Coronavirus: on the ground in Altrincham

As the coronavirus pandemic transforms the way optometrists practise, OT is sharing the experiences of optometrists across the UK. If you, or a colleague, is interested in sharing your story please get in touch: [email protected]

Before we stopped offering non-essential eyecare, which we decided to do along with many others and long before we were advised to do so, there was a week or so where a lot of appointments were being cancelled. The cancellations were by those who were either ill, at risk of becoming ill, or making the sensible decision that their appointment was not critical and therefore not worth the risk in attending.

At this time we were fully staffed with nine team members and so there were big concerns with regards to overheads versus the significantly reduced income. I have a large bank loan covering the purchase of the business, and whilst I have the support of the bank with the ongoing crisis, my personal assets – chiefly the family house – is on the line should anything detrimental happen to the business. This is not likely, but as a small business owner, these worries are always present when cash flow is down.

Over the last four weeks all my staff, bar one part-time team member, have been furloughed. Whilst I am topping up salaries to 100% it makes a huge help to the overheads, allowing us to go on for longer as things currently stand. I now find myself working six days a week to make sure that someone is available to answer the phones when needed, at an absolute minimum.

Since closing the practice to routine appointments, I have sent an update to patients every 10 days or so to remind them we are still available for emergencies if needed. Our social media use has become less about our services and products and a little more fun to try and keep spirits up a bit.

It’s about helping those who need it and doing it as effectively and safely as possible

The practice has been adapted physically to allow better social distancing for those patients who do need to come in, and there is only myself and the patient in the building at any one time.

Like many, I have installed slit lamp shields, and rather than my PC being at the side of the patient, it is now on the other side of the room around 4.5 metres away, so that we are further away when we are talking. During the outbreak there has been greater use of the phoropter than normal and our recent investment of the ZEISS VISUFIT1000 allows dispensing from a distance for those who require it.

I have also dispensed several emergency single vision spectacles based on frame selections over WhatsApp and I offer a daily pick-up and drop-off service to the local community for broken spectacles, new orders, contact lens solution, all whilst maintaining distancing and wearing masks and gloves.

I have had support from local people with PPE provision and have received donations of face shields from three different sources; a local secondary school, home user and a ‘maker space’ – all with 3D printers. I wear masks, face shields, gloves and aprons for every contact with patients.

None of this has a major impact on the cash flow as there’s nothing hugely profitable about this, but this is not about the money. It’s about helping those who need it and doing it as effectively and safely as possible.

At the time of writing, I think the uncertainties for optometrists lie not in when this will be over, but how. If lockdown is gradually reduced, which seems likely, and the older population or those at higher risk are still encouraged to stay at home then businesses in this sector will still struggle as that’s where a lot of the business comes from. If the government stop their support at that time, and all staff need to return to work then overheads will shoot back up but income will not increase to normal.

We need immediate guidance on what could happen when this is over. If lockdown is over and all practices need to continue to maintain things like social distancing, is that feasible in an opticians? Will patients still avoid going unless it is essential, if they are worried about being so close to someone? What is the best way to make sure that after one patient has been in, things are safe for staff and other patients to continue to use? We are waiting an unacceptably long amount of time in England to hear from the NHS, and we need to know what we can do before we need to do it.

There will always be the things that need to be done in close proximity, and devising safe ways to go about this and minimising the frequency of these will be critical

In addition to that, many optometrists are rightfully concerned about their own safety. With many unable to get appropriate personal protective equipment, the risk being taken is nothing to ignore. Many are battling the idea of supporting those who need their help, and protecting themselves in the necessary way.

There are many dispensing tools available to measure and dispense from a distance, and several pre-screening devices that allow the same. I expect phoropters will likely see a big surge in demand after this. But there will always be the things that need to be done in close proximity and devising safe ways to go about this and minimising the frequency of these will be critical.

Taking the time to reflect on the business

I have spent the last seven years at this practice happy that our contact lens business is static: it’s not gone up and it’s not gone down. The majority of our revenue comes from high-end dispenses. We have a good percentage of our contact lens wearers on direct debits, but only a small minority of non-lens-wearers on schemes.

The last month’s income has been almost entirely from direct debits and contact lens sales. This shows the true value of those elements of the business, and whilst I hope we don’t have a similar issue to this any time soon, preparing for any unfortunate eventuality is important.

There are major changes I have wanted to make to our pricing structure and our direct debit schemes since I took over my practice three years ago. I have never had time to implement these due to making other changes, refurbishing the practice, investing in new equipment and rebranding last autumn.

This has allowed me the chance to put the final preparation into these plans to go live with immediate effect once we are back open as normal, or to whatever extent ‘normal’ may now be.