20 October 2023
Speaking to OT about the changes to independent prescribing (IP) requirements in particular, Samara Morgan, head of education development at the GOC shared: “The changes for our qualifications in additional supply, supplementary prescribing, and independent prescribing, mean that trainees will acquire a single qualification approved by the GOC, leading to specialist entry to the GOC register in the relevant category, rather than the two approved qualifications gained either sequentially or simultaneously at present.”
As part of the requirements, qualifications must integrate a minimum of 90 hours “learning and experience in practice,” and trainees must have identified a designated prescribing practitioner as a supervisor for their placement.
First across the line
Aston University’s postgraduate IP course was the first to be noted by the GOC as meeting the new requirements, with the initial cohort joining this October.Dr Preeti Bhogal-Bhamra, director of optometry postgraduate taught programmes at Aston University, told OT: “The main difference is that, in the past the course has been based on the theoretical knowledge of prescribing and pharmacology.
“What we are finding now, to our delight, is that there is more on the actual prescribing. There is a lot of consideration given to ethics in the learning outcomes now, as well as safe prescribing and taking responsibility for your role,” she said.
This change may support optometrists gaining the IP qualification to leave with a greater level of confidence than previous cohorts may have experienced, the lecturer suggested.
Replacing the therapeutic common final assessment, theory will still be assessed throughout the course, but more weighting will be attributed to the actual placement itself.
“We found that the clinical placement was where everybody felt they learned the most,” Bhogal-Bhamra said. “We wanted to place more emphasis on the learning journey during the clinical placement. We think that will help students as they are working through their course.”
Students will remain responsible for sourcing their own clinical placements, but now that this is integrated into the course, the university will be able to provide a greater level of support and has sought to forge links with local trusts in preparation. “The change in the GOC outcomes has been a positive first step,” Bhogal-Bhamra said. “Giving universities that opportunity to develop the course further and have oversight of everything for an IP student, from the beginning to the very end, is going to really help.”
The change in the GOC outcomes has been a positive first step
New structures and outcomes
Dr Michelle Hennelly, head of optometry and visual science at City, University of London, shared that many higher education institutions are considering how best to integrate the placement into the IP qualification.
“At City, we will be combining theory with clinical skills and signposting key elements in practical workshops prior to going into the placement. This will give students the most opportunity to gain relevant experience,” she said.
Hennelly is part of the Sector Partnership for Optical Knowledge and Education (SPOKE), which was commissioned in early 2023 to form a Knowledge Hub, facilitating conversations in the sector in preparation to meet the requirements for the new IP courses.
SPOKE has established a list of learning indicators associated with the Outcomes for Approved Qualifications for independent prescribing.
“Once published, this will enable higher educational institutions to develop the new IP programme,” Hennelly said. “The main purpose of SPOKE is to support the successful implementation of the new GOC requirements.”
Considering the plans for City’s IP course, Hennelly suggested: “Finding a placement will be much easier in the integrated programme, because we will be working with partners to broker placements. We will support students in getting the placement in the first instance, and then we will enhance the learning during their placement experience.”
This added support will help combining theory with practice, for example, by considering different types of eye disease and supporting students with further development of eye disease management skills, she continued.
Cardiff University has also been looking at its IP programme in light of the new requirements, and how the course can support optometrists on their clinical placement.
Angela Whitaker, senior lecturer and IP programme director for Cardiff University, said: “It’s an opportunity to help students make the most of the placement for their own individual clinical context, for what their ambitions are, and to tailor that placement experience to help them develop into the optometrist they want to be.”
Cardiff University plans to expand its Teach and Treat clinics in order to support the provision of placements. Successful teach and treat clinics have been running for two years for glaucoma, medical retina and oculoplastics, while an independent prescribing optometry service (IPOS) has recently launched at the university, creating additional opportunities for IP placement provision.
I think we can put better structures in place for those that may not feel confident, simply because they don’t get enough exposure to different types of eye disease
Addressing placement concerns
However, placement capacity remains a key question for providers.
Whitaker acknowledged: “For me, the single biggest issue is placement capacity; we need high quality clinical experience that is relevant and meaningful, to help optometrists develop their skills and confidence.”
Bhogal-Bhamra also acknowledged: “With the number of applicants that come through for IP, the level of interest and the demand, I do think we will still face those challenges.”
The GOC’s move to allow IP optometrists to act as a designated prescribing practitioner (DPP) could help to ease some of the pressure around placement capacity, broadening the scope of who can supervise. However, Dr Peter Hampson, clinical and professional director for the AOP, has cautioned that the requirements the DPP must meet may limit those who could supervise, sharing: “Whilst there are some practices and practitioners with the correct case mix, unfortunately I don’t think there are that many.”
