Have members of your hospital department been redeployed to reflect COVID-19 challenges of the latest lockdown?
Thomas Hamper, Manchester Royal Eye Hospital (TH): Our team of optometrists already perform a broad range of extended roles and have been called upon to help back-fill our medical colleagues who have been redeployed elsewhere in the Trust. Optometrists who work in the Emergency Eye Department (EED) at Manchester Royal Eye Hospital (MREH) have been successfully reviewing patients in teleophthalmology ‘Attend Anywhere’ clinics who need following up on. We’ve also been using teleophthalmology to offer guidance and advice to our community colleagues in primary care on using the COVID Urgent Eyecare Scheme (CUES) advice line. Plus, we have been successfully running our cataract post-op reviews over the telephone where safe to do so. Recently, a number of our optometrists have volunteered to be trained as vaccinators within the Trust, with our first staff member beginning in February.
Dr Waheeda Illahi, Birmingham and Midland Eye Centre (WI): We are currently on standby and prepared for possible re-deployment of members of the optometry team for the third time. Several consultant ophthalmologists have recently been redeployed to support the intensive care unit (ICU) as the COVID-19 situation remains serious at our Trust. During the first wave, two WTE optometrists were redeployed to COVID wards (as previously discussed with OT in December). During the second wave, two days per week of optometrists’ time was allocated to supporting ICU services. This involved providing administrative support (for example, chasing blood results and so on). For the optometry team at Birmingham and Midland Eye Centre (BMEC), 2020 ended with optometrists on the frontline even though it was in a limited capacity. With regard to the third lockdown, members of the optometry team are ready to serve in whatever capacity the continued pandemic situation requires.
Have routine appointments been affected?
TH: Under the recent set of restrictions, routine appointments have not been affected. Outpatients appointments are operating at a similar capacity to after the first lockdown – whereby clinics are reduced with allowance made for social distancing. Some services have moved to virtual review to alleviate pressure on clinics and to help our patients and staff adhere to social distancing guidelines, which has helped to reduce patient waiting times and is garnering some good feedback from attendees.
WI: Routine appointments have not been affected at BMEC. At present we are working extremely hard to maintain a normal service and routine optometry appointments have not been affected.
I miss the little chats with colleagues in the hospital corridors or in the queues at the cafe bar during lunch breaks where solutions could be found to ongoing challenges
Are patients cancelling or failing to attend?
TH: Increasingly, yes. But I would say that attendance was very high when only urgent patients were invited for appointments. Now that our more ‘routine’ patients are being offered appointments, I would say, anecdotally, that the amount of do not attends per clinic is no higher now than pre-COVID.
WI: On the whole, our patient attendance has been good. An enhanced telephone triage is carried out on as many new patients as possible, and patients are risk-prioritised by a specialist optometrist. Follow-up patients are given a choice of attending a face-to-face consultation or deferring. A small number of patients are agreeing to attend and then not turning up on the day, wasting precious clinic slots, so we continue to urge patients to let us know if they are unable to come so we can reallocate the appointment slot. A weekly forward look by our optical assistant ensures that cancelled appointments are offered to other patients on the waiting list. We have been able to support urgent and routine appointments since May 2020.
Currently, IP placements are paused, but we are looking at innovative and exciting ways to engage IP optometrists in lieu of face-to-face clinics
Has elective surgery been cancelled, or is there a plan for it to be cancelled?
TH: Unfortunately, our routine cataract operations were suspended earlier this year to allow theatre-trained nurses to be redeployed to ITU. Our elective procedures at our main theatre sites have also been suspended for the same reason, with some theatre space being offered to other services such as oncology. The situation in Greater Manchester is still developing and sadly we don’t yet know when we’ll be re-instating procedures.WI: We have temporarily postponed our elective surgery so that the hospital can support all those who need urgent/emergency surgery and to best support the Trust’s COVID-19 response. We will reschedule patients when we are able to do so.
WI: All teaching and training posts are currently on hold at BMEC. This affects approximately 20 pre-registration and qualified optometrists. Our plans are under constant review, and placements will be reintroduced as soon as it is safe to do so.
