Comparing the value of community based and hospital eye service provision of referral refinement – MSc by Research in Social Policy

Location: Swansea University – College of Health and Human Sciences, Singleton Campus

Annual Stipend: £11,702

Application Deadline: 15th November 2019 (Start date – early January 2020)

Project Description (max 500 words):

 Wet age-related macular degeneration (wet AMD) is common and causes severe sight loss and blindness. A confirmed diagnosis is required before invasive active disease is treated until it becomes inactive; patients are then monitored regularly in hospital in case the disease reactivates, at which point further treatment is needed. A diagnosis of ‘suspected’ wet AMD made in primary care requires confirmation by an ophthalmologist. If a preliminary diagnosis wet AMD is made, this can cause patients considerable concern and if the diagnosis is not confirmed at a Hospital Eye Services (HES) appointment, the worry has been unnecessary and a scarcer HES resource has been consumed that might be more productively utilised by another patient. A referral refinement service should reduce the number of unnecessary referrals into the HES reducing stress for patients and demand for out-patient appointments.

Monitoring is also burdensome to patients, their carers and the HES. Provision of a follow-up service in the community may have considerable benefits to both patients by being local and more flexible and taking the pressure away from the HES.

A recent evaluation of Welsh Government (WG) funded Pathfinder services for wet AMD identified that there is an acute lack of medically trained staff in the HES who participated in the Pathfinder project, especially wet AMD intravitreal injection clinics. Optometrists were upskilled to provide key elements of patient management. Community optometrists in services in two different health boards showed that they can provide a referral refinement service in a community based practice and could monitor stable patients from several practices in collaboration with the HES.

The value of the provision of community based referral refinement and stable follow-up were not evaluated in detail in the evaluation of the pathfinder services as sufficiently detailed data were not available. This MSc by Research project would facilitate a more detailed evaluation of the impact on capacity and the value of substituting optometrists for medically qualified staff in the HES and potential impact on NHS resources. The relative value of the changes, in the context of this research, comprises the impact on patients, NHS health care resources, their costs and visual health outcomes for people who have wet AMD who require care from the NHS.

The methodological approach to the research would be ‘mixed methods’ combining qualitative research among the stakeholder communities, mapping out patient pathways and contact with community or hospital based services. Quantitative assessments using simple decision analytic modelling based on available data and the literature would be used to assess the potential impact on resources and outcomes of implementing different models of community based care compared with hospital care.

The setting for the research is Hywel Dda Health Board.

The scholarship offers all eligible participants (student):

  • KESS Scholarship holders do not pay fees
  • A monthly stipend to £11,702 per annum
  • An additional budget to support your research of £3,000 for travel, conference attendance, minor equipment, consumables and training
  • An opportunity to access a suite of higher level skills training & attendance at a residential KESS Grad School
  • A minimum of 30 days a year working with the company partner on their allocated project
  • All participants must complete the KESS Postgraduate Skills Development Award


Candidates should have a 2.1 or above in the undergraduate degree in a closely related subject. They should also be eligible for UK/EU fees (see–advice/fees-and-money/Wales-fee-status for more information. For more information on eligibility criteria please refer to section C of the KESS 2 Participant Proposal From.

How to Apply:

Applicants are advised to contact Dr Pippa Anderson regarding information on the area of research by email

To apply:

  1. Complete the KESS 2 Participant Proposal Form – and return to
  2. Complete the KESS 2 Supplementary form – and return to

You will also need to provide copies of the following documentation:

  • Degree certificate/s
  • Two references*
  • CV
  • English language certificate (if required)
  • All supporting documentation as detailed in Section C of the KESS 2 Participant Proposal Form
  • *The references can take the form of a letter on official headed paper, or via the Universities standard reference form. Alternatively, referees can directly email a reference from their employer email account to Please note that references received via private emails accounts (e.g. Hotmail, yahoo) cannot be accepted.

Please return both application forms and supporting documentation to the KESS office at the address stated on the KESS application form (original ink signatures only)

Application forms may be submitted in Welsh and any application in Welsh will be treated no less favourably than an application received in English.

For other queries, please contact:

 Mandatory text, do not delete:

Knowledge Economy Skills Scholarships (KESS 2) is a pan-Wales higher level skills initiative led by Bangor University on behalf of the HE sector in Wales. It is part funded by the Welsh Government’s European Social Fund (ESF) convergence programme for West Wales and the Valleys.

Due to ESF funding, eligibility restrictions apply to this scholarship. To be eligible, the successful candidate will need to be resident in the Convergence Area of Wales on University registration, and must have the right to work in the region on qualification.