Optometrist, Ankur Trivedi, the AOP’s Councillor for IP optometrists, told OT that placements have been a “definite barrier to gaining the IP qualification.”
Trivedi, who qualified in IP in 2014, self-funded his placement at Bristol Eye Hospital, but said: “I was really lucky, in that I knew the right people to signpost me to that pathway.”
In Gloucestershire, the Trust historically has not been able to provide a pathway for external IP candidates, Trivedi suggested, recognising that to be able to offer such a provision for any hospital setting, could feel like a lot of “red tape" for both the IP student and the hosting hospital.
Work has been ongoing with the local hospital trust, with input from the local optical committee, to establish placements for a cohort of trainees, however, with Trivedi explaining: “A couple of colleagues are now going to be the first in Gloucestershire to do their IP placements locally.”
This is something that, following recent discussion with Trust colleagues, will lay the foundations or a clear pathway for future candidates looking to do their placement in their local hospital.
Opportunities to reshape undergraduate education
The new requirements allow for greater flexibility in how qualifications are provided.
Morgan, from the GOC told OT: “One change as an example, is that trainees will no longer be required to have been practising as an optometrist for two years before undertaking an additional supply, supplementary prescribing, and independent prescribing qualification. As a result, providers may choose to integrate the AS, SP, or IP qualification within their undergraduate optometry level 7 programmes [Master’s], resulting in the student acquiring two qualifications.”
The qualifications will remain separate, ensuring qualified optometrists will continue to be able to access training, Morgan noted, while standalone qualifications are available from many providers.
Hennelly shared that the advent of the MOptom brought up the question of including prescribing as part of the Master's level of learning.
“One of the issues that we felt, was the consideration around experience, and would you have enough clinical experience in a four-year degree to exit the award as a prescriber?” she told OT. “I think our sense was ‘no.’”
Hennelly pointed to the Master's programmes in pharmacy, operating as five-year courses, where students graduate with the ability to prescribe.
“In that five-year course, you probably do get enough time and placement activity to support that as an exit point,” she said.
Discussions in Scotland seem to be working around this approach, with the Scottish Government working with both Glasgow Caledonian University and the University of the Highlands and Islands as they develop new undergraduate programmes.
A letter from the chief optometric adviser to the community eye care sector suggested this could incorporate independent prescribing as part of a five-year Master’s degree.
NHS Education for Scotland is supporting the universities to engage with stakeholders and develop the clinical placement model.
Considering the changing education requirements for future optometrists, Hampson noted the challenges around placement provision. He told OT: “The challenge around clinical placements for those outside of Scotland and potentially Wales remains, and these are likely to be hard to find. I hope that we don’t find ourselves in a situation where, we have built expectations amongst new entrants to the profession that ultimately we struggle to meet.”
Gaining experience is crucial, and a key challenge, he continued: “Ensuring graduates with IP not only have the qualifications, but also the correct level of experience to prescribe safely, is a significant challenge.”
Pathways for success
The GOC confirmed, as of 17 August, eight optometry qualifications had met the new requirements, with the providers set to offer the MOptom from September 2023.
Providers appear to have taken a variety of approaches to addressing IP as part of the Master’s level learning. For some, this looks like incorporating the theory as standard, while others have introduced optional modules that set final-year students up to pursue the qualification beyond undergraduate.
Cardiff University and Ulster University were the first to meet the GOC’s new requirements for undergraduate provision, and both welcomed their first cohort of students onto the updated MOptom programmes in autumn.
In Wales, optometry is on the verge of a new dawn, with the new and highly anticipated Wales General Ophthalmic Services (WGOS) contract.
With the new contract coming into play alongside the changing requirements for optometry education, Whitaker shared: “In essence, the core level is higher than the current level, or needs to be. So, our training at undergraduate, postgraduate IP, and other courses we run, has been looking ahead at what optometrists in Wales are going to need – not just now, but in the future, because there will continue to be ongoing development in the role of the optometrist, which is to be welcomed.”
Graduates of Cardiff University’s new MOptom will leave the course having covered the theoretical elements of IP, ready to take on a clinical placement, and will also have had the opportunity to work towards a suite of professional certificates in areas including glaucoma and low vision.
“Over time, we would like to embed the placement in the undergraduate course, but we don’t have the placement capacity at the moment,” Whitaker said.
