“Having this qualification will allow us to deliver even better patient care”

What led Hakim Group to establish a special cohort of independent prescriber (IP) training?

Amit Sharma (AS), optometrist and director at Pinder & Moore Opticians in Kingswinford, a Hakim Group practice: Around the end of April 2020, I had a conversation with our CEO and founder, Imran Hakim, about enrolling myself onto an IP course. He suggested we should try and secure a cohort for some of our optometrists at Hakim Group.

The thought process behind this was, especially with COVID-19, hospitals were not keen to see patients and patients were not keen to go into hospital. Having this qualification would enable us as a group to support our hospital eye service (HES) colleagues further, as there would be more conditions we could manage in practice. At that time, we didn’t know how long lockdown was going to be and so we thought, if there are going to be optometrists who are potentially furloughed, it could be a good chance to upskill.

I contacted all the universities that provide IP training and both City, University of London, and Ulster University responded. We had a few conversations and continued with Ulster, who put us in touch with its optometry department. The university typically only takes a cohort of 15 students on its IP course so we were not only asking if they could accommodate our optometrists, but if we could have a special cohort of over 100 people.

Ulster’s Dr Julie McClelland and Patrick Richardson carried out a lot of hard work. There was quite a lot of pressure involved in going from having 15 optometrists to 100 on the course. They pitched it to the General Optical Council (GOC) and in less than a month they received approval to run a large cohort and then had to source additional supervisors. The course went live on 4 June 2020, so it was all set up within the space of a month from that initial conversation.

Was the intention always to offer this to optometrists in the wider independent sector?

AS: Whilst we were in the planning stages for the IP course, Hakim Group were running the Stronger Together forum to help independent practices with the challenges of COVID-19. As we had the authorisation for 120 students on the IP course, this presented a great opportunity to extend some of these places to our independent friends. Around 50 optometrists joined the course from the independent sector.

What has the special cohort meant for the optometrists on the course?

AS: There were many reasons why there was such a good uptake for the course, and I can put myself in that position because it’s an idea that I’ve dabbled with for a number of years. Although I have other professional qualifications, the IP qualification is one of the harder ones because of the process to get qualified. It’s not just finding a place at a university but finding a clinical placement, which is a challenge, and the final assessment. I had always felt that I wanted to do it, but that it wasn’t the right time.

The first lockdown meant some people had a little bit more time than usual, and perhaps the typical work-life balance that might have previously prevented them from doing an intense professional qualification wasn’t there, so there was a short-term space to be able to commit to something like this.

I'm looking forward to getting qualified and being able to use this qualification for my patients

I think a lot of people may have previously toyed with the idea and found the cost was too high, or there was too much of a waiting list. There was financial support and resources provided by Hakim Group for optometrists within the business, which meant optometrists had the opportunity to get upskilled in something that really would benefit them.

It’s a win-win in many ways. For professionals, it's because we’re giving them an opportunity that they had potentially contemplated. It benefits the practice because it gives us another unique selling point compared to others in the locality. Thirdly, and the key motivating factor for us, is that it allows us to reduce the burden on HES because there’s an opportunity to be able to manage a lot of conditions in-house that normally would have had to be referred.

What do you think the IP training can mean for patients and the wider community?

AS: The benefit for eye care professionals is being able to manage your patient. Although there are some instances where there is nothing that as optometrists we can do, I think we always want to try and do whatever we can for our patient there and then in practice, because the patient is in our care. If we can see them through because of that additional qualification then obviously, it's better for them.

The speed of management is key as well and if you’re able to manage patients in-house then it’s more convenient for them. Especially during COVID-19 when local hospitals have not been seeing patients that they would have normally seen, and so patients have to go further afield. If the patient is getting drops that will dilate their pupils, then they can’t drive, and they would have to rely on someone to take them or get a taxi so there are financial implications as well. Patients tend to be in hospital environments for longer periods of time because of the waiting times, and because of the pandemic people have been frightened to go to hospital because of the risk of COVID-19.

What have been some of the biggest challenges in organising this cohort?

AS: The biggest challenge that we had was finding a clinical placement, which was always going to be the case. Under normal circumstances, most universities accept students on the proviso that they’ve got a clinical placement in theory, but that was not in place here. We appreciate it is already difficult and would be more difficult as an extra cohort to qualify with 120 people, especially during COVID-19 when a lot of face-to-face teaching and learning has not been going on.

Imran and the clinical lead for Hakim Group were in dialogue with the College of Optometrists and the GOC early in the programme to discuss the possibilities of new ways of working and securing clinical placements. Recently, the College did issue an update that a maximum 55% of a clinical placement can be virtual so that makes a big difference.

