Lockdown three: “Balancing the safety of colleagues and patients”

For many optometrists, remaining open during the new lockdown brings with it a range of complex and conflicting emotions. OT  considers practitioners’ key concerns

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A week into the new lockdown measures in Scotland and England, and with restrictions in place across the whole of the country, practices and optometrists had already started seeing the ripple effects.

In reporting the evolving updates on practising in the lockdown, a variety of practitioner concerns have become clear, including the safety of staff and patients in offering routine appointments, the financial implications for practices seeing appointment numbers drop, and a concern for the eye health of those patients who are choosing to delay appointments.

The concerns are wide-ranging and complex, and practitioners have describing balancing multiple and conflicting worries over the issues involved.

With the introduction of lockdown three, OT polled readers on the new measures, asking how confident readers were feeling about practising during the lockdown, compared to the first lockdown in spring.

In a poll of over 320 readers, 52% reported feeling “much less confident” about practising during the third lockdown, while 11% felt “somewhat less confident.”

On the other hand, 15% of readers reported feeling “somewhat more confident,” and 6% said they were “much more confident” about practising in the lockdown.

A further 8% said their confidence level was the same, while 5% shared that they would not be practising during the lockdown.

The reasons behind these responses are numerous, challenging and conflicting, and paint a complex picture of the feelings within the profession at this time.

Speaking to OT, Henry Leonard, optometrist and Head of Clinical and Regulatory at the AOP, explained that the AOP has received emails from members experiencing a spectrum of concerns including the safety of practising, as well as practice owners who are fearful of how their business would survive without routine appointments.

He added: “This is a topic which has polarised opinion within the sector.”

OT has spoken to a number of optometrists and practice owners to gain an insight into some of those perspectives.

The impact of delays

Optometrist and AOP councillor, Susan Bowers, described feeling a “tug of war” between balancing the safety of patients in the practice, and a concern for the eye health of patients who may have care delayed if routine service is not carried out.

Describing her difficulty, Ms Bowers highlighted the concerns raised over the pandemic that eye conditions were going undetected, and patients were losing their sight, where routine care had been delayed.

“The group most at risk of eye disease is the group most at risk of catching COVID-19, so although I want to see them to check for pathology, I don’t want to put at risk a vulnerable group.”

The practice – Susan Bowers Optometrists – is taking every precaution, Ms Bowers said, including a telephone triage to check for COVID-19 symptoms and carry out a history and symptoms over the phone to reduce time in the practice. Once in the practice, patients have their temperature taken, receive hand sanitiser, gloves, and a second round of hand sanitiser, and the practice is also thoroughly cleaned with 70% alcohol.

As an IP optometrist with a diploma in glaucoma and an FP10 pad, Ms Bowers has seen demand increase for community optometrists where hospitals have reduced down to telephone triage only.

Ms Bowers said: “It puts pressure on those in the community like me, but it also lets us use our abilities to the full and show how we would benefit from more care in the community, which is where the patients want it.

“This pandemic is changing the face of eye care forever,” she added.

A drop in patient numbers 

Some practice owners have reported a drop in patient numbers, expressing concern for the financial implications the lockdown could have without additional support.

Speaking to OT about her experience of the restrictions, Poonam Shah, director optometrist of Humphriss & Burgess Optometrists, said: “After an incredibly difficult 2020, where we have had to implement many changes into the practice, moving into another lockdown is obviously quite scary.

“The infection rates in our area, Bedford, are rocketing. Having a large elderly patient base, the sense of responsibility in protecting them is huge.”

Ms Shah explained that since the announcement of the third lockdown, the practice has seen “endless cancellations.”

“Our capacity is no more than 20% of the pre-lockdown levels experienced since June – even less if you compare it with January last year,” she said, noting that patients have either been unsure if they were allowed to attend the practice, or have expressed a preference of waiting for their vaccine.

This is a topic which has polarised opinion within the sector

Henry Leonard, AOP head of clinical and regulatory

Ms Shah has furloughed her staff and is working on her own, but is uncertain of how long this may last, or what the timescales could be.

“I think it is all well and good being allowed to stay open, but there has to be some sort of recognition of the fact that the footfall in some, if not all, practices will be greatly reduced,” Ms Shah observed.

Financial support, such as bounce back loans, from the first lockdown, have been utilised, and the latest grants announced for businesses by the Chancellor of the Exchequer are only being provided to businesses that have closed because of the pandemic, and so would not be available for practices that remain open.

The Optometric Fees Negotiation Committee (OFNC) has confirmed it is in discussions with NHS England regarding potential additional support for practices affected by the lockdown restrictions. The bodies are monitoring the situation, and the OFNC has invited contractors to get in touch with their optometric body to share information on the viability of services.

Without support in place, Ms Shah said, “the financial impact could be massive.”

Explaining that she feels the level of financial support that was available in the first lockdown should be made available now, Ms Shah added: “It is almost more financially viable not to open, but I would never consider closing. It is far more important for me to be available for my patients who do need me for emergency or essential care.”

Optometrist, practice owner and AOP council member, Stewart Mitchell, has also seen a “reasonable proportion” of patients cancelling appointments.

Mr Mitchell explained: “In November we were 50% down on patient appointments as opposed to November 2019. I am assuming worse for this period of restrictions.”

The optometrist shared his concern that urgent and essential eye care is not the bulk of an optometry practice’s workload, adding: “If we don’t see routine, we don’t survive.”