Our training at both undergraduate, postgraduate IP, and for the other courses we run, is looking ahead at what optometrists in Wales are going to need – not just now, but going forward, because there are always going to be further changes in the profession
Dr Julie McClelland, senior lecturer in optometry at Ulster University, told OT: “The ETR required significant changes to the programme, which included the amendment to a registerable degree. We are fortunate in that our MOptom programme has been running successfully for a number of years, which has helped to prepare the staff for this shift in course delivery.”
According to module guidance shared on the MOptom webpage, in the final year of the four-year degree, students will have the option to undertake a module in Ocular therapeutics and prescribing.
The optometry school suggests successful completion of the module as part of the MOptom could set students on a path to apply to join the specialist register as an IP optometrist.
Details are in the process of being finalised, but McClelland confirmed: “We consider IP knowledge and skills to be an important part of optometrists’ skillset in future years.”
At City, students in their fourth year will be able to choose a path of learning towards medical retina and glaucoma professional certifications, or to progress their prescribing knowledge – experiencing the theoretical half of the IP programme. Having graduated, students would then need to take one final module and complete a placement to become IP qualified.
Structuring it this way, Hennelly shared, “helps to deliver a sense for the student of where they want to aim to be, and what their commitment and career path is.”
This way, graduates will also have the opportunity to gain experience as a qualified optometrist, before returning to complete the IP qualification.
In addition, Hennelly explained that the College of Optometrist’s clinical management guidelines will be embedded much earlier in the MOptom programme: “We’re going to make sure that students are aware of those from year one, and build on that as a resource for learning so that they are much better equipped and familiar with the gold standard or the framework on which IP is structured.”
Choose your path
Looking at the changes in education, Trivedi suggested there could be opportunities for a cohort of undergraduates “with a lot of knowledge already from the course and who are still in that learning zone.”
He also emphasised the importance of the postgraduate programme, recognising that for some, gaining experience in practice before returning to gain the additional qualification would remain the best route.
Reflecting on the role IP plays in the profession, Trivedi shared: “There’s a misconception sometimes that the IP qualification is just about prescribing. It does give you the skill and the power to prescribe, but it is about the general management of patients as well – knowing when you maybe don’t need to prescribe and can just monitor and discuss with the patient what to expect and any red flags to get in touch about. Every patient interaction you have has the potential to utilise that knowledge and experience.”
With the changes in education, Morgan told OT: “The new education and training requirements were introduced in response to enhanced optical roles dealing with an increased volume of eye care and provision of specialist services in the community, helping to ease the burden on the NHS.Every patient interaction you have has the potential to utilise that knowledge and experience
“Independent prescribing has a role to play, along with many other education and training opportunities and initiatives in eye care.”
IP is not a path that all optometrists see themselves taking, and there are other paths to explore too.
Morgan highlighted the many initiatives, continuing professional development and training opportunities available that is “designed to meet different needs,” adding: “There will continue to be standalone optometry (OP) qualifications available as well as OP/IP integrated, and IP standalone qualifications available for individuals to choose their own pathway.”
Across the High Street
Pharmacy has been undergoing its own changes in the training of independent prescribers following updated standards from the General Pharmaceutical Council (GPhC).
According to register data from the General Pharmaceutical Council, as of 30 June 2023, there were 15,171 independent prescribers registered, and a further 916 who hold both prescribing and supplementary prescribing annotations.
“Course providers will assess the quality of a candidate’s experience prior to them starting the course, which is also accredited by the GPhC,” she said.
The training typically takes six months or longer to complete on a part-time basis and must include a minimum of 26 days teaching and learning, and the candidate must also complete a minimum of 90 hours of supervised practice.
Undergraduate training is also evolving, Wilson shared: “Changes to the initial education and training of undergraduate pharmacists now incorporate the skills, knowledge, and attributes for prescribing, to enable pharmacists to independently prescribe from the point of registration.”
The first cohort to graduate with IP-ready status will be in 2026.
Increasing the numbers of independent prescribing pharmacists will help to improve patient access and reduce pressure on other parts of the healthcare system, Wilson said, adding: “Our healthcare system is evolving, and we need to change with it to ensure patients still receive world class care in all settings.”
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Anonymous24 October 2023
While I am for improving the skill sets of optometrists, I think we are sleepwalking into doctor on the cheap situation ie. having the responsibly of a physician but without the same backup if something does wrong.
If I wanted to be a medic, I’d have trained to be one. I only hope IP doesn’t become mandatory in Scotland, as it mean a change in career for me.
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