What is the vaccination rollout plan for staff? Have they been vaccinated or are they due to be imminently?
TH: Our optometrists have all had their first vaccine and are mostly awaiting dates for second doses now. The Trust as a whole has vaccinated nearly 19,000 staff and affiliates.WI: The vaccination rollout at our Trust has been excellent. The vast majority of colleagues have had their first dose of the vaccine.
Are you and the team getting COVID-19 tested regularly?
TH: MREH and Manchester University NHS Foundation Trust has been a pilot site for a number of studies including twice-weekly PCR tests and daily saliva tests. We are currently around seven weeks in to a 12-week lateral flow testing programme.TH: Specific to optometry and away from the wider NHS, I expect we will be called upon more to meet the challenges of increasing caseloads as our skillset diversifies. Within the NHS, recruitment and retention of optometrists is likely become more of an issue. As optometrists time and skills become more and more in demand, particularly with NHS services being offered by private providers, the current Agenda for Change bandings may not prove attractive enough to bring new talent and retain skilled staff in to hospital eye service. I personally would like to see a new ‘Advanced Optometrist’ national job profile to bring optometry in-line with other ‘Additional Scientific and Professional Staff’ in the NHS, such as pharmacists. An ‘Advanced Optometrist’ banding would recognise that optometrists are able to work autonomously and manage a patient’s eye disease independently, without burdening consultant-led clinics.
WI: I would think there are four challenges we are considering:
1. Backlogs
When ophthalmology services resume at normal levels (including surgery and collagen cross linking), I expect a considerable increase in the number of referrals into optometry services. School eye screening has also been on hold for a considerable length of time, and a very large number of children who have been missed due to the pandemic will be added to the waiting lists. Managing the increase in demand with existing staffing levels and social distancing requirements in the waiting areas, as well as clinic rooms, will be an ongoing challenge.
2. Review of patient pathways and investment in technology
Research and audit evidence needs to be used to review current patient pathways and wherever possible evolve services, particularly where extended face-to-face consultations are required to ensure patient and staff safety. Investment in technology will be necessary. Implementing change may be a challenge where patient-friendly walk-in systems are replaced with appointment systems – for example, patients 'dropping in' to collect their glasses or contact lens solutions as opposed to booking formal appointments in advance.
3. Mental health and the wellbeing of colleagues
Colleagues who were required to shield during the course of the pandemic will need mental health support as they return to work and face the challenges of using public transport and public spaces. From working in a safe space at home to using a slit lamp and resuming close patient contact may be particularly difficult within the hospital environment. Our Trust offers a range of support including one-to-one counselling, referral to mental health practitioners as well as help through a ‘Wellbeing Together’ newsletter. SARS-CoV-2 Antigen Rapid Qualitative Tests are provided to all staff and they are encouraged to self-test twice a week. Surgical masks are being upgraded to silicone/FFP3 masks for all patient facing staff when they are providing direct patient care.
4. Patient and staff morale
Patients who look forward to seeing their favourite members of staff (and vice versa) and enjoy a chat may find the consultations a little impersonal in the post COVID era as patient contact time is reduced. Staff morale has also been affected as monthly informal gatherings of colleagues in the hospital cafeteria to celebrate birthdays or simply sharing home cooked dishes at the end of particularly difficult months have been replaced with zoom lunches. Innovative ways will need to be found to boost staff morale and keep colleagues connected. Staff at our Trust have been given mini goody bags and vouchers which have been well received.
Personally, I miss the little chats with colleagues in the hospital corridors or in the queues at the cafe bar during lunch breaks where solutions could be found to ongoing challenges which could at times drag on as sticking points in formal meetings. Hospital corridors have to be kept clear at all times and the social distancing rules mean that colleagues can no longer resolve complex ongoing issues in passing.
About the authors
Thomas Hamper is a specialist optometrist at the Manchester Royal Eye Hospital.Dr Waheeda Illahi is a consultant optometrist and head of optometry services at Birmingham & Midland Eye Centre.
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