On the other hand, he questioned whether practices should be open for routine care, with the numbers of hospitalised COVID-19 patients “staggeringly high.”

Optometrist Graham Phipps has also seen an impact to business, telling OT: “November and December have been worse for business than normal, and with January’s ‘Stay at Home’ message, I am likely to lose at least £8,000 this month alone – normally our busiest time.”

Mr Phipps also shared his concerns about offering routine care, suggesting it feels akin to a “loophole” to the lockdown message.

“I note the news suggests not using the rules as a limit to push against,” he added.

Phases, guidance and safety

Concerns have been expressed by a number of optometrists that, although the COVID-19 levels are higher than they were during the first lockdown, optometry remains in the amber phase of the College of Optometrists’ guidance.

Under the guidance, practices are advised to continue providing needs and symptoms-led primary eye care, prioritising emergency and essential care and only providing routine appointments where capacity permits and if it is in the patients’ best interests.

The College of Optometrists has explained that in the present lockdown, each nation’s government has stated that primary care services should remain open wherever possible and safe to do so. The optical body also highlighted the impact to eye health that delays in identifying and treating issues could have.

In an FAQ, the College of Optometrists emphasised that following the amber phase guidance “does not mean business as normal.”

This is a concern that practice owner and optometrist, Ed Adkins, has looked into, launching a survey to gather the views of almost 900 fellow optometrists.

The optometrist feels that the new lockdown was a necessary measure, commenting: “Ultimately, there are no correct answers to dealing with COVID-19, only less incorrect ones.”

Compared to the first lockdown, the practice knows more of what to expect, and the required adaptations are still in place, Mr Adkins said. However, he expressed concerns that continuing routine appointments where capacity allows and where it is in the patient’s best interest “is contrary to the spirit of the ‘Stay at Home’ message.”

To establish if his concerns were commonly held, Mr Adkins launched a survey, finding that 30% of respondents wanted to return to providing only urgent and essential eye examinations, while 60% supported changing the guidance to the red phase.

Of the respondents, 10% supported the current amber phase guidance of prioritising urgent and essential eye care, with routine appointments where capacity allowed.

Reflecting on the findings, Mr Adkins said: “The two main concerns rotate around the safety of staff and patients, and also the financial implications for businesses, should routine testing be paused.”

He added: “There appears, at present, to be very limited financial assistance to help businesses weather the storm and cope with further loss of income.”

As a business owner, Mr Adkins explained he also has mixed emotions. “My overriding concern is balancing the safety of my colleagues and patients, with providing care for those that need it, and ensuring we are still around after the pandemic has been cleared up.”

Optical bodies work to support optometrists

In a message to members, AOP chief executive, Henrietta Alderman, addressed concerns around the advice, suggesting that optometrists should continue to provide needs and symptoms-led primary care, including appointments where capacity allows, and in the patient’s best interests.

“We recognise that the COVID-19 pandemic has had an impact on the nation’s eye health, with some patients suffering avoidable sight loss due to cancelled and missed appointments, and that some businesses have faced a difficult financial situation,” Ms Alderman said.

“However, it is important that practitioners are protected as much as possible and that they shouldn’t be expected to take unnecessary risks with regard to their own health, or the health of their families.”

The AOP has emphasised that if a practice continues to offer routine care, it “must maintain stringent measures” to manage the risks of COVID-19 infection, including the use of longer appointment times.

My overriding concern is balancing the safety of my colleagues and patients, with providing care for those that need it, and ensuring we are still around after the pandemic has been cleared up

Ed Adkins, practice owner and optometrist

Speaking to OT, Henry Leonard, optometrist and Head of Clinical and Regulatory at the AOP, explained that the employment team has been assisting members throughout the pandemic to raise concerns with their employer, on a case by case basis, where adequate measures have not been put in place.

“The AOP has also contacted some of these employers directly to raise concerns, where we feel they are putting their commercial interests ahead of the safety of our members and their patients,” Mr Leonard explained.

Reflecting the concerns shared by optometrists, Mr Leonard said: “As a practising optometrist, I fully understand the concerns about the current guidance, and the potential risk this could pose to ourselves, our patients and our families.”

“There are still lots of unknowns, but I want to reassure members that we are working hard to find a way through this,” he added.

Optical bodies are working to support optometrists practising in the pandemic, sharing guidance and FAQs, and recently hosting a Q&A on delivering eye care in the lockdown, while with the OFNC is also in conversations with NHS England over potential additional support.

A joint statement shared this week from the chief executives of statutory regulators of health and social care professionals, signed by the General Optical Council, re-iterated the principles they will rely on as the pandemic continues.

The regulators shared that the regulatory standards are designed to be flexible and provide a framework for decision-making in a range of situations, adding: “We recognise that in highly challenging circumstances, professionals may need to depart from established procedures in order to care for patients and people using health and social care services.”

In the meantime, optical bodies are working to continue updating optometrists on the provision of the COVID-19 vaccine, which has begun to roll-out across the country and offers some hope for the long path ahead.

Speaking to OT, Ms Bowers said she is still trying to recover from the first lockdown, which, like many, she worked through to see emergencies with NHS 111.

In a message to fellow optometrists, she said: “Hang in there everyone, and try your best to stay safe.”

OT endeavours to keep the most up-to-date news on our website and this information was correct when published. However, the situation regarding coronavirus (COVID-19) is rapidly evolving.

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