I’ve also been in touch with Local Health Network chairs, Local Optical Councils and hospital eye departments, to see if they could help our group of optometrists who are spread around the country.

We’re in a health care profession to be there to help patients

Is the relationship with Ulster something Hakim Group intends to build on in the future?

AS: We’ve had conversations with Ulster regarding other professional qualifications. As a group we are keen to keep upskilling our people. I’m very appreciative of the way Ulster worked with us and the efforts they put in.

What has been your personal experience of the IP course?

AS: It has been enjoyable. I think Ulster did a fantastic job and were very supportive throughout. One of the challenges for me was to keep everyone motivated. There was a range in experience and age groups, with some more recently qualified optometrists, and some who had been qualified for perhaps 40 years. It was tough to get back into studying again, while working and home-schooling as well. But it’s a challenge that we got through.

I have started my placement with a medical retinal consultant, and I am learning loads. I get most of my learning from listening and interacting with a physical patient – seeing how something was managed and how it could have been done differently or the variety of options available.

What has been a key takeaway from this experience for you?

AS: I really enjoyed helping people do something that maybe they thought they wouldn't have been able to do. I'm looking forward to getting qualified and being able to use this qualification for my patients. I think as a clinician it will expand the scope of my practice and provide a point of differentiation, as its still only a small percentage of optometrists who are IP-qualified.

Community IP optometrists will be the key to helping to reduce the number of referrals into the HES

What adaptations were needed to run the special cohort of IP training at Ulster University?

Dr Julie McClelland (JM), senior lecturer in optometry at Ulster University, and course director for The Theory of Independent Prescribing for Optometrists: We were contacted directly by Amit, from the Hakim group, enquiring about whether during the initial period of lockdown we would be able to deliver the theoretical part of the IP programme to a number of his optometrists. This was a great opportunity to upscale our programme for this special cohort. We initially had to gain approval for this increased cohort from the GOC and Ulster University.

As a relatively small course team, we also approached eight independent prescribing optometrists who we had worked with previously for various different events to ask them if they would consider taking on an e-tutor role for the larger cohort. These IP optometrists undertook an e-tutoring programme prior to becoming involved with the teaching and assessment. They were all experienced clinicians with teaching experience and adapted to the role very quickly. We are very grateful to the e-tutors for stepping into this role and doing such a great job in supporting the students. This experience has allowed us to see what we can potentially do with the IP programme and our other distance learning courses.

How has running this larger cohort compared with Ulster’s previous IP courses?

Patrick Richardson (PR), lecturer in optometry, optometry clinic manager at Ulster, and an independent prescribing optometrist: As the course is primarily an online programme, the main adaptations were to consider how we could carry out the assessments and the administrative requirements for the programme. We were supported by our E-Learning Support Unit and Office for Digital Learning at Ulster who provided great advice despite all working remotely.

JM: The assessments are all completed online outside of COVID-19, so the main issue that we had was scaling up the assessments for larger numbers. However this worked well with the support for the e-tutors.

Were there any challenges involved?

JM: Apart from home-schooling during the process, the challenges were mainly due to the fact that everyone in the university was working from home and therefore communication relied on online meetings and telephone conversations rather than just calling into someone’s office. However, we all adapted quickly to the new way of working.

From the students’ perspective, the challenges mostly related to technical issues, such as internet connectivity and experience with using virtual learning environments (VLEs). However, we were able to iron out any issues within the first few weeks of the course and our university VLE support services provided excellent support for the optometrists.

What has it been like to deliver the course over the past year?

PR: The pandemic definitely affected the optometrists’ perspective of how they manage their patients. It was great to hear stories from the students about how they had to adjust their practice to conduct telephone consultations and manage remotely. The pandemic has also opened-up and strengthened communication with our ophthalmology colleagues as we have all had to try to deliver eye care in a slightly different way. During lockdown, in our own clinic we were managing pathology in partnership with the local ophthalmologists, and we feel that there is an interest in having discussions on how to take this forward.

What role do you feel IP optometry will take in the future of community eye care?

PR: I really believe that IP is important for the future of eye care, for those optometrists interested in increasing their scope of practice. Community IP optometrists will be the key to helping to reduce the number of referrals into the HES, and those based within hospitals will continue to widen the scope of their role and enhance their clinical knowledge and skills.

Was there anything you have taken away from delivering training to this cohort?

JM: It was great to get to know practitioners from across the UK working in a variety of different clinical settings.

In one sentence, what might you say to an optometrist who might be considering undertaking IP?

PR: Just do it, you won’t regret it.