"The future of the profession is still really strong"

The challenges of the past year have led to closer working between the profession and with secondary care, as well as a greater opportunity for optometrists to utilise their professional judgement when meeting a patient’s needs.

These were key points raised in a panel of optical organisations at an online event held by contact lens manufacturer, Alcon.

The ‘Alconversation’ event, chaired by Richard Edwards, professional adviser to the Optical Consumer Complaints Service, aimed to reflect on the issues that impacted optometry in 2020 and what it has taught the profession moving forwards.

The panel comprised AOP’s clinical director, Dr Peter Hampson; Lesley Longstone, chief executive and registrar at the General Optical Council; Daniel Hardiman-McCartney, clinical adviser for the College of Optometrists, and Max Halford, the clinical lead for the Association of British Dispensing Opticians.

Reflecting on the past year, panellists first recognised the hard work and agility of professionals, as well as the impact the pandemic has had on individuals.

Commenting on the challenges faced by the profession, and particularly in certain groups, such as locum optometrists, Ms Longstone acknowledged: “Although there has been a bounce-back, and it is positive and strong, we also recognise that, for some, there won’t be a bounce-back.”

She emphasised however, “I think the future of the profession is still really strong.”

Supporting professional judgements

Panellists addressed a number of questions provided from industry media and professionals. OT asked: “2020 saw the GOC allow optometrists more professional discretion on supplying contact lenses to patients who were overdue a check-up. Does this pave the way for less regulation and more ‘professional judgement’ for optometry?”

The panel agreed that the increased emphasis on professional judgement was a positive step, with several suggesting ways the framework for regulation could be reconsidered going forwards. However, they also noted the need to balance this by ensuring ‘checks’ are in place.

Responding to the question, Mr Halford said that it had been “empowering” to hear the GOC emphasising the importance of exercising clinical judgement to care for contact lens patients. However, he shared his view that there was “a time and a place for relaxation of the rules.”

Describing professional judgement as “integral” to the work of optometrists, Dr Peter Hampson also said: “I do think it needs a framework in which to work.”

However, Dr Hampson shared: “I think we could look at a different sort of framework and take more of a risk-balanced approach to when you can and can’t extend,” emphasising that the framework would need to be patient-centred.

While checks and balances were needed, Mr Hardiman-McCartney also shared that a “middle ground” might be struck in future.

He shared a concern that the past framework for contact lenses was not always patient-centric and if the system isn’t updated, more people could be tempted to go outside of the regulated systems, adding: “It is critical that we get this right and we do change. I don’t think we can stay the same.”

From the regulator viewpoint, Ms Longstone suggested that, to an extent, a lot of the capacity to be able to exercise professional judgement was already there.

Looking forward, Ms Longstone added: “We are open to a conversation about where that framework should be set, how tightly and loosely.

“I think in all things, we feel that generally the more discretion for the professional the better, because it is a profession, and we want you to be able to exercise your judgement.”

Ms Longstone highlighted that the GOC has been consulting on its COVID-19 statements, put in place to support practitioners operating during the pandemic. The consultation is open until 7 January.

Lasting legacies

Asked what the lasting legacies might be of COVID-19 on optometry and optometric retail, panellists agreed that the provision of eye care services could look slightly different going forwards.

The adoption of remote and virtual consultations was a key change for many practices. Mr Hardiman-McCartney commented: “The sight test has really transformed over the last 10 months, the way we communicate with our patients and with systems has changed.

“I don’t think we should completely migrate to using virtual consultations, that’s not possible in optometry. But there are aspects of that we can lock into the future to triage more effectively.”

Personal protective equipment and infection control measures are expected to be part of the ‘new normal’ for practices going forwards both from the expectations of patients, and for the safety of optometrists and the practice team through the future of the pandemic.

Collaboration across the profession, greater ties with secondary care

The introduction of the COVID-19 urgent eye care service (CUES) was seen as a step forward for the profession by many panellists, in working with secondary care to deliver eye care and support patients and the NHS.

Commenting on the number of Clinical Commissioning Groups that have now adopted CUES or a minor eye condition service (MECS), Mr Halford said: “We’ve got this national care system for patients that we’ve longed for. That will hopefully be one of the legacies of this year.”

The strengthened ties between primary and secondary care, as well as between practitioners, was highlighted as both an outcome of the past year, and a focus to build on going forwards. This is particularly the case with the backlog of patients in both primary and secondary care as a result of the pandemic.

Considering the opportunities that lie ahead for the profession, Dr Hampson shared: “I think greater levels of working between the profession, a problem-oriented approach and not underselling what we do, because we can already do so much.”

Reflecting on this, Dr Hampson suggested that CUES “starts us along the path” of closer working between practitioners and upskilling. But he also emphasised that, while looking forward and upskilling is important: “We need to embrace what is already out there and what we can do.”

Panellists also agreed that, going forwards, the National Eye Care Transformation and Restoration Programme presented a “huge opportunity.”

The funding challenge

Panellists discussed the need for a change in how optometry is funded, though the question of where this will come from is a difficult one.

Discussing how optometry could change in the future, Dr Peter Hampson said: “Optometry has had a business model, for good or for bad, over the last 50 years or so, that has been heavily linked to the sale of spectacles and contact lenses.

“We think that is going to potentially change and break going forwards,” he said. “I think this period has potentially moved that forwards quite a bit.”

The topic of funding is increasingly challenging as the profession moves into the new year, and a “post-COVID, economically-crunched environment,” Dr Hampson pointed out.

The panel highlighted that secondary care is also underfunded, with Mr Hardiman-McCartney sharing: “As more things move out of secondary care, the budget will shrink and they will have to deal with more complex cases with a smaller budget.”

Acknowledging that the GOS budget is “not sufficient to do what it does,” Mr Hardiman-McCartney suggested that, even if the two budgets were combined, “It is not enough to deal with everything.”

Dr Hampson said: “We’ve got to look at taking some of the money out of secondary care. That brings its own challenges though, because our secondary care colleagues also have a cross-subsidy issue.”

He suggested that the conversation needs to include ophthalmology to acknowledge the cross-subsidy issues and “find a way to work together.”

A united message

Panellists spoke of the need for optometry professionals and bodies to speak in unity on the key issues surrounding funding and collaboration between primary and secondary care. The panel also reflected on how optical bodies collaborated cross-sector throughout the year over the key issues surrounding COVID-19, including funding and PPE.

Likening it to a choir, Mr Hardiman-McCartney said that to support change in the future, the whole profession was needed to make a “loud, unified approach in order for the health systems to hear us. To make the case for optometrists, dispensing opticians, contact lens opticians, practice teams, to all be part of the concerted effort to help deliver in this challenge of ‘how do we square this circle of an ageing population, huge backlog and very little extra resource available?’”

Concluding the discussion, Richard Edwards said: “I do feel heartened about increased collaboration and recognition that we need a unified voice, and it feels like there is a direction of travel to get that.”

The full session can be seen on Alcon’s YouTube channel.