Why I did IP...

How optometrists are finding the experience of independent prescribing in practice

15 Apr 2017 by John White, Laurence Derbyshire

The number of optometrists currently on independent prescribing (IP) courses in the UK continues to rise. But what are the drivers behind this trend, are the optometrists with the qualification able to put it to good use, and what are the factors optometrists should consider before signing up?

Speaking to Dr Paramdeep Bilkhu, an IP qualified optometrist who now acts as an IP course leader at Aston University, it was the “challenge of doing something new both professionally and personally” that first attracted him to the course.

He recognised the benefit to patients of offering an enhanced service, while also supporting the business by creating an opportunity to develop patient loyalty.

For Suresh Munyal, AOP Awards Contact Lens Practitioner of the Year 2017, and a qualified IP optometrist, it was his time working part-time in hospital eye casualty units that got him thinking about IP.

He explained: “All my prescriptions had to be checked, verified and signed by an ophthalmologist.”

Noting how busy ophthalmologists are – “they do not want you hanging outside their door” –  Mr Munyal opted for IP training as a direct solution to this challenge.

"I am on the first leg of the journey, but already I feel that I have ‘levelled-up.’ I am actually approaching optometry slightly differently, which is fascinating"

OT’s clinical editor, multimedia, Ceri Smith-Jaynes, is part-way through her IP course. She told OT that it was attending SECO’s spring conference in Atlanta last year that captured her imagination. “I was a bit jealous,” she confided: “Everyone over there seems to be a therapeutic optometrist. I thought: ‘I should be able to do that.’”

Recognising what she describes as “a shift toward optometrists as primary health care providers,” Ms Smith-Jaynes was clear that she “did not want to get left behind.”

The steps to achieving IP are “time consuming and challenging,” Mr Bilkhu shared with OT. Course requirements include both the theoretical and the practical side of prescribing. This point is reinforced by Ms Smith-Jaynes, who described the course as a “daunting prospect.”

She is, however quick to add that she is “really enjoying the experience. The information I am learning is sticking.”

Mr Munyal notes that, unlike the training on the undergraduate degree where the focus is on passing the exams, want-to-be IP optometrists are likely to have the additional pressures of a job, a family – “and in my case, grandchildren. You have got to fit it all in.”

Lingering questions for any potential IP optometrist include whether the practice will offer support, and, once qualified, will the practitioner be able to use the new skills, Ms Smith-Jaynes notes.

But some benefits for Ms Smith-Jaynes are emerging already. “I am on the first leg of the journey, but already I feel that I have ‘levelled-up.’ I am actually approaching optometry slightly differently, which is fascinating.”

For extended interviews with Dr Bilkhu, Mr Munyal and Ms Smith-Jaynes, watch the video below.


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    I'm really pleased to see this article talking up the career progression of IP. I have been IP since 2012 and I have now supported (not mentored, thats the role of the placement ophthalmologist) six others through the course, 5 of whom have completed their placements. All of us have completed the entirely on-line Aston/Manchester course. Universally all of us are clear that the coursework is not in the least bit difficult or complicated. Module 1, anatomy, physiology and pharmacology is barely above undergraduate level except in the pharmacology of treatment. There is certainly no reason why this entire module is not undergraduate. Module 2 gets into specific disease investigation, diagnosis and management. A little more detailed on differential diagnosis perhaps and on treatment but very little on drug choice and dosage. The two modules take around 3-4 months each consisting of on one lectures, MCQ examination after each, easy and case records. Once completed and having demonstrated competence at SL, SL-BIO and GAT (which are obviously core competencies that every MECS and PEARS also requires demonstration) its time to start placement. It is ONLY the placement that has to start a minimum of two years post-registration so it is possible to graduate as IP within two and a half years of registration. The placements can be done en bloc or on days per month depending availability and your own practice demands. Placement is where you start to learn like Dr's learn. Its all about experience and ST1 and ST2 who you may work with in Cas or OPD are on a meteoric warning curve that optometrists need to actively seek. You need to be prepared to support your ophthalmology team, often with showing the ST1 how to do VOLK or GAT, and you need to be prepared to ask questions and look things up. Prescribing is an art in itself and to be honest our experience is that it is simply not taught in any part of the course, its learned in placement. In placement you learn the concepts of risk management. There is NO SUCH THING as certain diagnosis and NO SUCH THING as risk free decision making. You may pick up a case of review that has turned out to be a misdiagnosis or you may make one yourself. Every single Dr has done this, no shame or blame. You may feel that many cases are well below the pay grade of an entry level optometrist let alone and IP but then every so often a diagnostic challenge comes along that make you think, bloody hell thats when consultants and registrars earn their money ! By virtue of the degree that we do every single optometrist is perfectly intellectually capable of doing IP. The decision to move into that area says a lot about your vision and your attitude to decision making. In my opinion it is the critical decision making and sheer experience that is poorly taught or not achieved in the training of optometrists. The longer you work in an environment where you do not test these limits because you don't feel comfortable or supported or where your business manager won't let you, the harder it is to expand your scope of practice. Its possible to do 75% of what an IP Optom can do without IP and in practice as long as you have the mindset and business plan. Hell, as an IP optometrist its possible to do 95% of what a non surgical ophthalmologist does but that last 5% is where medicine and medical training comes in. They just have more experience than us. As to cost, in an earlier article in OT in 2012 I demonstrated that the cost of achieving IP including fees, locum HES payment etc was just over £6500. all of which is recouped inside 18/12 with a 15% fee differential (as long as you charge privately over GOS). Thats faster than OCT ROI. It changes how ophthalmology feels about you and opens doors. Four of us are doing or have done HES sessions as Bank IP cover in a mix of clinics. Of course placements aren't easy to come by but if you've built up the respect with your local ophthalmology team by the quality of your referrals and decision making pre-IP how could they turn you down ? if they do its from sheer ignorance or prejudice. So get out there and do it 400+ out of 14,000 is nowhere near enough.

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