“I wanted to create impact on a bigger scale”

I was 14, and trying to decide what I wanted to do in preparation for my choices for GCSEs.

I always loved sciences, and I knew I wanted to do something around helping people. I didn’t want to be a doctor. My aunt was an optometrist, so I read about it, and I thought, ‘Actually, I want to pursue this.’ That was when I decided I wanted optometry as my degree and my career.

Before university, I did work experience in pharmacy and in different settings, which solidified that I wanted to do healthcare.

Just before I started university, I started working at Dollond & Aitchison as an optical assistant. I ended up going to UMIST, now the University of Manchester, which meant I stayed in the city I already lived in. I worked at Dollond & Aitchison all through university, at weekends and in holidays.

I went to do my pre-reg at an independent practice, Simon Dunn Opticians, in Bedfordshire, moving to the other side of the country.

I got to experience the whole breadth of optometry, which was fantastic. I qualified, and then came back to live in Manchester, and looked for my first qualified job. I started at an independent optometry practice in Sheffield, where I worked for a year.

I then made the jump out of core optometry, and went to work for Ultralase in Leeds in laser refractive surgery, doing pre and post-operative consultations.

I shifted to their Manchester site a number of years later, and then went on to support them at various sites, including Newcastle, Glasgow, Nottinghamshire, Chester, and Liverpool. I became their lead optometrist for the North West of England, and was there for three or four years, supporting clinicians in both clinical and non-clinical performance.

I got to do lots of work in what is now called refractive lens exchange – effectively cataract surgery without cataracts.

I helped them set that up, and supported the care that they were evolving at the time. It was great, especially for later in my career – I’ve used a lot of that knowledge around cataract surgery and lens implant surgery in the subsequent years.

I only left Ultralase because I wanted to buy my own practice.

I was looking for a little while, and then in 2008 found a practice in Stockport. The practice had been around for 100 years, and the previous owners, a couple, had had it for 36 years. I fell in love with the practice. My wife and I decided to buy it, and jump into owning a business.

That’s where my journey in enhanced clinical services really started.

I got involved in things like diabetic eye screening, and the local enhanced services around glaucoma. I was introduced to the local optical committee (LOC) by Trevor Warburton. He said, “Dharmesh, welcome to Stockport – get involved.” I was involved with work around what services beyond the General Ophthalmic Services sight test could look like in the local area. Trevor was almost like a mentor, for the next 10 or 15 years, up until his recent retirement.

Shortly after, I also joined the Local Optical Committee Support Unit (LOCSU), to support pathway redesign around the country.

I got really involved in commissioning pathway redesign: how do we make the shift of care? How do we support the pathway? How does the NHS work? I was supporting other areas in setting up their own primary care companies: Cheshire, Lancashire, North East, Midlands, East of England, and other places. I was getting to do local but also national work, supporting other areas as we went through that journey. I did that in parallel with owning the practice.

In 2011 and 2012, we set up Primary Eye Care Stockport, from the LOCSU model.

Trevor and I, and colleagues locally, led that. We bid for one of the first tenders from a primary care company for a minor eye conditions service (MECS) in Stockport. That was the first tender I’d written, and it was a steep learning curve.

The passion for eye care is always the underlying thing.

The realisation for me when I was in practice was that, while I really enjoyed seeing patients every day, I wanted to create impact on a bigger scale. I wanted to take the work we were doing in Stockport and push it further. Passion drove it, as well as lots of hard graft, learning from other people, reading around the NHS, and engaging with systems. It was a lot of work, but really fruitful and enjoyable.

You have one passion, but you find other passions along the journey.

It’s a bit geeky, but I started to like things like procurement and NHS commissioning – not many people say that. I grew to have a passion for that side of eye care. That’s what drove those next developments. Over time, I did less clinical and more of this kind of work.

Primary Eye Care Stockport was very quickly made Greater Manchester-wide, becoming GM Primary Eye Care.

There were four or five LOCs in Greater Manchester at the time, and we came together, rather than creating lots of similar organisations in a relatively small area. There was a lot of collaborative work across Greater Manchester at the time, developing one joined-up system.

Around 2014 or 2015, Greater Manchester was undergoing devolution.

That was a big change locally, and I was quite embedded within the team. There were two developments in my career at this time: firstly, I became the chair of the Greater Manchester Local Eye Health Network, which was developed to help bring hospitals, primary care, the voluntary sector and others together around the question of what eye care looked like in their systems.

Also, we created what is now called a Primary Care Provider Collaborative, bringing general practice, pharmacy, optometry and dentistry together.

