“Everybody wins when you're IP-qualified”
Ian Cameron, of Edinburgh’s Cameron Optometry, on building an IP-qualified workforce and why upskilling is essential for the future of the profession
We had always wanted to be doing more prescribing work.
Even in the days before we could prescribe, we were working with GPs and using signed orders as much as we could, so we built a reputation with patients for being able to ‘prescribe’. So, it was a natural step to jump at the opportunity to become formally qualified in prescribing.
We've been at it for a long time and it's a massive part of our business. Once that culture is in place in the business, it becomes what's expected of our optoms. At the time there were only two of us independent prescribing (IP) qualified, and then we took on another optometrist who wanted to do the IP qualification, so she did it, and then we took another one, and she did it too. The most recent optometrist who has come to work with us already had IP, which was part of the reason we recruited her. One of our longer term optoms was then the only non-IP. She was keen to upskill and so has now completed the training, meaning all our optoms are IP-qualified.
Once that culture is in place in the business, it becomes what's expected
That ‘IP culture’ isn’t really a feature of the profession at large, but the younger optoms coming through are generally very keen to get qualified and we’ll likely see a steady increase in uptake over the next decade or two. And the more people that get the qualification, the more pressure there is on non-qualified people to take it up. So, as well as more new optoms doing it, we’ll increasingly see that critical mass encouraging more experienced optoms to do the training too.
I know there are some people who get the prescribing qualification and don't really use it. We are the absolute opposite. We are determined to use it as much as we possibly can. We are very active in prescribing, as well as getting the qualification. Everybody is on board with that.
It's just how the practice is. That is the culture, to be that kind of place. If someone wants to be a part of that culture, then they're going to have to be comfortable with IP and what that entails.
We (the owners) were among the first to get IP-qualified, so we were leading from the front.
We were saying "we've done it, and we want you to do it too", rather than expecting our staff to do it while we watched on.
When you’re the business owner and particularly in a smaller, more agile business, it’s easy to overcome the obstacles to training. Time out of practice, funding, ability to integrate into the practice – we had already done it and set those things up for our own benefit to get qualified, so it was easy for the other optoms following on from us, because we'd already established the pattern.
Back in the day, we used to go and work in the local eye hospitals, in acute referral clinics, mainly for wider pathology experience but also to retain the good links with secondary care. So again, that pattern of day release for training was a rhythm we were used to.
Getting IP-qualified is hard – no question. When I started the course, I was doing quite a lot of that kind of work informally already, but the qualification was still difficult. It was hard work academically, and it was hard work practically, and the final exam was difficult. Anybody who slogs away for a couple of years and gets through it has earned my respect. It’s not easy to find the time and motivation for such significant study, so I take my hat off to anyone who steps up to start the course.
It’s not easy to find the time and motivation for such significant study, so I take my hat off to anyone who steps up to start the course
But anything that's worth doing is hard, right? And this is undoubtedly worth doing. I’m involved in helping advise younger optoms on career progression and no matter where they want to end up, I always say the very first thing you should do is take IP. The very second you are eligible to take the course, sign up and get started – the sooner you get it done and make it part of your practice, the better.
IP is about more than just the ability to give out prescriptions. You get experience in glaucoma, in red eye, systemic problems, pharmacology, anatomy, general medicine... it's a huge learning opportunity, not just enabling you to get a prescription pad. You learn an awful lot in doing the academic work, and then actually spending the time at the eye hospital or in the supervised clinics is hugely beneficial to your practice.
We support staff in terms of the time out required to go on the clinical placements, and in giving them an experience of seeing prescribing in practice from watching us. We'd show them patients, explain our prescribing decisions, do case review and help them along the way as they train. Our practice is a good place to learn to do IP; there are now five IP optoms all doing a lot of prescribing, so we have a lot of opportunity to learn from each other and continue to improve.
In Scotland there are number of funded IP training places paid for by NHS Education for Scotland (NES), so as long as you get on one of them, then it doesn't cost you anything. But it does take time out of practice and you need time to study, to attend the course, and to attend the exams. You’ll certainly need significant time over a prolonged period to go on your clinical placement. I think it's much harder if you don't have the firm support of your boss.
