practice links to law. Independent prescribing optometrists will manage more complex anterior conditions within GOS, while non‑IP colleagues can refer to those IP clinics locally. Earlier in 2025, the Scottish Government signalled a specialist supplementary examination for IP optometrists and an enhanced GOS fee to support this model-useful context for learning how commissioning supports clinical roles.

Let’s walk through a real‑world scenario. A 28‑year‑old arrives with a painful red eye and light sensitivity. Signs point to anterior uveitis. Under the new rules, the optometrist refers the patient to a nearby specialist independent prescriber who has agreed to take the case. Treatment starts in the community under GOS, and the patient is reviewed locally rather than waiting for a hospital slot.

Because Health Boards specify which anterior eye conditions they commission under their local arrangements, you may see small differences between areas at first. If you work in practice, keep an up‑to‑date contact list for neighbouring specialist clinics, agree a simple process for confirming a patient’s home address before referral, and document how you obtain acceptance from the receiving specialist. This helps patients and keeps referrals compliant with the Regulations.

Timeline check for your notes: the Regulations were made on 5 November 2025, laid before the Scottish Parliament on 7 November 2025, and come into force on 1 January 2026. They were signed on behalf of the Scottish Ministers by Jenni Minto at St Andrew’s House, Edinburgh. Look out for Board‑level guidance that will sit alongside the national rules.