I chaired what was then called the Primary Care Advisory Group. We got a seat at the table with a voting right in Greater Manchester devolution. The ability to have optometry at the primary care table, and for primary care to have a say in the devolution healthcare agenda, was a real shift. It was also great because I was exposed to wider primary care, and the wider health service, which was fascinating.

“The ability to have optometry at the primary care table, and for primary care to have a say in the devolution healthcare agenda, was a real shift”

The next big set of changes was around 2017, when some of the primary care companies around the country were struggling, some with leadership, capacity, or finances, or because the NHS had changed its system for procurement.

It made less sense for the smaller primary eye care companies to continue as they were, geographically and in scale. We merged the North West ones – Cheshire, Greater Manchester and Lancashire – first, in January 2018. I became chief executive, and I’ve held that post ever since.

Before we knew it, there was a domino effect. I oversaw bringing lots of these primary eye care companies together into one at-scale provider model, which is now called Primary Eyecare Services.

Between 2017 and 2019, we merged 21 primary eye care companies into one, which was an interesting journey, and a true collaboration across the sector: LOCs and primary care companies coming together, to see how we could work more effectively, in a way that worked for the sector, with optometry practices still providing enhanced services along the way. That was a very busy but really fantastic demonstration of working together.

It allowed us to start the journey of standardisation, where that was appropriate.

That’s the big challenge for us: the NHS isn’t one big NHS, it’s lots of small elements. How we got the consistency that our practitioners need, and that patients need across the postcode lottery, was really key.

During COVID-19, we led the organisation through IT changes, and through a massive implementation of lots of services to step up to support urgent care.

That really benefited the sector. We had Primary Eyecare Services as the vehicle to enable us to do that. That was a big part of my COVID-19 life: at my desk, making that happen, along with lots of colleagues around the country.

The biggest challenge, when you’ve had a portfolio career, is how you manage your time.

I had an amazing portfolio career during the 2010s, but you have to do some consolidation at some points, and rationalise your time amongst family commitments and work commitments. I did a bit of that, leaving the local health network role and my role as commissioning lead at LOCSU, to focus more on Primary Eyecare Services and local work in Greater Manchester, to make sure I was still quite rooted.

Two or three years ago, I joined SeeAbility as a trustee.

I’ve always had an interest in health inequality and learning disabilities and eye care. When you do the research around SeeAbility, a lot is around social care. It’s great, because it’s an opportunity to learn something new. My journey is about stepping out of your comfort zone, every single step of the way: moving and learning at pace, trying your hand at something, and hopefully being effective in it. At SeeAbility, I got to learn a whole new sector, and how it links it into eye care. That has been a great journey, with a great group of people, who have such passion around a cause.

Primary Care Services has grown tremendously in the past seven years.

We have taken on more areas, more services, and have grown the organisation in size and scale to deal with all the requirements of the NHS. We have created that infrastructure that a lot of other primary care providers, in general practice and pharmacy, have struggled with. We’re really a standout in what we’ve been able to do in that regard as a sector. For myself, leading and supporting that along the way, it has been great.

I had my practice in the background all the way along.

I bought it at the turn of the recession, in 2008, which was a very challenging time to buy a practice. We brought in all the clinical services that Stockport had available over the years, and also specialised in specialist contact lenses, supporting people with keratoconus and other medical contact lens needs.

With that consolidation of roles, and making sure the practice is able to get the attention that it needs, I made the choice to sell it to my optometrist two months ago.

He had been working for me for quite a number of years, so it’s a lovely succession, and he will be able to go on and develop it further. It’s going to be odd, not having my own practice for the first time in nearly two decades. It’s a new world, and I’m firmly focused on Primary Eyecare Services and building the ability for practices to deliver more for their patients.

There has been a lot of change in the NHS, this year.

When we look at the 10-Year Health Plan, and the ambition around those three shifts from the Government and from NHS England, it’s clear that optometry plays a central role in that. Ophthalmology is still the number one cause of attendance in outpatient departments in this country. We know that we can make that shift from hospital to community. We’re doing that already. Through Primary Eyecare Services, we have supported 800,000 patients to have their care in the community, in primary care optometry, across 3000 practices – just in the past year.

But we are only part-way through the journey.

There’s so much more that can be done, from more consistency around reducing referrals into hospitals and being the first port of call for eye care, to the work that is in hospital, and how we support that to be happening inside optometry practices. That is at the heart of that shift, and we want to support more of that to happen. We are really ambitious around that.