Primary Care services
(MECS, cataract pre- and post-, repeat measures, referral refinement, children, learning disabilities).
Practitioners who participate in extended primary care services should ensure they recognise and work within their own limits of skills.
The relevant GOC standards are:
- GOC Standards1
- 5. Keep your skills and knowledge up to date. …do not perform any roles in which you are not competent
- 6.1 …work within the limits of your scope of practice
- 6.3 Ensure you have the required qualifications relevant to your practice
With the exception of some aspects of ‘referral refinement’, extended primary care services are within core competency. However, they may involve knowledge and skills that have not been regularly used in day to day practice. All CET is aimed at core competencies, and practitioners should ensure that they target some of their CET at any extended primary care services in which they are involved2.
Most practitioners, when first getting involved in extended primary care services, undertake some CET, this is usually delivered by WOPEC on behalf of LOCSU3. This enables them to refresh their knowledge and also allows them to provide evidence that they have done so. This is helpful if future complaints are received in relation to primary care extended services.
According to the Royal College of Ophthalmologists Commissioning Guidance, repeat measures schemes can be performed by any community optometrist, but enhanced case finding of suspect glaucoma referrals (sometimes thought of as enhanced referral refinement) requires the College of Optometrists Professional Certificate in Glaucoma or higher4. Therefore, practitioners should ensure that they have adequate qualifications before taking part in schemes that could be considered as falling into this category. It does, however, recognise that it may take a while for existing services to comply.
Community monitoring services
(“Step down care” or secondary care in the community). i.e. monitoring OHT, diagnosed glaucoma, stable wet AMD.
Community monitoring services are different to extended primary care services in that the requirements for these services cannot necessarily be considered as falling under core competency. Therefore practitioners participating in these services should have the appropriate higher qualifications or be clear that they are acting under the supervision of a Consultant ophthalmologist4. The supervision for this service may be delivered virtually from a remote location. The GOC standards quoted above also apply here.
If the supervision is virtual, the practitioner should be especially careful to ensure that the care being provided meets accepted standards such as those published by NICE. As with extended primary care services, practitioners should still be able to demonstrate that they have refreshed their skills and knowledge, although not necessarily to the level that would be required to monitor independently.
Practitioners should be clear what can and cannot be managed under supervision. For instance, under NICE guidance and Commissioning guidance, diagnosis of glaucoma is not recommended virtually.
Data gathering for virtual review
Some care in the community may not be monitoring but may be data gathering for an ophthalmologist to review the results and recommend further management. Where this is the case, the additional qualifications are not required, but practitioners should be clear that the service specification states their role as data gathering and not decision making. If this is not clear, they should seek written assurance from the provider that all cases are reviewed by the ophthalmologist.
This does not preclude the service from inviting the practitioner to provide their own opinion and then providing feedback as a means of learning to aid progress toward higher qualifications.
As noted above, it would be unusual for glaucoma to be diagnosed via a virtual pathway and, if this is happening, it is even more important that practitioners are clear that they are data gatherers and not decision makers.
Providers of the above types of service will wish to be assured that practices working as their sub-contractors have sufficient governance and policies in place to enable them to meet the terms of the NHS Standard Contract. Usually this is via checklists, of which the most commonly used is QiO – both for GOS and NHS Standard contracts. Practices can expect to be asked to complete these extensive checklists which also provide reassurance that the practice does meet the appropriate NHS standards.
1. General Optical Council. 2016. Standards of Practice for Optometrists and Dispensing Opticians
2. ABDO, AOP, College, FODO, LOCSU. 2017. Continuing Education for Extended Primary Eye Care Services
3. LOCSU. Community Services Education
4. The Royal College of Ophthalmologists. 2016. Commissioning Guide: Glaucoma