“Hospitals need to think differently and for the long-term"

Can you describe working as a hospital optometrist in one sentence?

Varied, rewarding, challenging and ever-evolving.

How long have you worked as a hospital optometrist?

In total, 17 years. I completed my pre-reg placement at St James’s University hospital in Leeds in 2006–2007 and then started at Moorfields in 2009, after a short break working in independent community practice in between. I have worked in hospital ever since, and cannot envisage ever leaving – it is so much a part of me now.

My current role involves clinical work in glaucoma, paediatrics and external diseases, safeguarding, supervision and training, leadership, and service improvement.

When and why did you decide to become a hospital optometrist?

One of my clinical supervisors at university told me about her hospital optometry background, and I was drawn to the variety and the clinical exposure it would provide. I had such a fantastic experience on my pre-reg placement and knew that hospital optometry was where I wanted to go on and build my career in the long-term.

Do you do any other work or volunteering alongside hospital optometry?

Yes, I am a module lead on the University College London MSc Orthoptics (pre-reg) degree, developing and leading an ophthalmology module on the course. I also locum once a week in a local High Street practice. I volunteered at the London 2012 Olympics, testing the athletes’ eyes – that was an experience to remember.

How does working as a hospital optometrist support you as a High Street optometrist?

I am a true believer that simultaneously working in both primary and secondary care settings helps massively to complement both roles. Knowing how things work in the hospital gives you the knowledge to refine your referrals and advise your patients accordingly. It gives you confidence by widening your breadth of clinical skills and the exposure to more specialist clinics, like glaucoma or medical retina, for example, helps you keep current with which treatments would be offered on the NHS.

How does working on the High Street benefit you in the hospital setting?

Working in practice maintains your expertise in completing full eye examinations and seeing the whole picture. Often, you are working completely autonomously with your own list of patients, whilst also supervising dispenses or answering patient queries, so it helps you develop good time management and communication skills and become quick-thinking. Taking the leap from my hospital pre-reg straight into an independent High Street practice was a steep learning curve, but it made me decisive and resilient.

I also think it is crucial for hospital optometrists to maintain insight into High Street practice and the pressures faced in community, especially as we need to strive to better integrate primary and secondary care.

It is crucial for hospital optometrists to maintain insight into High Street practice and the pressures faced in community

What is the biggest challenge facing hospital optometry currently and why? How can the profession support, or how can this be resolved?

The ever-increasing burden on hospital ophthalmology departments, with an ageing population and chronic conditions that need life-long monitoring. Paired with frozen or cut funding and reduced trainee ophthalmologist posts, so there is the expectation to do more with less. Waiting times can be a postcode lottery depending on where someone lives in the UK. I have seen some children waiting a year for routine strabismus or amblyopia treatment on the NHS in other parts of the country, which is shocking.

Hospitals need to think differently and for the long-term, upskilling non-medical practitioners, like optometrists, and investing in advanced clinical practice roles and newer models of service provision, such as virtual pathways and community hubs.

High Street optometrists are also well-placed and equipped to provide care for certain eye conditions, but they can’t be expected to do this without investment in training and funding of enhanced NHS pathways to account for the additional responsibility and time needed.

What is hospital optometry’s biggest success in the past three years and why?

On the back of COVID-19, hospital optometry has changed a lot, and it feels like people are starting to listen. At Moorfields Eye Hospital, optometrists played a huge role in delivering patient care both during the pandemic and to clear the backlogs afterwards, for example streamlining optometry-led cataract and glaucoma pathways and running virtual or remote monitoring clinics. We have demonstrated that optometrists are a highly skilled, sustainable workforce, who should be invested in properly to develop more of these roles and pathways.

What is your biggest success in the past three years and why?

Leading my optometry colleagues within the paediatric service. This role has grown hugely over recent years, and I have worked hard to ensure that I represent our department in all aspects, whether providing advice and guidance to staff, fostering links with other teams, or championing optometry in service design and delivery.

I’m passionate about developing our workforce through training and education and expanding extended roles within paediatric ophthalmology and, although it can be a hard role to juggle in amongst my other work and a busy home life, I am proud of what I have achieved so far.

What is the most surprising case you have seen in the hospital setting?

The gory cases are the ones that you remember. In A&E, I saw a woman who had tripped and fallen onto a large nail sticking out of a floorboard – she came into casualty holding the floorboard with the nail still in her globe.

What would you say to optometrists working on the High Street about working in a hospital environment?

It is so worth considering. Combining High Street and hospital optometry can help to create a more varied and interesting career, and it can give you the opportunity to explore different areas and find what you really love doing. Hospital optometry is a constantly changing field and, as a result, it can also act as a platform to branch out into other areas, like digital medicine, service design or research. There is no need to be fearful if you haven’t any prior hospital experience, as training is provided and the whole ethos of a hospital is teamwork and constantly asking questions – nobody ever stops learning.