Scotland’s Record Eye Exams Still Miss the Poorest

Scotland’s community optometrists delivered about 2.54 million NHS eye exams in 2025/26, up 108,199 or 4.44% on the year before. Public Health Scotland published the General Ophthalmic Services figures on 15 September 2026. About 21,000 of those visits were the new specialist supplementary exams that started on 1 August 2025.

The same release still puts a 6.4 point gap on the front page. Only 29.3% of people in the most deprived fifth of Scotland had a routine primary exam, against 35.7% in the least deprived fifth. Home visits reached a record 61,200 and still made up 2.4% of the work.

2.54 Million Exams in a Single Year

Public Health Scotland says 2.54 million eye examinations were undertaken under GOS between April 2025 and March 2026. About 1.82 million were primary exams, up 74,891 or 4.3%. Supplementary exams, the follow-ups, emergencies and extra tests, ran at around 720,000, more than double the 300,000 or so recorded in 2010/11.

Volume has climbed for most of the life of the 2006 Scottish GOS contract, which replaced a simple sight test with a full eye-health exam paid by the NHS for every resident. Exams rose from around 1.57 million in 2006/07 to over 2.34 million in 2018/19, then fell to 2.18 million in 2019/20 before the pandemic cut activity again.

GOS ACTIVITY IN 2025/26

Self-referrals, people who booked themselves in, sat at about 1.2 million in both 2024/25 and 2025/26, down just under 10,000 or 0.8%. Unscheduled appointments were the most common reason for a supplementary exam, at 35.9%, then anterior eye conditions at 30.0% and follow-up or repeat procedures at 14.5%.

Johnathan Waugh, an independent prescribing optometrist and practice owner, called the headline “good news for Scotland that the message is getting out there and more people are getting their eye examinations.” He still wants more public-health campaigning around the free exam itself.

People in the Poorest Areas Still Come Less

PHS analyses exams against SIMD 2020, the Scottish Index of Multiple Deprivation, in population-weighted fifths. The primary-exam rate was 29.3% in SIMD 1, the most deprived fifth, and 35.7% in SIMD 5. Across Scotland, 32.5% of residents had a primary exam in the year. Supplementary rates were similar across most fifths and highest in SIMD 5, so the inequality sits in the routine check, not in the emergency slot.

That is not because the shops are missing. A 2018 study of 672 practices across nine health boards found optometry practices cluster in poorer postcodes: 25% and 33% of practices sat in the two most deprived fifths, against 14% and 11% in the two least deprived. The authors concluded that uneven uptake is not a problem of empty high streets.

WHO HAD A PRIMARY EXAM IN 2025/26

Board rates ran from 23.2% in NHS Orkney to 36.4% in NHS Dumfries and Galloway. Supplementary rates were lowest in Orkney at 5.7% and highest in NHS Ayrshire and Arran at 11.0%. Of the 1.8 million people who had a primary exam, 56.4% were female and 43.6% male, against a mid-2024 population split of 51.4% female and 48.6% male.

Waugh asked whether a habit of hearing “eye exam” as “expensive glasses” still keeps people away in the poorest postcodes, even though the exam itself is NHS-funded. Glasses are not. Over 408,000 spectacles, lenses and supplements were claimed on GOS(S)3 vouchers, which help children, students, people who need complex lenses, and adults on listed benefits. Tax Credit as a claimant group ended on 6 April 2025, and only 63 claims landed in that box.

Why Home Visits Still Make Up 2.4%

Patients can be seen at home or in a residential centre if a physical or mental illness or disability stops them leaving unaccompanied. PHS counted about 61,200 of those visits, the highest figure in the series, and the share of all exams stayed at 2.4%, the same band as recent years except 2020/21, when the rate halved to 1.2% under pandemic rules.

Waugh called the graph worrying. “If we’re only doing 60,000 domiciliary examinations every year; that must be a fraction of the number of people who are entitled,” he said, putting Scotland’s population at more than 5.5 million and getting older. He wants more work to promote home visits. The report does not estimate how many people meet the legal test, so the unmet pool is still a judgement, not a headcount.

