The journey to an entirely IP-qualified practice

1 My tipping point came in the late 1990s.

I was at the British Contact Lens Association (BCLA) conference, and a guy who’d just come back from Canada was talking about therapeutics. I remember realising how little I understood. That was the kick I needed, 10 years before independent prescribing (IP) was even mooted. It gave me a head start. It was the moment when I realised the historic model of optometry was not the model I thought was best for patients, and that I had to change it.

I was able to go through things slowly: first my Master’s, then my additional supply, then my supplementary prescribing, then my IP. It took five years, because at the time the whole thing was an experiment. When you’re one of only a few IPs in the country it’s difficult, because nobody knows what you are. It does take time, but it’s starting to accelerate. Now optometrists can get their IP done, COVID-19 aside, in about 18 months.

2 I decided that I wanted to get all my optometry staff IP-qualified, and I was lucky that I had staff who were willing.

For a while I was the only IP in the practice. We learnt a lot. Everyone could prescribe via me, so they were all getting experience. I jumped the first hurdle, then I got the next person do it, and so on.

If you want to supply a quality service to all your patients and not be there yourself seven days a week, you really do have to have more than one IP optometrist. My goal was to be able to offer, from Monday to Saturday, an IP optometrist on the premises. We’ve been there for a while, now.

3 Securing hospital placements has always been a challenge, and of course COVID-19 has made it worse.

One of our optometrists, who will be our fourth IP, is at Manchester Royal Eye Hospital at the moment. He passed his final exam about 18 months ago, and he hadn’t been able to get a placement. COVID-19 has certainly delayed things, but it’s really difficult to get places anyway. When I first started, I got time at Moorfields and at Sunderland Eye Infirmary, as well as in St Albans with a private ophthalmologist. I do think you’ve got to be prepared to be flexible. Now, I use every avenue I can to get all my optometrists through the placement.

4 Patients don't always know to walk into your practice initially.

I’ve been IP-qualified for so long that people locally know that if they’ve got something wrong with their eyes, they can come to this practice. But that doesn’t happen overnight. You don’t suddenly get your IP qualification and expect patients to start storming through the doors. You’ve got to build up a reputation, both with GPs and with the community, and that only comes with time.

We allowed it to happen naturally. We were lucky. I knew I wanted to do this long before there was any official IP qualification. My Master’s in therapeutics gave me a knowledge base, so I started requesting that GPs prescribe things, instead of referring to the hospital. You start on the cases that are non-sight threatening, and given time you start asking for slightly more significant medication.

5 The benefits are enormous, particularly to our contact lens patients.

In Northumberland, we have no funded services. We simply charge patients, and virtually all of them accept that, because they’d rather be dealt with in the community than drive to a hospital. We also have a fee-based contact lens service. Patients are paying us a fee for our clinical services, so we have to provide a service they will value. One of the most valuable commodities we have is IP. I’ll tell them that if they have a red eye, or irritable eyes, they shouldn’t go anywhere else. I don’t care if we’re fully booked, we will see them. We’re really pushing the clinical side of contact lenses.

Some optometrists will say there’s no funding stream for IP. Well, there is if you’re a contact lens practitioner. If you’re selling contact lenses, you are selling a medical appliance that carries a risk. To be able to supply a service that solves the problem without sending patients to hospital is a critically important thing, cost-wise for the clinical commissioning group and service-wise for your patients. Being IP-qualified can really enhance your contact lens practice, and the opportunities within that are unreal.

6 IP has definitely brought more income to the practice.

The immediate business argument is the contact lens patients. You’ve already got them there, they’re already your patients, you’re ready to roll it out. Our practice is 40% contact lenses, which is above the national average. People are conscious of their eye health, and when we tell them what they’re buying from us they accept it, and they’re extraordinarily loyal. Long-term loyalty has value, but the main revenue stream that you can quantify easily is the contact lens work, and ours is huge. Being IP-qualified can really enhance your contact lens practice, and the opportunities within that are unreal. Also, patients love not being referred. Nobody wants to go to hospital and sit for five hours.

The other work coming in, from patients who pay privately, is not a big revenue stream in relative terms. But you see them, you fix it, and they spread the word. I can’t think of an argument, business-wise, for not doing this. If optometrists just think of money in the till and acute episodes that walk in and get done, I don’t think that’s thinking on a large scale. I tell colleagues to never turn a patient away. It might not gain a lot of money at that moment, but if they come in and you treat them, they’ll go away and tell people.

7 I want to ensure that we can always give patients continuity of care.

I don’t want patients to think they’ll never see one particular optometrist again. That would never happen in my practice. We’re strong because we’ve got a strong group; one of my IPs has been working with me for 25 years. It’s about continually developing, but also maintaining the ethos. We’ve got IP as the educational standard now, and we’re building on that with more qualifications. To educate, educate, educate, and keep honing it, is the plan.

I’ve pretty much achieved my goals for the practice. From a medical optometry point of view, obviously you’ve got to keep fighting. It’s competitive. I would certainly like to have more people paying into our funded schemes, which is something we’ve got to push for. My goal is to keep my patients out of hospital. I think, in being able to do that, we supply a really valuable service in the community.

• As told to Lucy Miller.