Previous research has reported that inequalities exist in uptake of NHS sight tests in relation to socio-economic status, and that community optometric services have potential to improve system efficiency. The current research found inequalities in sight test outcome related to socio-economic status and the type of practice that a patient visits (multiple, or independent). Patients attending multiples were more likely to receive a ‘new or changed prescription’ relative to ‘no prescription’ compared to patients that attended independent opticians (36-71% more likely). Those living in the least deprived areas were also less likely to receive a new prescription (1-12%) and those aged <16 years were less likely to be referred (9%). The study examining the need for a Minor Eye Condition Service in Leeds and Bradford found it would produce theoretical cost savings, whilst maintaining high patient satisfaction. Subsequently, a MECS was commissioned in Bradford. The study attempting to collect data from MECS across all areas of England found that data is not routinely collected, or shared. The limited data available typically showed that 73-83% of patients were retained in optometric practice with 12-18% receiving a hospital referral. A prospective evaluation of a COVID urgent eye care service found that teleconsultations frequently did not resolve patients’ eye problems (27%). These telephone consultations failed to detect some serious conditions such as scleritis, wet macular degeneration, retinal detachment. The results from the thesis support the view that the current method of delivering eye care in England is contrary to the public health interest.