Deprivation and NHS General Ophthalmic Service sight testing activity in England in 2022–2023

Purpose Socioeconomic deprivation is associated with an increased incidence of sight‐loss. To inform potential developments in eyecare, General Ophthalmic Service (GOS) sight‐testing activity was explored in relation to deprivation for GOS contractors submitting National Health Service (NHS) claims in England. Methods Data on NHS sight‐test claims for the financial year 2022–2023 were sought from NHS England (NHSE), including number of sight‐tests by GOS contractors, their unique Organisation Data Service codes and postcodes and age‐bands of patients accessing sight‐testing. Deprivation scores were assigned to contractor practices using the Index of Multiple Deprivation (IMD) and the average number of sight‐tests for all contractors within each IMD decile calculated, allowing rate of sight‐testing per 1000 population per decile of deprivation to be estimated using Office of National Statistics (ONS) Lower Layer Super Output Area mid‐year population estimates. Inequality was examined using the Odds Ratio (OR) and slope and relative index of inequality measures (SSI and RII). Results Overall, 12.94 million NHS sight‐tests were provided by 5622 GOS contractors in England in 2022–2023. Most affluent decile GOS contractors undertook an average ~2200 NHS sight‐tests, while in the most deprived decile, average NHS sight‐tests per contractor was ~1100. Rate of sight‐testing per 1000 population in the most deprived decile was one quarter of that in the most affluent, with an OR of 5.29 (95% CI 5.27–5.30), indicating those in the most affluent areas were ~five times more likely to access NHS sight‐tests. Overall, SII and RII were 333.5 (95% CI 333.52–333.53) and 6.4 (95% CI 6.39–6.40), respectively, findings reflective of substantial inequality in uptake. Conclusion There remains substantial unwarranted variation in uptake of NHS sight‐testing, with those in more affluent areas accessing sight‐testing substantially more than those in more deprived areas. Strategies are required to facilitate primary care optometry to provide more equitable access to eyecare.