Connecting vulnerable families with sight tests in Blackpool

Blackpool Better Start is a pioneering initiative that aims to address inequalities by linking vulnerable families with pharmacy, dental, and optical practices.

Three optometry practices have signed up to an initial pilot of the project.

Lancashire & South Cumbria Local Eye Health Network chair, Tom Mackley, and locum optometrist, Sarah Bentley, talk with OT about the initiative.

Tom Mackley: “We hope to improve health outcomes across the whole community”

Blackpool Better Start aims to address different areas of social deprivation. The community connectors are the people who link these families into services. These are services that already exist – most of these families could walk into a practice and get a General Ophthalmic Services sight test. The majority would be eligible for that but their lives have not led them to a place where they routinely interact with healthcare services.

We provide trauma-informed training – this is training designed for a whole plethora of people who interact with families in need to understand what motivates and demotivates those people. Our optometrists, dispensing opticians and optical staff will be going on those courses. It helps to develop their empathy for the situation and not just think ‘This is someone who has missed an appointment three times in a row.’ Their lives are difficult and complex.

We are trying to focus attention on where we can make a difference – how can we get people to access services, who don’t normally, and understand the barriers that exist? This isn’t necessarily the solution, but it is an attempt to address the problem.

Their lives have not led them to a place where they routinely interact with healthcare services

We spent some time discussing what the service might look like – should we deliver it through family centres as a domiciliary service, or alongside the pharmacists and the dentists in the same room? There was a lot of toing and froing. Eventually we settled on seeing patients in optical practices.

We are trying to create new patterns of habits for these patients. We need to find them their optical, pharmacy or dental home – the place they will go in the future when they have optical, dental or pharmacy needs.

The idea is to run this service for a period of months and then look at the data we have collected and see how effective we have been in all aspects of this and refine what we are offering. Then we will offer this in other areas with similar demographics.

The Better Start project is largely focused on children. I have spoken to the local screening services and they say that they get a high proportion of referrals where the children don’t attend hospital. They locate the child in the classroom, they identify that they need a referral to secondary care, but the child is not taken.

It is complex and it is individual. There are multiple demands on their attention and time, and limited resources with which to meet those demands. If you are in a low paid job and you have three children, just getting to an optical practice can be difficult. If, when you get there, you can’t afford the products that you need, you might put it off. You are worried about the financial barriers when you get there. It is sometimes easier to deal with the more immediate problems in life.

Communication and having the time to communicate with this patient group is the crux of the issue. When they make contact with the practice, they will often arrive with preconceptions built on previous bad experiences where they feel like they might be judged. It is the extremely good interpersonal skills of optical staff that will enable these people to be reassured and help them to access care.

The community connectors aren’t social workers. They are people from directly within the communities who work with these families. They are the link between social and healthcare services and that local community. They are someone that the family will trust. A lot of this is about gaining trust with people who have had multiple knockbacks in their lives – times when they are made to feel unworthy of attention.

I’d be naïve to think that we are going to end health inequalities, but if we can demonstrate that families we have seen continue to engage in healthcare in the long-term, then I think we will have succeeded. Ultimately, we hope to improve health outcomes across the whole community. Better Start delivers that by focusing on the children.

This sort of project is really the reason that I took on the local eye health network role. It is an opportunity to make a difference. Through this I get to see direct changes to people’s lives. That is the main thing.

Sarah Bentley: “At times, you can be a bit of a social worker”

I work three days a week – two days in a practice in Layton, Blackpool, and one day a week in St Annes, which is about 20 minutes away from Blackpool in a wealthier area and with mainly private patients.

There is quite a stark difference between the two practices. The Blackpool practice has a low turnover because it is mainly NHS patients. The equipment in the practice itself is more limited. There is an inequality there. There is no way that my Blackpool practice could go private because 80% of patients are GOS. We offer a lot of services free – we replace and repair frames without charge because we know that our patients can’t afford it.

As an optometrist, at times you can be a bit of a social worker. We talk with patients about screen use, eating and sleep patterns We have people who do not turn up for their appointments. There are issues with people not collecting glasses for children. You might put a patient down for a three or a six-month check and not see them for three years. For many families, money is a consideration but there is also apathy. You can see it through the generations. It is hard to break that cycle.

I found out about Better Start through Tom [Mackley]. I thought, even if I can get a few more people into the practice, that would be great. Many people don’t understand that if a child has no visual symptoms, they still need their sight tested. Providing eye care to children is massive from an educational point of view. If they can see everything they need from their first day of school, that is huge. It is a great starting point for them.