Sarah Lowry: “Extended pathways allow you to manage everyone who comes in”

Moving into the commissioning side of eye care after I sold my practice in 2022 after 16 years at the helm was a real eye-opener. Having previously been critical of how fees were negotiated, I came to appreciate the challenges faced by those involved in those discussions. It highlighted the difficult balance between ensuring optometry is properly valued and funded, while also recognising the financial constraints within the NHS.

As clinicians, we must be careful not to undersell our profession simply because funding is limited. At the same time, we need to remain engaged in the conversation, demonstrating the value we bring and ensuring that optometry continues to play a leading role in the delivery of eye care.

As clinicians, we must be careful not to undersell our profession simply because funding is limited

Services that make a difference

Throughout my career, I have seen first-hand how Extended services have been able to improve access to eye care for patients. As a business owner, my practice was located in Greater Manchester, which has a long history now of delivering Extended services. However, I recall a time when people a mile down the road in Cheshire couldn’t access services, which they found very frustrating – and I’m sure that this continues in some areas today.

I also work a lot in Wales has also given me a real appreciation of the benefits of having Extended services available nationwide. Patients can access a high standard of care wherever they live, and practitioners have the opportunity to develop and use their skills consistently across the country. I believe this has been a major factor in strengthening the role of optometry within the wider healthcare system and ensuring we remain at the forefront of delivering accessible, community-based eye care.

I’ve observed a number of challenges when it comes to developing and implementing Extended eye care pathways, and apart from the obvious funding and commissioning problems, there have also been issues for optometry to be recognised for its skills and capability to deliver extended services.

Getting pilot schemes funded, and then the data published, has been a great way to show our abilities and the effectiveness of services. Creating a strong evidence base is important in getting these services running, but also important in keeping them running.

Critical to the success of Extended eye care pathways is the persistence and commitment of the people and practitioners who worked behind the scenes to make these pathways a reality. We can sometimes not realise the work that goes on to develop services, secure funding, build relationships and bring stakeholders together.

Creating a strong evidence base is important in getting these services running, but also importantly in keeping them running

The patient benefit

As an independent prescribing (IP) optometrist, I have had a number of patients who have benefitted from being seen through an Extended service pathway who have then started on treatment without going to the hospital, especially those with anterior uveitis.

I can think of one particular patient who had recurrent episodes of uveitis every time she was stressed – which was generally Christmas and her kid’s birthdays– when she was so busy that taking time out to go to hospital to get treatment was incredibly hard. Her relief when I first qualified in IP and she knew she could come and see me to initiate treatment without huge waits in A&E or trying to get through to her GP was enormous and meant that she was able to get on treatment much faster, reducing the extent of each flare-up.

As an IP optometrist, I’m glad that detect and refer is a long way in the past – Extended pathways allow you to manage everyone who comes in.

There are obvious cost benefits to the NHS with this approach too: an optometry appointment runs cheaper than a hospital appointment, but it also frees up the hospital eye service to see other patients, reducing waiting times. For many, like my uveitis patient, it reduces the time taken to get seen, and often gets them seen closer to home. Most people just want convenience and to be seen by someone who is competent – they don’t want to go to a hospital.

Getting nationwide coverage across the whole of the UK for minor eye conditions and community urgent care services would be amazing. There are also huge gaps in low vision services that really need to be addressed as they are some of the most vulnerable populations.