AOP Council: updates from devolved nations, certificate of vision impairment, and refracting children

The AOP Council meeting on 4 June explored updates from across the devolved nations, certification of low vision, and a report by the British and Irish Orthoptic Society (BIOS).

Chair of the AOP Council, Emma Spofforth, opened the meeting by welcoming six new designated Councillors.

Niall Hynes joined the Council, representing academic optometrists, Judith Tate represents Northern Ireland, Rebecca Donnelly represents franchisee and joint venture partners, and Parminder Kaur represents domiciliary care optometrists.

Ki Yan Lam represents newly-qualified optometrists, while Deepali Poojara represents pre-registration optometrists.

OT has gathered key insights from the conversations.

Policy and transformation in healthcare

Adam Sampson, chief executive of the AOP, provided a summary of the AOP’s position in the world of policy, which he described as “where a lot of the action is.”

The Government is expressing an interest in optometry and has committed to shifting care and services from hospitals to community settings, and has taken “radical” steps such as closing NHS England.

Commissioning is being “utterly transformed,” he added, with cuts at integrated care board levels and a revisiting of where primary care commissioning sits.

The ambition of Government to move services to community represents an opportunity for the optometry profession, but also a challenge – with a potential threat to eye care services that are already established, Sampson said.

As an organisation, the AOP has to be engaged, capable of moving quickly, and ready to answer the question of: what is needed to bring eye care services into the community?

Sampson highlighted that the AOP has its policy asks prepared and acknowledged that while there is a risk of action, there is a “bigger risk” of not acting.

Councillors provided an overview of updates from the devolved nations, sharing the emerging opportunities for the profession, and the challenges optometrists are navigating.

An overview from Scotland

Johnathan Waugh, AOP Councillor representing Scotland, explained that the profession “remains in a fortunate position in Scotland,” with general ophthalmic services (GOS) and community eye care remaining priorities for the Scottish Government.

This is evidenced in the 6% uplift in GOS fees from April 2024, Waugh suggested, as well as the recent announcement of the GOS Specialist Supplementary service – which will see a higher fee for independent prescribing optometrists to manage specific anterior eye conditions in the community from August this year. Non-IP optometrists will be expected to refer certain cases to IP colleagues.

The community glaucoma service is slowly growing, Waugh shared, despite some challenges at secondary care levels as several health boards fall behind predicted discharge targets, partly due to long waiting lists and problems posed by IT.

“It is slowly progressing, but it’s taking a lot longer,” Waugh said.

Optometrists in Scotland have also seen a change to the Protecting Vulnerable Groups scheme, with guidance available from the professional bodies.

Opportunities ahead in Northern Ireland

Catherine McGuckin, AOP Councillor for Northern Ireland, delivered an update from Northern Ireland, sharing: “It is a very exciting time.”

She explained: “Optometry Northern Ireland have recently commissioned Ulster University to gather data on all the great activity that’s happening in primary care. This will be very useful should an opportunity arise to look at a new contract.”

Recent events have seen optometry practices in Northern Ireland invited to share their thoughts on the schemes in Wales and Scotland.

The post-operative cataract scheme is also rolling-out, McGuckin explained, “after six years.”

McGuckin highlighted the long waiting lists in secondary care, particularly for cataract appointments and surgery, describing this as a “major issue” for the profession and emphasising the impact on patients.

Funding in domiciliary optometry is also an issue, McGuckin said, with many people – particularly younger patients – unaware of the services, and uncertain of what benefits they are entitled to.

The latest updates from Wales

AOP Councillors representing Wales, Kamal Kalsi and Martin Sweeney, described the Wales General Ophthalmic Services (WGOS) system in Wales and shared the most recent updates to manuals, including removing a requirement on WGOS2 forms to notify GPs.

A key change for optometrists in Wales has been the updated guidance enabling optometrists to issue a certificate of vision impairment (CVI) for patients with any eye condition.

Previously, optometrists could only provide a CVI for patients with bilateral age-related macular degeneration.

Kalsi explained that Wales will be the first nation of the UK in which optometrists will be able to issue a CVI for all eye conditions.

Calls for change: certificate of vision impairment

Earlier this year, the AOP launched its policy project and campaign Transforming Eye Care for Older People, which recommends five areas for change to improve optical services for the older population.

