My IP qualification

It was a very traditional part-time practice with no computer systems and very little in the way of clinical services and equipment. Since then, we’ve had a full refit and introduced practice management systems, as well as invest in clinical equipment such as OCT.

We then began to build clinical services in to our practice such as Community Urgent Eyecare Services (CUES), diabetic eye screening, pre- and post-operative cataract surgery care, as well as hearing care services.

Prior to practice ownership, we had both had various experiences in optometry such as locum work, domiciliary, academia and hospital optometry.

I was very academic throughout my years at university, and very clinically-focussed throughout my pre-registration year (I was lucky enough to do my pre-reg split between Manchester Royal Eye Hospital and Aarons Optometrists in Northumberland). Peter Frampton, who was part of the first cohort of IP optometrists, was one of my supervisors and mentors during pre-reg, and he really inspired me to take the independent practice and IP route. But, once qualified, as a full-time locum at the time, I felt disillusioned and bogged down by routine sight-testing. By having my own practice, I’ve really been able to build patient rapport, and practice optometry the way I always wanted to. This included prioritising the IP qualification and introducing clinical services, particularly CUES.

I’m currently one of the very few IP optometrists in our local area, having qualified since 2023. We’ve got access to FP10 pads, and have developed good relationships with local pharmacies, GPs, and other optometrists who can’t see patients in the appropriate time-scale for various reasons. We endeavour to see these patients for everything, from foreign body removal, to uveitis and keratitis. We also have several industrial businesses locally that also send employees if they ever get something stuck in their eye. We treat and manage everything we can in-house, and we also follow them up until resolution. For us, reputation is everything.

With regards to CUES, if you’re not an IP optometrist, you would still have to send these patients to eye casualty or the hospital, because you can’t treat them independently. You can treat more straightforward cases such as conjunctivitis, but beyond that, you would have to refer.

At Cacoullis Opticians (Halesowen), we have a ~5% referral rate, meaning, on average, 95% of our patients are successfully treated and managed in-house without the need for onward referral. The cost-savings for the NHS is huge, but it is a shame that community optometry is still not being appropriately renumerated for this.

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Optometrist duo purchase first practice

Ameerah Riaz Ahmed and Nasir Ahmed have taken over Cacoullis Opticians

The wider picture

From the patient’s viewpoint, if they approach their GP first, the GP will, in most circumstances, correctly advise that they should seek a CUES appointment. They might send them to us, but if the GP doesn’t know about our service, they might send them to a high street practice. As most of our local high street opticians are usually busy and have limited same-day availability (or do not participate in the CUES service), they will kindly recommend our service. We have a great relationship with our local practices, both high-street and independent. We are also well-known by local GP surgeries and pharmacies.

IP optometry is about avoiding delays to treatment, relieving hospital burden and reducing inconvenience for the patient. A collaborative approach between opticians, pharmacies and GPs is essential. For a foreign body removal, they could come here, be seen straight away, and be in and out of the chair in 15 minutes and then back to work, rather than spending the whole day in eye casualty.

From a hospital perspective, it’s helping them to free up capacity, so they can see the more serious cases. In general, the majority of acute eye care presentations can be dealt with in the community; particularly with independent prescribing.

“As an independent opticians, we don’t only think about what’s happening that day – we think about the next 10 or 20 years”

A long-term outlook

Unfortunately, for IP in England, we don’t get the right amount of funding. That’s a critical issue and something that really needs to be addressed. There is no funding in certain areas for follow-ups, for example. However, a lot of patients who come to see us end up staying with us, primarily because they appreciate the fact that we could see them so quickly and are impressed by the level of service we provide. They become long-term patients and bring their families along with them. As an independent practice which is still growing, we don’t only think about what’s happening that day – we think about the next 10 or 20 years. Every patient encounter is so important to us.

I usually ask every patient who comes in for a CUES appointment, who referred them to us. Some say their GP, or the pharmacy, or a local high street practice. Some say that a friend or a family member came in with an eye problem, and they recommended us. People will commonly say, ‘I wish I was told about this before. Why didn’t the GP or Pharmacist tell me this?’ Ultimately, there’s not enough public information that the first port of call for an eye problem should be an optometrist, rather than a GP or pharmacist.

“There’s not enough public information that the first port of call for an eye problem should be an optometrist, rather than a GP or pharmacist”

Professional fulfilment

I’ve gained a lot more exposure and confidence with treating and managing more and more complex presentations. The only way for me to improve my skills and be able to manage more cases is by getting out of my comfort zone and doing things that may sometimes feel a bit scary. That’s the only way we grow.

When I did my IP course, I learnt the most during my hospital placement. Since qualifying, I have been able to continuously progress my knowledge and confidence through attending IP conferences, and networking with like-minded professionals. I am also a member of various WhatsApp groups which has been invaluable in sharing cases and learning from each other.

Overall, having the IP qualification has really rekindled my love and passion for optometry. I now really enjoy it and it gives me a lot more autonomy in my day-to-day practice. If I want to treat a patient, I no longer need to rely on a GP or ophthalmologist to prescribe. Looking towards to the future, my dream would be to just see emergency eye appointments most of the day. However, I do still enjoy routine sight-testing but we want to be a clinical hub for eye care in the local community; the go-to place for urgent eye care. We’ve recently rebranded our practice to Cacoullis Opticians – Specialist Eye Clinic; primarily because I strongly believe the future of optometry is gearing towards enhanced clinical services, not just routine sight-testing and dispensing.