My practice team

We’ve got six DOs working within my practice, which is a high number for a multiple. I recognise that they have a massive role to play in the evolution of our profession.

We run a diabetic scheme, monitoring diabetic patients who have not been able to be recalled for diabetic screening in the hospital. I can see twice as many patients by effectively utilising my team than I could if I was trying to do it on my own. I can use my DOs to undertake vision screenings, take a history and symptoms, and to instil drops at the beginning of the examination. I can also use my clinical technicians to undertake the scans and photography that I need.

Similarly, I use the team to help with my glaucoma monitoring work. A patient will have their fields and optical coherence tomography (OCT) scans done, and drops administered if necessary. When I get to the patient, I can focus on the bit that only I can do.

We hear about practices struggling to recruit optometrists, but if you’ve got a good team behind you, you can do more work with what you have

Power of delegation

I think, as an optometry profession, we need to be moving towards doing only the work that we are qualified to do, and delegating other work to others within the practice team. We’ve got a massive population. We hear about practices struggling to recruit optometrists, but if you’ve got a good team behind you, you can do more work with what you have.

I rely on my team booking my diary sensibly. The ability to shift patients, where appropriate, allows emergencies to be seen by the appropriately qualified professional. For example, if there’s a potential iritis patient coming in, who is going to need to see an independent prescribing (IP) optometrist, I’ve got colleagues who are switched on enough to say, ‘actually, Andy doesn't need to see this other, non-emergency, case. We can move that patient to another optometrist, or a pre-reg. We’ll get Mrs Jones, who is likely to have a flare up of her iritis, seen by an IP, who can solve that problem there and then.”

The team, fundamentally, allows us to field the triage. My team members undertake triage calls, listening to patients. That information is then passed on to the practitioner, who will make a decision as to the urgency of the care. The optometrist reviewing the triage will identify the preliminary examinations and preliminary diagnostics that are required, which will be undertaken by team members.

Our DOs also take the lead on our low vision service, where we’re looking after those with the most profound sight loss in provision of magnifiers and low vision aids.

I can see an evolution of care. With the evolution of the contract in Wales, we’re going to be doing more and more clinical work within primary care, and you can’t do that on the back of a half hour examination, with you doing everything. It doesn't stack up. If you use a well-trained team, you can see patients for the bit that only you can do.

If you’re leading from the front, with higher qualifications and higher training, you inspire other people to do the same

Upskilling the team

The team is a great motivator. You bring them with you. I’ve always pushed myself clinically, to the front of the profession. I want to be in the top 1% in terms of what I can do, but I can’t do it all. If you’re leading from the front, with higher qualifications and higher training, you inspire other people to do the same.

All my optometrists have some form of higher qualification. I’ve got people who have only been qualified three or four years, who have higher certificate glaucoma, with IP. We encourage our DOs to become contact lens opticians; we encourage them to do low vision. I want the contact lens opticians to be doing anterior Eye Health Examination Wales work, when possible. My team is multidisciplinary, supporting the best care for patients, in the best location, in a timely manner, which allows us to run a profitable business that keeps everyone happy.

My team is multidisciplinary, supporting the best care for patients, in the best location, in a timely manner

I can’t imagine practising without an OCT nowadays, but I couldn’t use the OCT as efficiently if I didn’t have my team taking those scans for me well in the first place. My advice for practice owners is to strategically invest in the equipment, and never say no to anybody who wants to get a higher or further qualification. I’ve got an optical assistant who is potentially interested in doing the DO course, but doesn’t have the required grades for the degree. I said that if he wants to redo his GCSE maths, we’ll pay for it.

We’ve always paid for employees’ qualifications. Over the years I’ve trained 12 pre-regs. Some of those started as Saturday people; some were students. We’ve had DOs who came to us from checkouts at Morrisons and are now contact lens opticians. There are efficiencies to be had in the future by making more use of a multidisciplinary team.

If we didn’t have efficient diary management and we didn’t have efficient team members in place, I would be seeing more patients who I don’t need to see, and more patients would be being seen in secondary care when they could be managed in primary care. We wouldn’t have the capacity to deliver all the enhanced schemes and services that we do. It allows me to grow my business, and to see large numbers of emergency and acute eye care problems, as well as run chronic care clinics with aspects like glaucoma screening and data capture.

It’s about empowering people to aspire to be their best, and removing any barriers to people developing and having a career. That means regular reviews and appraisals, and chats with people on the shop floor: what do you aspire to do? What do you want to do? Look for efficiencies within the system, and aspire to a model of only doing what only you can do.