Following the launch of the campaign, the AOP sought Councillors’ views on the first of these recommendations: that optometrists should be enabled to certificate vision impairment.

Councillors were asked to consider if this is something the AOP should be lobbying for, and what should be expected in terms of training, renumeration, and the process.

Councillors were broadly in support of a move to enable optometrists to issue CVI, emphasising the improved access for patients.

Several factors that would be required to support this move were also noted, such as the need for training and renumeration.

The existing Low Vision accreditation by the Wales Optometry Postgraduate Education Centre was highlighted as one example of training.

Nizz Sabir, AOP Councillor for Yorkshire and the Humber and AOP Board member, said: “We should be advocating for optometrists to be involved.”

Councillors noted the time required and potential safeguarding concerns of what can be highly emotional conversations regarding low vision.

Karan Vyas, AOP Councillor representing employees of multiple practices, noted that support structures are in place in hospital settings for handling safeguarding concerns, and that this is something that should be considered if this care is expanded to community settings.

Councillors identified funding and commissioning as potential barriers. There could also be issues with local variation, for example, if some areas have a high number of practices offering the service, while others have limited access.

Ankur Trivedi, AOP Councillor representing independent prescribing optometrists, said: “We do need to be mindful of another postcode lottery situation.”

Refracting children – enhancing support

The British and Irish Orthoptic Society (BIOS) has called for a review of the sight testing regulations to allow orthoptists to be named within the Opticians Act (1989) Part IV, enabling them to conduct refractions and prescribe glasses in hospital settings.

BIOS has proposed that an annotation to the register would allow an orthoptist, after completing post-registration training, to sign prescriptions, and emphasised that this would be limited to the hospital eye service.

The report highlighted the long waiting times in ophthalmology and noted a particular problem of children waiting too long for routine refractions, delaying treatment. 

The report also suggested that some optometrists in the community refuse to refract young children or are resistant to doing cycloplegic refraction, leading to delays in treatment.

Councillors were asked to consider the skills optometrists have to refract young children, what could be done to empower optometrists to see very young children, and their thoughts on orthoptists being able to prescribe within the hospital setting.

Financial and commercial pressures, and GOS restraints, present a barrier when providing paediatric eye care in the community, Councillors shared, suggesting that increased funding for these appointments – particularly cycloplegic refraction – could support provision.

Councillors agreed that it should be within the core competence of optometrists to see and refract young children, but that barriers to providing this can be based in a lack of confidence or experience.

Josephine Evans, AOP Councillor representing employees of independent practices, highlighted the importance of continuity of care and follow-ups in the community.

Evans described a paediatric screening pathway in her area whereby, if a child fails a screening, they are sent to a local practice. The practice is required to see the patient within a set time frame, and receives renumeration for those appointments.

Having completed the professional certificate in paediatric eye care, Evans also recommended this as beneficial in enhancing confidence in this area.

Councillors also recommended local mentorship or buddy schemes, such as bringing a representative from practices in a locality to work together.

Councillors pointed out that when student optometrists learn to refract in university, this is often with peers of their own age, or volunteer patients who tend to be older, and so exposure to young patients can be low.

Niall Hynes, AOP Councillor representing academic optometrists, acknowledged the challenge: “We have a big difficulty in universities with getting enough paediatric patients.”

Orthoptists and refraction in hospital eye services

Councillors were asked for their views on orthoptists taking on refraction in hospital eye services.

Concerns were raised over the potential for a “slippery slope” that may not stop at hospital services, and in regards to separating refraction from the sight test.

Waugh expressed a concern that the move could erode the traditional role of hospital optometrist, restricting optometrists in the future from accessing the same opportunities to be involved in advanced practice in secondary care as they do now.

He suggested the report could provide a spur to put better support structures in place to enable referrals between practitioners in the community with experience in paediatric provision.

Councillors illustrated the importance of the sight test, beyond refraction alone, with Evans feeding back from a group discussion: “There are so many other things you can identify – it fits into a whole jigsaw and is part of a specific skillset that we felt was quite valuable to keep in optometry.”

The feasibility of conversion courses for orthoptists and training to support skills in refraction was also debated.

Fundamentally, Councillors noted that the optometry workforce already exists for this provision.