“We are very busy area of the sector”

That day, seeing patients in their own homes really demystified what was involved in domiciliary optometry – I was impressed with the set up and the equipment being used, as well as the general time and level of care provided. I saw first-hand that the provision of eye care was completely comparable to what was delivered on the High Street. I joined the domiciliary sector soon afterwards and haven’t looked back for the last 17 years.

What I enjoy most about being a domiciliary optometrist is getting to know the patients. As I can spend a longer amount of time with them, I get to hear their life stories and get to know them. Because they are in their own home, I can assess and demonstrate, for example, good lighting. I also get to see daylight and enjoy some fresh air between every patient.

Domiciliary optometry has changed immensely over the last 17 years. The main day to day change has been the equipment: when I first started, we used paper records, but now it’s on a tablet and the forms are personalised for domiciliary. Fundus cameras, slit lamps, laptop-based field testing – the equipment is improving all the time.

The most amazing thing is that domiciliary is now considered a i eye care offering. On industry questionnaires, for example, domiciliary is acknowledged as a recognised and mainstream form of practice. There are also a lot more optometrists providing domiciliary care, but patient numbers are increasing every month, especially since the pandemic.

Patients are waiting to access eye care. In the area I cover, we book two months ahead. Even when patients cancel as they are not well, for example, these slots get filled within the hour

Access and awareness

With an ageing population an increased awareness of domiciliary eye care, optometrists are more willing to make internal referrals, recommending a domiciliary provider when required. We see lots of patients who have become aware of domiciliary through word of mouth – my mother, neighbour or brother saw you is a common response.

Patient access is better today that it was 17 years ago, but it’s not complete. I still see a lot of patients who ask, ‘Is this a new service post COVID?’, but OutsideClinic where I work has been doing this for 37 years.

There’s still more to do in terms of patient access and awareness, but it’s getting better, and we are reaching more people all of the time.

We are very busy as a sector. Patients are waiting to access eye care. In the area I cover, we book two months ahead. Even when patients cancel as they are not well, for example, these slots get filled within the hour. We need more optometrists to consider domiciliary as a career, especially because of the increasing ageing population.

I am passionate about this sector and making sure students know it is a career option. I teach a session at 13 universities now where optometry students watch me with a patient live from their lecture room. A week later I will visit the university and talk through the equipment and the patient they saw live. I tell students in my lectures, it is such a good time to become an optometrist as there are so many diverse rolls available to them.

We must look at the optometry training programme and make it mandatory in all universities for domiciliary optometry to be covered so all optometrists graduate knowing what avenues of practice are available to them

Further and additional education is just as important for domiciliary optometrists as it is for the rest of the profession. Professional certificates are brilliant because we see lots of pathology – we see lots of patients with medical retina problems, with glaucoma, and with cataract. For the optometrist to be able to manage that without having to send the patient to hospital is valuable for the patient and the hospital eye service.

However, domiciliary can sometimes be overlooked when it comes to commissioning enhanced pathways for patients. For this reason, I would encourage domiciliary optometrists to actively talk to and join their local optical committees (LOC). Their voices are needed when LOCs are preparing pathways for commissioning. In the north east I have been able to recommend and secure caveats for referral refinements schemes to ensure domiciliary optometrists can provide the service, for example.

In the future, I would like to see dementia training across the profession as more people will experience this with the ageing population.

In terms of the domiciliary eye care model in the future, we must look at funding. While we receive an increased fee for domiciliary eye care, it still does not cover anywhere near the cost of the service, as it doesn’t in practice either.

Developing the sector

We must look at the optometry training programme and make it mandatory in all universities for domiciliary optometry to be covered so all optometrists graduate knowing what avenues of practice are available to them.

I would also push for the removal of pre-verification notification in England. This has already been removed in Scotland and Wales with no consequence, just increased access to timely eye care for the patient. It was developed from data in the1980s, but the world is different now – electronic records and eGOS support this.

In five years’ time, hopefully we have a high number of well-qualified, skilled domiciliary optometrists who patients can access for their eye care needs when and where required.

Simon Raw is a domiciliary optometrist at OutsideClinic. He is an AOP Councillor representing North East England.