The age pattern in the clinic already leans old. Primary-exam rates peaked at 62.2% for women aged 75 to 79 and 60.4% for men aged 80 to 84. Supplementary rates peaked at 22.8% for women aged 80 to 84 and 20.6% for men aged 85 to 89. The people who cannot get to the shop are the group those curves do not capture.

A Higher Fee for Conditions Already Treated

GOS Specialist Supplementary, GOS-SS, began as an interim service on 1 August 2025 so independent prescribing optometrists and ophthalmic medical practitioners could manage listed anterior-eye conditions in the shop rather than send them to hospital. Full rollout on 19 January 2026 took the list from nine to ten acute anterior eye conditions, adding corneal foreign-body removal. About 21,000 of those exams were claimed from 1 August 2025 to the end of March, fewer than one in 100 of the year’s GOS visits.

On 31 March 2026, 674 independent prescribing optometrists sat on a health-board ophthalmic list. Waugh’s reading of the new item of service is blunt: government was paying properly for work the clinics were already doing.

I think the important background to the GOS-SS is that this was an acknowledgement by Government that we were already managing these conditions.

Johnathan Waugh, independent prescribing optometrist and practice owner

The higher fee is meant to cover longer chairs, more skill, and extra reviews that disrupt a clinic diary. Frances Jamieson, also an IP optometrist and practice owner, said fewer cases than she expected met the higher-paid bar, because the condition has to need stage-two treatment and “a surprisingly high number of cases can be fully treated in stage one.” With Pharmacy First, she said, any optometrist can already handle a good share of acute presentations. The specialist exams she has billed have mainly been acute anterior uveitis, herpes simplex keratitis, and foreign-body removal.

CONDITIONS ON THE GOS-SS LIST

• From 1 August 2025: Anterior uveitis, anterior and posterior blepharitis, episcleritis, herpes simplex keratitis, herpes zoster ophthalmicus, infective conjunctivitis, marginal keratitis, ocular allergy, and ocular rosacea.
• Added 19 January 2026: Corneal foreign-body removal, taking the list to ten.
• Stage-two scripts: Independent prescribers write them on GP10(O) forms for community pharmacies; Pharmacy First stage-one supply did not change.

Waugh wants the 21,000 claims treated as proof the service works, and as a reason to add more conditions. Jamieson’s chair-side view is that the paid specialist slice is narrower than the acute work already sitting in Scottish GOS.

Hospital Referrals Rose With the Exam Count

PHS notes that 93.7% of people who had an exam were not referred on, “demonstrating that most patients were managed within community optometry.” The other slice still grew. Referrals to hospital rose from around 21,500 in 2006/07 to over 119,500 in 2025/26, a climb the report calls stable relative to the extra exams. Referrals to a GP fell from 45,000 to less than 24,000 over the same span.

Those two facts sit together. Community clinics now hold most of the work, and hospital eye services still receive more than five times as many GOS referrals as they did when free exams began. The specialist service was sold as a way to cut that hospital load. In September 2025 the Scottish Government said the new anterior-eye service should free up an estimated 20,000 hospital appointments a year, a figure drawn from earlier local schemes in NHS Grampian and NHS Fife, inside a stated £139 million spend on community eyecare that year.

This new service will mean people can get treatment for more eye conditions in the community, without the need to travel for a hospital appointment. It will get people the treatment they need faster, improving outcomes while also freeing up vital hospital capacity for more serious cases.

Jenni Minto, Public Health Minister, Scottish Government, 24 September 2025

Twenty-one thousand GOS-SS claims in eight months is in the same zone as that annual 20,000 estimate, but a billed community exam is not the same thing as a hospital slot released. Full national rules only applied from 19 January. Hospital referrals for the year still cleared 119,500. The public argument around Scottish GOS has always been this trade: a large, free community service against a hospital list that does not shrink just because the high street is busier.

Universal Cover Has Not Equalised Attendance

On 1 April 2006 everyone in Scotland became eligible for a fully funded NHS primary eye examination, with a recommended interval of at least every two years. A 32.5% primary-exam rate in a single year is a heavy use of that two-year rhythm. It is also a reminder that a third of the country did not have that routine check in 2025/26, and that the missing third is thicker in SIMD 1.

