The Business Services Organisation (BSO) has published its annual statistics for Northern Ireland’s General Ophthalmic Services, revealing that nearly half a million health service sight tests were carried out last year amid rising costs and shifting workforce patterns. The report, covering the 2025/26 financial year, shows that while patient numbers continue to climb, the number of practices has slightly decreased, and significant inequalities persist in eye care access across different communities.
Workforce Shifts: More Practitioners, Fewer Practices
At the end of March 2026, Northern Ireland had 264 ophthalmic practices registered with BSO—a decrease of 1% compared with March 2025, though still representing a 2% increase since 2014. The number of individual practitioners tells a different story: 714 ophthalmic practitioners are now registered, up 2% on the previous year and 18% higher than in 2017.
Geographic access remains relatively robust. The statistics show that 94% of the Northern Ireland population lives within five miles of an ophthalmic practice, with at least 85% living within three miles in more urban Local Government Districts.
Who is Getting Tested? Persistent Inequality Gaps
Approximately 477,000 health service sight tests were carried out during 2025/26—an increase of 4% from 2024/25 and 34% higher than in 2005/06. However, the distribution of these tests reveals ongoing disparities:
- Four in every five (80%) sight tests were for children under 16 or patients aged 60 and over—the groups exempt from payment
- Females were more likely to receive tests than males, with 26% of the female population attending compared to 21% of males
- For children under 16, attendance in the most deprived areas was 4 percentage points lower than in the least deprived areas
- For adults over 60, this deprivation gap widens to 11 percentage points
Approximately 168,000 optical vouchers were processed during the year, remaining stable compared with 2024/25 after three consecutive years of decline. Almost half (47%) of these vouchers were issued to children under 16.
New Services and Rising Costs
The financial year saw the introduction of a new Primary Care Optometry Post-Operative Cataract Review and Assessment Service, which began in July 2025. During its first nine months, 262 assessments were undertaken.
The Northern Ireland Primary Eyecare Assessment and Referral Service (NI PEARS) continued to expand, conducting approximately 54,000 unique assessments—an increase of 5% on the previous year. The vast majority (90%) were first assessments rather than follow-ups.
Enhanced services saw mixed referral outcomes:
- 59% of Level I assessments resulted in onward referral
- 55% of Level II assessments resulted in onward referral
- 90% of Ocular Hypertension and Glaucoma (OHT) claims were for ‘Routine OHT Review’
The total cost of primary care ophthalmic services reached approximately £27.9 million—a significant increase of 13% on 2024/25. Sight tests accounted for £12.3 million of this spend, while vouchers cost £10.1 million.
Eligibility Changes and Data Standards
The reporting period included a significant policy change affecting access. From 1 December 2025, people receiving Universal Credit no longer require a separate HC2 certificate to qualify for free sight tests and optical vouchers, provided they meet earnings thresholds. This change, which took effect partway through the financial year, aims to bring Northern Ireland into line with the rest of the UK, but its full impact on attendance figures will likely only become clear in next year’s statistics.
The publication marks the seventh year that these statistics have been released as a standalone report. The BSO notes:
“This is the 7 year that General Ophthalmic Services Statistics for Northern Ireland have been released as a standalone report. This information was previously included as part of the FPS compendiums published in 2017/18 and 2018/19.”
The statistics maintain their status as Accredited Official Statistics following an independent review by the Office for Statistics Regulation (OSR) in May 2022. The BSO states:
“These official statistics were independently reviewed by the Office for Statistics Regulation (OSR) in May 2022. They comply with the standards of trustworthiness, quality and value in the Code of Practice for Statistics and should be labelled ‘accredited official statistics’.”
Family Practitioner Services (FPS), which oversees payments to primary care contractors, disbursed over £1.1 billion across all services—including GP practices, dentists, opticians and community pharmacists—on behalf of the Strategic Planning and Performance Group (SPPG) during 2025/26.
Gaps and Considerations
While the data provides a comprehensive overview of payment claims and activity, several questions remain unanswered. The 13% cost increase—significantly outpacing the 4% rise in test numbers—warrants scrutiny, particularly as the average cost per head of population is not explicitly broken down in this year’s summary. Whether this reflects fee increases, higher complexity of cases, or the new cataract service costs is unclear.
The slight reduction in practice numbers (down to 264) alongside rising practitioner counts suggests consolidation in the market, potentially favouring larger chains over independent optometrists, though the data does not distinguish between practice types. Additionally, while the deprivation gap is documented, the statistics do not reveal what specific outreach measures, if any, are being implemented to close the 11-percentage-point gap for over-60s in deprived areas.
The new post-operative cataract service appears to be operating at modest volumes (262 assessments in nine months), raising questions about uptake barriers or eligibility criteria that might be restricting access to this community-based alternative to hospital follow-up.
Outstanding Questions
- What is driving the 13% increase in ophthalmic service costs, and how will this trajectory affect future health service budgets?
- Will the December 2025 Universal Credit eligibility simplification help reduce the deprivation gap in sight test attendance, particularly for working-age adults who previously faced bureaucratic barriers?
- Does the decrease in practice numbers alongside rising practitioner counts indicate consolidation that could affect patient choice or rural access in the long term?
- With 55-59% of enhanced service assessments resulting in onward referral, are these pathways successfully reducing pressure on hospital eye services, or merely adding an intermediate step?
- Given the persistent 5-percentage-point gender gap in sight test attendance, should targeted public health campaigns focus specifically on men’s eye health?
The full statistical tables and quarterly updates are available on the BSO Family Practitioner Services Information Unit website.