Professor Barbara Ryan: “The journey of upskilling optometrists and community practices is not over”

First established at Cardiff University, the clinics have now extended out to other areas of Wales – and are providing opportunities for continual learning even as the problems that they were set up to resolve begin to ease.

Here, professor of optometric practice at the School of Optometry and Vision Sciences at Cardiff University, Barbara Ryan, tells OT about the rollout of Teach and Treat clinics, the importance of patience when building relationships, and how the clinics have created a stepping stone for the optometry upskilling of the future.

Why was it important that the Teach and Treat model was rolled out widely across Wales?

We were finding that there was a need to upskill optometrists in medical retina, glaucoma, and IP, but we weren’t able to get them placements, which are needed for the higher qualifications, in hospitals.

Hospitals already had long waiting times. They didn’t have capacity to let upskilling optometrists have a room, access the equipment, or have the required supervision. As a result, we were seeing bottlenecks, with more practitioners wanting to complete the qualifications than we had placements to offer in Wales.

It was a problem across the country, but it first became apparent in Cardiff. In fact, it was Cardiff and The Vale University Health Board that came to us first. They couldn’t meet the demand for glaucoma placements and saw the Teach and Treat clinics as a double win, providing more placements and reducing waiting lists. We started with the glaucoma clinic and then became aware that we had 80 practitioners backlogged waiting for IP placements in South East Wales, and so we established and acute eye care clinic. A medical retina clinic followed.

In different areas, hospitals have more capacity for some placements than others, and there also seems to be more interest for some qualifications in some areas than others. We have adapted to fit the needs of the local area and the local practitioners. In some places we do more IP, in other places we do more medical retina or glaucoma – it depends on what is needed.

We have three Teach and Treat sites across Wales currently, including in Neath Port Talbot and Holywell. The site in Cardiff operates out of our clinics, and the ones in Hollywell and Neath Port Talbot operate out of community hospitals.

Needs are different in different areas, making localisation within Teach and Treat clinics important – which ties into the Government’s neighbourhood health agenda. Is that an accidental consequence, or a deliberate choice?

It’s just the way it has panned out. The new WGOS contract came in in Wales, and practitioners were asked to complete additional qualifications in order to deliver the contract, allowing optometry to manage more patients in the community rather than in hospital.

The uptake of that has been slightly different in different areas. We’re finding in Cardiff, for example, where we had that 80-strong backlog for IP initially, that need is now much reduced. We do still have postgraduates going through it for the IP qualification, but we are now also able to offer sessions in our acute eye care clinics for our undergraduates.

Relationships are a long-term thing, usually not something that you can build in one or two meetings

How important is building relationships with the health boards, and by extension other stakeholders, for this kind of work?

Health boards are really important, both for primary care and secondary care. Also, Health Education Improvement Wales (HEIW) – they often commission people to do courses in Wales, so they understand the demand and the people

Local practitioners and practices are important in making sure people are aware of what is happening. Optometry Wales represents all optometrists in Wales, so keeping them updated is vital, as it is with regional optical committees. A lot of the setting up and sustainability of the clinics is just making sure everybody is aware of what is happening and what the issues are.

Sometimes practitioners can be hesitant about building relationships outside their own immediate sphere of influence. Do you have any tips for building those relationships?

Always listen to the other party, because they will usually have a different perspective. It is important they get some benefits too. It’s not easy: some things take much longer than others, and it’s a marathon, not a sprint, which is one of the phrases I use in a lot of things to do with change and optometry.

Relationships take time to build; you go through bad times as well as good times together. Always be open, honest, and transparent. Listen, and understand other perspectives, but do not give up. Having stamina [is important]. Relationships are a long-term thing, usually not something that you can build in one meeting or two meetings. It takes a while, and a lot of problem-solving together, to really to make those strong. Sometimes it can be frustrating, because people change roles, and then you have to start all over again. That can be hard.

Do you think that universities can act as an anchor in these situations, helping all the other parts to come together?

We [universities] don’t have skin in the game in the same way as some other people or organisations do, so I think that helps us. We are there to educate, and that is our primary goal, which is slightly different.

Most parties benefit from what we do, because if you don’t have training and education, you don’t have a future workforce. Whether you’re a hospital, a primary care team, or in community practice; whether you’re HEIW or you’re in government, you want a well-trained workforce. There are fewer pulls and pushes from us, maybe, than there would be from other parties.

Government health strategy currently is very much from hospital to community. As the need for us to do other things changes, I hope that we would adapt to that

What do you hope the long-term impacts of the Teach and Treat clinics will be?

We are already seeing impact from what we have been doing. Lots more people have higher qualifications and are delivering the enhanced elements of the WGOS contract in Wales. As demand is changing, the future role of the Teach and Treat clinics is uncertain at the moment. In Wales, we’re also doing training in practices now. But I think that the journey of upskilling optometrists and community practices is not over yet. I hope we will continue to play a relevant role.

Future-gazing, people will continue to upskill. When you look at the prevalence of eye conditions, the need is going to keep increasing. We’re in a unique position, with great equipment on every High Street, and are really accessible.

Government health strategy currently is very much from hospital to community. As the need for us to do other things changes, I hope that we as a profession would adapt to that and universities are there to support those changes.

There is also a role for practitioners to train each other, which is somewhere we haven’t seen that much of before. That’s certainly starting in Wales, through Advanced Training Practices for independent prescribing optometrists. That means practitioners training practitioners in their practices, rather than hospital or university. That’s got to be an important element for the future. There’s a whole network of Advanced Training Practices in Wales now for IP, and that is coordinated through HEIW.

As a profession overall, I’ve been really pleased that experts like Jeenal [Shah] and Matthew [Chan, both optometrists and senior lecturers at Cardiff University] have been happy to come and work for us in university clinics. They have obviously come from hospitals, as have some others. Other staff have worked in practices for many years and have stepped up and come into the university to teach.

The success of the Teach and Treat clinics has been down to all of those who come forward to share their experience and teach others. Hopefully being an educator, being a mentor for others, will spread. We do it well in what was pre-reg and is now clinical learning in practice, and hopefully that will spread into higher qualifications as well, with time.

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