Common conundrums answered

Whether answering a patient query about an obscure product or navigating new regulations, it is these head-scratching situations where being a member of a practice team is invaluable.

The experience and knowledge that colleagues offer makes it easier to work through even the most perplexing decisions.

In this feature, OT approaches experienced eye care professionals for their approach to common conundrums that support staff face in daily practice.

How my practice team approaches… Explaining eligibility for an NHS sight test if a patient presents early

Ian Cameron (IC): As we are based in Scotland, this is usually more straightforward, because if a patient presents early with a genuine change in vision or another concern, there is often an NHS route available through a supplementary eye examination. Staff are trained not to fixate on the recall date and miss the real issue. We try not to let the conversation become a debate at the desk about entitlement. The real question is whether there is a new symptom or problem that means the patient should be seen.

Sarah Farrant (SF): We are based in England and staff explain that NHS eligibility is based on both qualifying categories and recommended recall intervals. If a patient reports new symptoms or concerns about their vision, we reassure them that this can still be assessed, but it may need to be arranged as a private sight test unless they meet NHS criteria for an earlier examination. Importantly, the team are trained to escalate symptomatic cases to a clinician, as clinical need should always override administrative assumptions.

How my practice team approaches… Dealing with non-tolerance issues if the prescription was from another practice

IC: We would usually escalate this to a dispensing optician, as it is rarely a conversation for a busy reception desk. We generally follow the view that the dispensing practice should resolve non-tolerance issues first. The dispensing optician would check the basics, but we would still usually encourage the patient to return to the dispensing practice before an optometric recheck is considered.

SF: Our team approaches these situations with empathy. We first check whether the issue relates to adaptation, lens design, measurements, or prescription accuracy. If the spectacles were made elsewhere, we explain that the dispensing practice has the duty of care to fully assess and resolve the problem. We always print a written statement of The College of Optometrist guidelines relating to this on our prescriptions.

KP: We would usually try and deal with this ourselves. We have great colleagues around the county and we trust their work. Usually, the issue is not the prescription – it’s a design issue with the lens or some other non-tolerance issue. If needed, we might take the step of doing a refraction ourselves. On the rare occasion the issue was the prescription, then we simply act in the best interests of the patient. We have good relationships with our lens manufacturers and can offset at least some of the cost of a product that might otherwise have gone to waste.

How my practice team approaches… Making sure that support staff are appropriately supervised

SF: We follow General Optical Council guidance closely. Dispensing to children, and patients who are registered blind or sight-impaired or severely sight-impaired always involves a registered member of our team. Non-registered staff are trained to recognise these situations and seek immediate support, ensuring supervision and patient safety are maintained.

IC: This is mostly about having clear protocols and a culture where staff know when to stop and ask. Non-registered team members can do a huge amount well, but they should never be left guessing when a patient group or situation needs input from a registered colleague. Supervision has to be real, not just a policy in a drawer.

KP: Our practice always has a registered practitioner – an optometrist or dispensing optician – on site. We make sure our staff are appropriately trained. Contact lens application and removal training is the main delegated task that our support staff perform. We make sure they are comfortable and confident doing this. They will shadow an experienced practitioner and then be shadowed themselves. As they become more confident, we'll give them space, but there's always someone on hand to help if needed.

How my practice team approaches… patients who are sent by a GP or hospital for a service that the practice is not funded to perform

IC: Our staff are trained to be kind and clear, but also to hold the line. Patients are often just following advice from a GP, hospital clinic, or another clinician who may not fully understand what NHS primary eye care is, and is not, funded to provide. The patient is usually caught in the middle. That said, we do not provide unfunded care for free simply because someone has asked for it. If there are symptoms or clinical concerns, the case is escalated. If it is a pathway or funding issue, staff explain that clearly and direct the patient to the right alternative route.

SF: At Earlam and Christopher Optometrists, our team are trained to respond helpfully. They will clearly explain the scope of services we provide. If the request sits outside an NHS-funded pathway or our commissioned services, we explain this politely and offer appropriate options – for example booking a private clinical appointment or advising the patient to return to the referring GP or hospital department. Reception staff know to check with a clinician if they are unsure, so that patients receive consistent and safe advice rather than an informal test that lacks proper clinical context.

KP: We have a good relationship with the consultants at the hospital, so usually if they do send patients to us they will make them aware of the cost implications. Because we offer a subscription model, any additional tests will often come under their care plan.

I think it is important that we make patients aware that we can’t give away services for free, otherwise we will not receive fair remuneration. For patients who receive NHS sight tests, they often assume that the practice is reimbursed for any service – and that is not always the case.