I could not live without…

The hospital optometry team

Elaine Hawthorn, director and therapeutic optometrist at Specsavers in Stranraer, Scotland, on how close links with Dumfries and Galloway Royal Infirmary makes life easier for her patients

A woman with hair in a ponytail is leaning over a desk and writing with a pen in front of a mounted wall screen in an optometry testing room

We have always provided emergency care where we can, but our actual relationship with the hospital came to fruition during the pandemic.

In Scotland, we set up Emergency Eyecare Treatment Centres (EETCs). The hospital is 75 miles away, in Dumfries. There were three EETCs set up in the county: one in the east, one in the centre, and my practice, in the west. I was the furthest point from the hospital, so my role in the EETC was seeing all the emergency patients, covering a 25-mile radius.

The hospital would contact us to see how their patients were doing, or if there were any issues. If there was anything they were concerned about, they would contact me and ask if I could see the patient here, because obviously there were issues with travel – patients didn’t want to be seen in hospital unless it was absolutely necessary.

I would see patients here, and we would either organise a treatment plan for me to provide or, if necessary, they would go to the hospital. There were lots of cases I was treating that I wouldn't normally be.

Maintaining relationships

The relationship has flourished from there. We have retained that communication and now have direct links with the hospital, by phone and email. I can see patients following surgery, or if there are any issues that might be of concern.

A lot of our patients are elderly. For the majority of eye appointments patients can’t drive, because they need to have drops in their eyes. Some don’t have family or friends who can easily take them – it is an over 150-mile round trip to the hospital and back.

We’re working hand-in-hand. It means that I’m quite happy, if I see something, I say to the hospital, ‘I’ve got this. Do you want me to start treatment?’ They can then review. If there’s something that’s more complex, or has got to the point of being advanced before we’ve been able to see the patient, the hospital is quite happy for me to start treatment for them to review in a few days. It’s usually easier, at that point, for transport to be arranged to the hospital. If we’re lucky, they’ll have a clinic in Stranraer that they’ll be able to squeeze the patient into in a few days’ time.

It’s about being able to have that working relationship: they trust me to see their patients, and I’m happy to find a way to fit them in – which can be easier said than done sometimes, but we always strive to do our best.

It’s about being able to have that working relationship: they trust me to see their patients, and I’m happy to find a way to fit them in


Patient and business benefit

We get a lot of patients saying that it is much easier. We have had patients going to the extreme and saying, ‘can we always come here?’ We’ll keep them here as much as we can. They are very grateful for the fact that we can try and treat here rather than having to send them on that long and complicated journey. If you go on public transport, it’s nearly two hours on a bus. If you drive, you can get there in maybe an hour and a half. They’re very grateful for the fact that we’re able to see to see them here, or at least treat them until there’s a clinic happening in the local community hospital.

We take patients in when others won’t. I have got the independent prescriber (IP) qualification, and we have glaucoma appointments. It’s a small town, so reputation is everything. If you build a good rapport with your patients, that reputation can spread, especially via social media.

It’s a small town, so reputation is everything. If you build a good rapport with your patients, that reputation can spread


Speaking to ophthalmology

I do remember phoning up once and saying, ‘hi, it’s Elaine from Stranraer,’ and the response I got was, ‘I’ve heard all about you.’ I joke with them that one day they’re going to block my number.

I see so many patients in this area. We’re the largest practice outside Dumfries, 75 miles away. Going north into Ayrshire, we’re the largest practice until Ayr, which is 55 miles away. So, we see the majority of the patients. Word seems to spread through the hospital, and the different ophthalmologists get to know you.

I go to them with all the information: what I’ve done, what I’ve seen; what I think the plan is. I’m always respectful and say, ‘what would you like me to do? Do you want me to start treatment? Do you want me to do nothing right now?’ It's just building that rapport with the team in the hospital and showing them that you’re there to help.

I’ve got the direct email for the eye clinic and a direct phone line to the hospital. That works very well. It is a sparsely populated county, so we get to know each other. It’s not a city; it’s much more personal than that, because there are fewer practices, and fewer patients.

I’ve got a patient at the moment who had a bad experience; they found their treatment painful, and they don’t want to go back to hospital, although they do need to. I’m working with the hospital, reviewing the patient every four weeks until they feel ready to go back, and sending all the information on. It is important to keep those lines of communication going, with some of the more specialist patients.

Optometry stepping up

There are many more things optometrists can do than perhaps has been known about in the past. Even without IP qualifications, we’ve got equipment to examine patients that GP surgeries don’t. In Scotland, we are the first port of call for eyes. Even if we’ve got optometrists who aren't IP qualified, there are still some medications that we can get hold of.

Those of us with IP qualifications can do a lot more: we can treat uveitis; we can treat herpes simplex keratitis. There are lots of things we can treat here without the need for hospital input, until it gets more complicated. That takes the weight off the hospital thinking that that patient has to come in immediately.

We’ve been part of community glaucoma care since it was set up post-COVID-19, to see routine, stable patients. They’re now looking at the NESGAT qualification, so all optometrists who are seeing these glaucoma patients will have that qualification. I’m about to start that, so we’ll hopefully continue to be the glaucoma care optometry practice when the new system comes into place in the next couple of years. That takes all these patients, who we are perfectly capable of dealing with, out of hospital.

There are lots of things we can treat here without the need for hospital input


Advice for strong optometrist-ophthalmology relationships

Find a way to show what you can do, and how you can help. In the past, I was quite scared to phone ophthalmology departments if there was an emergency, because I didn’t always know how they were going to respond.

The important thing, when you do need to contact ophthalmology departments or triage, is to make sure you’ve got all the information, and you’re giving it an a sensible order, showing them that you know what you’re doing, what you’re looking at, and whether you’re looking for advice or [telling them] what needs to happen. Build that respect so that they respect you and understand that their patients are safe with you, and you’ve got that knowledge and ability to be able to help them.

They know that if I’m not sure on something, I'll ask the question. That will build their confidence in me, knowing that when I know what I’m doing, I'll carry on, and when I'm not 100% sure I’m happy, I'll ask. That builds the relationship and rapport between both you and the ophthalmology department.

Having this relationship is great. It makes things flow much better. I feel like I’ve got support from them, and I hope they feel that they have support from me. I think that’s really important.