On the ground
Coronavirus: on the ground in Hackney
Optometrist and practice owner, Simon Rose, shares some of the ways he has adapted through COVID-19 and how technology can help in providing eye care
Initially, at the start of the lockdown, there was a bit of panic amongst the profession and certainly employers and business owners, wondering what they were going to do.
Then you had to start to sit down and think about things carefully. I think the biggest hurdle was dealing with the amount of information coming in – that was really hard as there was a staggering amount of data. You’re trying to run a business, keep everyone safe and pay the rent and you’re assaulted from all angles. Most of it was information overload; dealing with that in itself was really challenging.
My girlfriend helped me through that time by not letting me be near my phone or computer after a certain time of day and by doing that I was able to sleep and relax. That was really important.
When things started to become clearer it was much easier to deal with things through a step-by-step approach, a bit like doing an eye test. You have to do something first before you can do the others and form a conclusion.
There have been different stages to this. In the beginning there was the panic, the overload, and then we thought we may survive this after all. Now we have to plan for a different world. A key challenge is managing the furloughed staff, getting them back to work safely and fundamentally changing the way we work completely.
The vulnerable groups I encounter in my Hackney practice in East London don’t have mobile phones. Some of them don’t have telephones, yet they are expected to be seen by teleconferencing
We’re looking at automated information acquisition with complete isolation or separation. We’ve developed a way of imaging the patients without us being in the same room, minimising the contact.
Not all equipment allows for that but I’ve got a particular piece of equipment called the Optopol Revo FC which allows me to control it remotely. This is fundamentally important. The only thing I can’t do on it is a refraction and so we’re trying to find a machine that can do refractions remotely and reliably.
We’ve been asked to do video and telephone consultations and we can get a lot of information from those patients. We found there have been some that are still at risk, so the options were to send them into an A&E eye unit after discussing it with them if it was an urgent or emergency matter, or we offered for the patient to see us – as depending on their vulnerability, comorbidities and risk, we can image them without contact between us and them.
We can get patients to come to the practice alone or with a carer who has been in isolation with them and they can be instructed over the telephone to sit down at the right instrument and I can operate that instrument remotely. Of course there are limitations to that, but where it is the only option, if the patient is at risk or doesn’t wish to go to the hospital, it made sense to try.
What is sad is that the vulnerable groups I encounter in my Hackney practice in East London don’t have mobile phones. Some of them don’t have telephones, yet they are expected to be seen by teleconferencing.
I don’t think I could ever go back to the way it was, because it won’t be as it was
Optometrists are going to have to receive testing for the virus because we are in such close proximity to our patients to do the job properly. That’s why I’m desperate to try and develop ways of not being in such close proximity to people and if we do have to get close, finding ways of being in front of them for the minimum amount of time. It’s all about changing the way we work, being proactive and challenging everything we do.
Our relationships with the GPs have changed a lot as well. We’ve been speaking to some of them directly or they’ve been asking for help rather than phoning the hospital. I think this will continue and I hope the relationships we have now will continue to evolve.
After lockdown I think the eye departments are going to struggle with the surge they are going to face and they’ll need to rely on us to help them. We do Minor Eye Conditions Services (MECS) organised through the Local Optical Committee Support Unit (LOCSU) and are also working with Evolutio that subcontracts through the Clinical Commissioning Groups (CCG). This will take pressure off the GPs and local eye services, which I think will struggle to cope. If you think of the patients that have not been seen, and the patients that need to be seen that are currently not, you’re going to have a massive waiting list.
In trying to work from home I have seen some of the holes in the business. For example, we don’t have an internet offering. We’re just an ordinary, old fashioned opticians and that shows how vulnerable we are to these sorts of things. The traditional opticians need to join together and have some sort of internet offering to compete with the big players.
I don’t think I could ever go back to the way it was, because it won’t be as it was. It can’t be. I’ve been working on my own in my practice and am able to cope with a much greater workload than I thought, so we’re going to have to change the way we work completely.