CUES and urgent eye conditions in Greater Manchester evaluated 2026

Key Points

• The Community Urgent Eyecare Service (CUES) in Greater Manchester allowed 54,994 patient episodes in 2024, out of which 83% were kept and discharged in primary care.
• Painful red eye is the leading complaint among CUES patients (66%), followed by flashes and floaters (17%), vision issues (12%), and foreign body sensation (4%).
• Approximately 17% of CUES patients require hospital referral; however, there is an agreement between the emergency department clinicians and the optometrist’s diagnosis in 75% of cases.
• IP optometrists discharge 88% of their patients from CUES compared to 78% from other optometrists, who write prescriptions for around three-quarters of IP patients.
• According to the researchers, the IP optometrists could deal with 40% of the hospital referrals, providing a way of reducing secondary care pressures.
• Public awareness programs such as “Get to Know Where to Go” in Greater Manchester are used to increase the popularity of CUES together with other community services.
• There is a case in August 2026 when CUES contributed to same-day urgent referral and the diagnosis of giant cell arteritis of 78 years old patient.

Manchester (Manchester Mirror) October 01, 2026 – The Community Urgent Eyecare Service (CUES) in Greater Manchester is an NHS-funded pathway that allows residents registered with a local GP to access urgent assessment and treatment for sudden-onset eye problems through accredited community optometry practices rather than attending hospital emergency departments or waiting for GP referrals. The service covers conditions such as sudden loss of vision, red or painful eyes or eyelids, flashes and floaters, and minor eye injuries or foreign bodies. Patients contact a participating optician, describe their symptoms, and are triaged for a same-day or next-day appointment; the service is not walk-in and operates throughout the week, with some sites offering weekend and evening slots.

As reported by Emily McCormick of Optometry Today (OT), the service has been integral in facilitating rapid referrals for serious conditions, illustrated by the case of 78-year-old Edwin Causey, who lost vision in one eye and was seen the same day at a Specsavers practice in Wigan before being urgently referred to Manchester Royal Eye Hospital, where he was diagnosed with giant cell arteritis. Optometrist Irem Ahmed told OT that the patient’s additional symptoms of jaw pain and headaches raised immediate concern, prompting same-day emergency referral.

How effective has CUES been in reducing pressure on hospital eye services?

The largest evaluation of CUES in England to date, published in Ophthalmic and Physiological Optics in July 2026, analysed 54,994 CUES episodes across Greater Manchester in 2024 and found that 83% of patients were retained and discharged within primary care. Around 17% of cases were referred to hospital eye services, and in 75% of those referrals, emergency eye department clinicians agreed with the optometrist’s initial diagnosis, indicating appropriate triage.

The study authors noted that among hospital-referred cases, 40% could have been managed in primary care if independent prescribing (IP) capacity had been available, suggesting a significant opportunity to further reduce secondary care demand. Only 496 of the 54,994 CUES cases in 2024less than 1% were managed by practitioners using their IP qualification, yet IP optometrists discharged 88% of their patients compared with 78% for non-IP colleagues.

What symptoms are driving CUES appointments and how are they managed?

According to the 2026 evaluation reported by OT, painful red eye accounted for 66% of CUES appointments in Greater Manchester in 2024, followed by flashes and floaters (17%), vision problems (12%) and foreign body sensation (4%). IP optometrists issued FP10 prescriptions in roughly three out of every four IP-managed CUES cases, with corticosteroids the most common (44% of prescriptions), followed by antibiotics (14%) and antimuscarinics (12%).

Service guidance states that CUES provides remote and/or face-to-face urgent assessment, treatment, or referral for sudden-onset problems including vision loss, red eyes, flashes and floaters, and minor injuries. Providers such as Optieye Care and Hazeldene Medical Centre describe typical presentations as red, sore or irritated eyes; sudden blurred or reduced vision; eye infections; new floaters or flashes; foreign bodies; and painful or swollen eyelids

How are public awareness campaigns supporting uptake of CUES?