Patients expect us to be highly qualified; that's always been a part of our practice culture.
Over the years, we’ve invested heavily in technology to stay at the forefront of scope of practice and we've always maintained our qualifications and done extra qualifications.
I don't think patients particularly know that I'm an independent prescriber - I don't think that really means anything to them. But they expect me to be highly qualified, and they expect if there's an optometrist out there that can prescribe for eye conditions, it’ll be the team at Cameron Optometry. That's an expectation built up over many years of progressive practice and complex case management, even before we were IP. I think they'd be more surprised if they ended up at another practice for some reason, and the optom said, "Oh, I can't do that, you can't get a prescription from me, you'll have to go to the GP."
It's just an incremental increase in our scope of practice. Patients aren't suddenly surprised that we can deal with a great range of eye problems. We've always been able to do that. This is the next logical step in that process of development.
Being a bigger practice is a real benefit.
Having five IP optometrists makes me a better IP optometrist because I'm able to engage in peer discussion on a regular basis. I'm always asking the others "Can you come and look at this red eye for me? I'm not totally sure what I should be doing”. We’re learning from each other by discussing cases, attending lectures or conferences and bringing that learning back into practice. I would say the best way to develop your IP skills is to work with other IP optoms.
It's a long-term investment in people, and that always benefits the business
We always want to encourage optometrists to get better at gaining qualifications, and to open the door to gaining new learning experiences and being able to manage a greater range of conditions. There are costs associated with such staff development. In the short term, we’d be better off having the optom rattling out refractions than to send them out of the practice for half a day a week, six months of the year. But in the long term, the rewards for the business and the rewards for the optom personally far outweigh that. Almost all of us enjoy the chance to be out learning new skills and getting new qualifications. It's a long-term investment in people, and that always benefits the business.
As we reach capacity, and begin looking for our next optometrist, IP is really the standard level of qualification that I'll be expecting.
I would be unlikely to employ people, except in potentially specialist positions, who weren’t IP-qualified or weren’t planning to be IP-qualified. It just informs so many different areas of your practice, and increases your scope of practice so significantly that it’s really necessary to work in our practice.
It’s good for you as a practitioner, because there's academic and practical learning. It is good for you as an optometrist in practice because you deal with a lot more, which is helpful in terms of your clinical interest, keeping the job interesting, and stretching clinical experience. It’s good for patients because more is dealt with, quicker and at lower cost, and with greater convenience than referring to a GP or hospital. And whatever is good for practitioners and also patients is undoubtedly good for the practice. Happy, well-motivated staff means better patient care and customer service, which is what independent practices like ours are built on.
The more of us that are IP-qualified, the more seriously we have a seat at the table when we're discussing with medics about shared care and patient management
The profession wins as well, because the more of us that are IP-qualified, the more seriously we have a seat at the table when we’re discussing with medics about shared care and patient management. We need to be retail people, obviously, we all depend on that, but we do need to be medical professionals as well. That aspect of our profession is a key to securing our future. Particularly up here in Scotland, the shift generally in health care is out of hospitals and into community. You may have noticed, optometry was mentioned specifically alongside GPs, dentistry and pharmacy in COVID-19 briefings and advice by the First Minister. That’s a huge step forward for us as a profession, to be considered in that way.
In Scotland there are about 10% of practitioners that are IP-qualified, which is a good cohort. That means we are taken seriously as a prescribing profession. Compared to other non-medical prescribing professions, we've got a high percentage, and we can therefore expect to be a significant player in conversations about shared care innovation in moving care out of hospitals and into communities, where it belongs.
It’s a long-term cultural shift, taking optometry from a profession of retailers to health care professionals in the eyes of legislators. It's taken a long time to get to where we are, but there’s still a long way to go. It's come a long way in one generation so it’s inspiring to think where things might end up in my professional lifetime. Wouldn’t it be amazing if optometry really was viewed by the public and government as ‘the GP of the eyes’? Think of what avenues that would open up – these are exciting times.