From 1 August 2025, GOS(S)1 forms started logging myopia as its own clinical flag. Between that date and 31 March 2026, practices recorded 170,030 myopia flags and 862,222 entries for corrected refractive error. Jamieson called the new myopia field a useful UK-based dataset. Cataract with reduced visual acuity (259,799) and diabetes (86,687) were also among the conditions logged in that eight-month window. A patient can carry more than one flag, so the counts are marks on forms, not a clean census of disease.

HOW SCOTTISH GOS GREW

1. 1 April 2006: The NHS (General Ophthalmic Services) (Scotland) Regulations replace the old sight test with a funded comprehensive exam for every resident.
2. April 2010: Rules tighten how often a primary exam can be claimed, and supplementary volume starts its long rise.
3. October 2018: An enhanced supplementary exam that needs dilation is added.
4. 1 August 2025: Interim GOS-SS lets independent prescribers manage nine anterior-eye conditions in the community.
5. 19 January 2026: Full GOS-SS implementation, with a tenth condition and new claiming rules.

Optometry Scotland, looking at a decade of fees in January 2026, said practices now receive £57.80 where dilation or cycloplegia is required, against about £37 for under-60s and £45 for over-60s in 2016. England’s NHS sight-test fee, in that same comparison, moved from £21.31 to £24.13, about 13%. Independent prescribing in Scotland ran at around 142 optometrists in 2016 and 600 by 2025, before PHS’s 674 on 31 March 2026.

Minto’s line still stands: Scotland is the only part of the UK with universal free NHS eye exams. PHS still puts 29.3% versus 35.7% in its three main points, next to the 2.54 million. The next of these accredited statistics is due on 14 September 2027. Until then the record year is also a map of who did not come in, and of how few of the exams happened in someone’s front room.

Frequently Asked Questions

How Often Can You Get a Free NHS Eye Exam in Scotland?

When free GOS exams began on 1 April 2006, the recommended interval was a primary examination at least every two years for all patients, with supplementary visits used for emergencies, extra tests and follow-up. Children, people with changing prescriptions and those under active monitoring can be seen sooner under the claiming rules, which is why supplementary volume now runs at around 720,000 a year beside 1.82 million primary exams.

Who Qualifies for Help With the Cost of Glasses?

The exam is free; glasses are not, unless the patient holds a GOS(S)3 voucher. Eligible groups include children, students, people who need complex lenses, and adults on listed benefits such as universal credit or pension credit. Most 2025/26 voucher items were for children or for adults on those two credits. Repairs and replacements sit on a separate GOS(S)4 form and are not inside the 408,000 GOS(S)3 item count.

Who Can Get an NHS Eye Exam at Home in Scotland?

GOS pays for a visit at home or in a residential centre only if a physical or mental illness or disability means the patient cannot leave unaccompanied. That legal test is narrower than “older and less mobile,” which is why a record 61,200 visits can still look small against an ageing population. Practices claim the exam as a domiciliary GOS item rather than as a private home visit.

How Many Independent Prescribing Optometrists Work in Scotland?

Public Health Scotland counted 674 independent prescribing optometrists on a health-board ophthalmic list on 31 March 2026. Optometry Scotland put the 2016 figure at around 142, more than a third of all UK IP optometrists at that time, and 600 by 2025. Glasgow Caledonian University’s MOptom course now graduates every new optometrist with the IP qualification, so the register is expected to keep rising as GOS-SS beds in.

Disclaimer: This article is news reporting on Public Health Scotland’s General Ophthalmic Services statistics and related Scottish Government eye-care policy. It is for information only and is not medical advice, a diagnosis, or a guide to whether any person should seek, delay or change an eye examination or treatment. Readers with vision changes, eye pain, flashes, sudden loss of sight or a long-term eye condition should speak to a community optometrist, GP or hospital eye service, and should not rely on these figures to make clinical decisions. Counts, rates and service rules are those published by Public Health Scotland, NHS National Services Scotland and the Scottish Government for the periods named, and they can be revised in later releases.