Public awareness campaigns have played a supportive role in promoting CUES alongside other community services. As noted in a Primary Eye Care Services (PES) document, the Greater Manchester “Get to Know Where to Go” campaign has been part of a system-wide approach to raising the profile of CUES. The campaign, run by Greater Manchester Integrated Care, targets residents and healthcare staff to help people understand where to seek care for urgent but non-emergency conditions, including eye problems.

Materials emphasise that CUES is suitable for recently occurring conditions such as sudden vision loss, red or painful eyes, flashes and floaters, or foreign bodies, and is available to anyone registered with a Greater Manchester GP. The service aims to deliver quick community-based assessments and treatment from local optician teams, avoiding unnecessary GP visits or A&E attendance.

What benefits are patients and practitioners reporting from CUES?

Practitioners involved in enhanced eye care services, including CUES, have reported quicker and more convenient access to care, reduced waiting lists, continuity of care, and greater professional satisfaction. During National Eye Health Week 2026, OT highlighted that CUES supports fast access to frontline emergency eye care, normally with less waiting and in a more convenient environment than A&E or a GP surgery.

For patients, the service offers same-day or next-day assessment close to home, with the ability to receive treatment, self-care advice, or urgent hospital referral as needed. In Edwin Causey’s case, the CUES pathway enabled same-day assessment and urgent referral that led to diagnosis and treatment of giant cell arteritis, preventing further vision loss and reducing stroke risk.

What role does independent prescribing play in CUES outcomes?

Independent prescribing capacity appears to be a key determinant of CUES efficiency. The 2026 evaluation found that IP optometrists discharged a significantly higher proportion of CUES patients (88%) compared with non-IP optometrists (78%). IP practitioners issued prescriptions in around three out of four IP-managed cases, predominantly corticosteroids, antibiotics and antimuscarinics.

The authors concluded that addressing barriers to IP qualification, such as cost and hospital placement availability, could improve the CUES pathway by enabling more cases to be managed fully in primary care. They estimated that four in ten referrals to hospital eye services could have been managed by an IP optometrist if capacity had been available.

Background of the CUES development in Greater Manchester

CUES forms part of a broader shift in Greater Manchester towards enhanced primary eye care designed to relieve pressure on general practice and hospital eye services. The Greater Manchester Primary Care Blueprint, published in 2024, set out plans to ensure residents can access the Community Urgent Eye Care service and related initiatives to improve and enhance eye care. Urgent Eyecare Services (UES) were expanded to be available seven days a week across the region, with a network of optometrists providing telephone triage followed by face-to-face appointments where required.

An electronic referral system, the Electronic Eyecare Referral Service (EERS), has also been implemented, allowing optometrists to refer directly to hospital eye services rather than via GPs. Over 55,000 referrals were made through EERS in 2022–23, with 99% of Greater Manchester practices signed up, improving speed, reducing lost referrals and enabling richer clinical information and images to be shared with hospitals. Public campaigns such as “Get to Know Where to Go” have complemented these structural changes by educating residents on appropriate routes for urgent care.

Prediction: How might CUES affect patients, optometrists and the wider health system?

If CUES continues to expand and independent prescribing capacity increases, patients in Greater Manchester are likely to experience faster access to urgent eye care with fewer unnecessary hospital visits, particularly for common presentations such as red eye and minor injuries. Greater use of IP optometrists could further reduce the 17% hospital referral rate by managing an additional proportion of cases in primary care, shortening pathways and potentially improving outcomes for time-sensitive conditions such as giant cell arteritis.

For optometrists, expanded CUES and IP roles may increase clinical responsibility and professional satisfaction but also require additional training, funding and hospital placement opportunities to overcome current barriers. For the wider health system, sustained growth in CUES activity could meaningfully relieve pressure on emergency eye departments and GP surgeries, especially during winter peaks, provided public awareness campaigns continue to direct appropriate cases to community optometry.