“Fighting the good fight” to influence system change for optometry

Primary Eyecare Services provided insight on what it means to shape change in primary care when you don’t already have a seat at the table during NHS Confed Expo 2026 (10–11 June, Manchester Central Convention Centre).

Lisa Gibson, Primary Eyecare Services’ clinical director, told attendees that, when it comes to influencing the systems that optometry works within: “We all need to remember that we don’t need permission – we don’t need a particular title.”

Gibson was joined by colleagues from pharmacy – Amit Patel, chief executive of Community Pharmacy South West London, and Nick Kaye, chief officer of Community Pharmacy Cornwall – for the Shaping systems from the edges panel.

During the discussion, Patel noted that: “In health and care, people with the greatest influence are not always the people with greatest authority.”

“Many of us have found that, to improve services, build partnerships, or influence decisions without holding formal power to make things happen, takes a certain set of skills, and they come with experience,” he said.

Patel reflected: “Whether you’re a clinician, commissioner, provider, a leader, a representative body within the voluntary sector, or a manager, you’ll probably recognise the feeling of being just outside the room where decisions are made, usually looking in through a glass window, and wondering if your voice is being heard.

“Yet, we know that meaningful change happens every day, because we build trust, we build relationships, we build credibility, and [we build] shared purpose.”

Kaye shared his view that primary care can define the inverse care law – the notion that the people who need the most care are the least likely to receive it – because it has the opportunity to bring care closer to people.

Gibson shared that, on joining her local optical committee, she found herself in an “exciting world,” but realised quickly that, when it came to making decisions about primary care, “optometry simply wasn’t at those tables.”

Gibson was once directly asked why she was talking about primary care when she was not a GP, she told attendees.

This interaction made her more determined to keep talking about it, she shared.

“I realised that that question was exactly why I needed to be there,” Gibson said: “If we weren’t in the room, optometry would simply become a forgotten thread of primary care.”

Her proudest achievement is helping Primary Eyecare Services grow into a “strong, credible, and trusted not-for-profit delivery partner of optometry services, delivered at scale across England,” she said.

“We went from being right at the edge of conversations to being a genuine system partner,” she said.

She added: “Sometimes the very fact that somebody asks ‘why are you here?’ is the very reason you have to be there at all.”

If we weren’t in the room, optometry would simply become a forgotten thread of primary care

Skills for influencing system change

Patel asked Kaye and Gibson what they believe to be the critical skills that are needed to become an effective systems influencer.

Kaye believes that ability to build trust is the most important factor.

“There’s a trust and delivery that you have to build up to be part of that conversation,” he said.

People are primarily working with other people, and genuinely listening to what the system wants is important, he noted.

He outlined an example from Cornwall, where asking community pharmacy what it needed to be able to help the population that it served led to an NHS England pilot that has seen six community pharmacies refer patients to cancer services in secondary care.

It is necessary to “sell the story of why” this is important, Kaye emphasised.

Kaye also noted that data has been very helpful to community pharmacy in helping to get its point across.

In terms of skills, Gibson advised perseverance, as well as demonstrating to the other side “what is in it for them.”

An example of this could be demonstrating to the hospital that High Street optometry can see all their emergency eye care patients, for example.

“The biggest lesson I’ve learned is perseverance: have a thick skin, keep going, keep knocking on those doors, and keep fighting the good fight from your corner,” she said.

Gibson added: “It is vital to position yourself as the useful person in the room.”

Kaye emphasised: “If you say you are going to do something, then do it.”

He noted that GP colleagues in Cornwall were strong advocates of the precursor to Pharmacy First because they could see the real value for their own roles.

The cancer pilot is the most successful cross-sector project he has worked on, Kaye said.

Gibson noted that in recent years optometry has become “more embedded in the primary care collaboratives and joint system primary care approaches, working alongside our GP and pharmacy colleagues.”

“To have that joint voice of primary care has been so, so important, as well as allowing us to shield and build pathways that flow together, such as urgent care services that flow two ways, in and out of pharmacy, and in between GP services,” she said.

The clear benefit for GPs has been that they “don’t have to see as many eyes,” Gibson added.

Persistence in building and maintaining relationships

In discussing how relationships can be maintained when parties are under pressure and have competing roles, Gibson noted that integrated care board relationships have been disrupted because of recent changes in structure and in individuals’ roles.

The answer is to ensure that relationships are built with the new people in the positions of influence, she said.

Local relationships and work delivered well have led Primary Eyecare Services to become a nationally trusted organisation that is “dynamic and able to respond to needs,” Gibson said.

Kaye also acknowledged that change often takes time, and that it is important that practitioners are kind to themselves when this is the case.

Gibson advised that practitioners: “Believe in what you are good at, and make sure you get that message across – because it will get across eventually.”

Wider primary care is 20 years behind general practice in terms of improvement planning, Gibson believes.

Optometry is “playing catch-up,” she said, adding that in terms of influencing change: “No one is going to do it for us.”

Gibson believes that the primary care neighbourhood of the future will see “patients being seen in the best place by the best professional at the right time within their neighbourhoods.”

She added: “From an optometry point of view, we need to be using our skilled workforce to deliver the aspects of the services that we can.

“We need to [also] look at opportunities outside the standard, such as: how does optometry benefit the frailty pathway? How do we look at hypertensive case findings?”

When asked how far along primary care is in creating a more joined up model, Gibson said: “We have built a lot of bridges, but I think there is still a long way to go in terms of how we work together: how we collaborate, and how we put that patient in the centre, and make sure that we make things better.”

She added: “In five years’ time, I really hope, for our patients, that we have this more joined-up, integrated care model.”