"Mindsets have shifted"
Optometrist and AOP chairman, Dr Julie-Anne Little, discusses the ever-evolving business model on the High Street, the GOS fee and pathways across the nations
During the pandemic optometry businesses across the High Street responded quickly and adapted to the changing requirements that they faced as a result of COVID-19. Now, more than two years on, it appears that a number of these changes may be here to stay due to the resulting benefits. Considered a striking change initially, optometry practices across the UK introduced locked door policies as they moved to offering emergency eye care only. While routine eye care and sight testing has long since restarted, this closed-door policy has remained in place for many. During the pandemic, as a result of this policy, practices had to formalise appointment times for not only eye exams, but for dispensing and the picking up of optical appliances, which they will not have been used to previously. Many practices found that this appointment model enabled them to provide a much more dedicated service to patients when they did come in, particularly for dispensing and collection, giving it much less of a casual feeling. The collection of the optical appliance is the culmination for many of what they were there at the opticians for initially – those spectacles are so important to the overall outcome and to the patient for allowing them to see. It is interesting that while some practices have gone back to an open-door model, a significant many are staying with a much more formalised appointment policy for all services. That is quite a shift from how optometry operated on the High Street pre-COVID-19.
Another change that appears to be here to stay for the majority is mask wearing, personal protective equipment (PPE) and disinfection routines between patients. The introduction of both of these things in practice as a result of COVID-19 has made practitioners question why they were not in place before the pandemic. Optometrists are in such close proximity to patients for a prolonged period of time, that it is generally sensible to wear a mask. The pandemic has broken the taboo about wearing PPE.
As clinicians, we don’t all need to be specialists in everything, and we can work together with our optometry peers and colleagues across primary care
During the pandemic, optometry practices on the High Street were classified within the healthcare profession. I think this has helped shift the perception that the public has of optometry and the delivery of their eye care. It may be subtle, and it may not be overt, but mindsets have shifted. For optometry practices to be open during the pandemic, and for the reasons why we were open to have been emphasised, all helps the public see optometry in a different light.
During the pandemic there have been some nice examples of internal referral between practices that have each got difference skillsets. This recognises that, as clinicians, we don’t all need to be specialists in everything, and we can work together with our optometry peers and colleagues across primary care without fear of a patient leaving our practice. Of course, that is a valid fear as, for many High Street practices, the sale of spectacles will be what underpins their business model. Nevertheless, this is a really welcome shift. Referring in such a way enables us as optometry professionals to build networks in primary care, allowing us to feel less like islands.
Consumer focusHaving an online presence, particularly for independent practices, is more important today than ever before. We have to consider how people – potential patients – access information. If someone is thinking about getting their sight tested, they are very likely to initially reach for their phone and do a quick search online. Therefore, an easy to use website and a presence on social media will be what drives people to a practice. There is a lot of work involved and a significant investment to really make that successful. If done right, it can significantly increase a practice’s reach, help it diversify and capture a new audience. The look and feel of a practice, as well as the patient journey, is also of primary importance today. People have high expectations nowadays regarding the environment that they want and expect to walk into. This extends to the environment created for employees too.
It feels like five years ago we were talking about the death of the High Street, but it hasn’t died, it has evolved and is continuing to do so both from a retail and a clinical perspective.
Technology and the pace at which it is changing and developing, and the impact that it could have on optometry, cannot be ignored. Technology, as an overarching term, if integrated correctly, can help us diagnose, treat and detect. We can’t ignore that. We have to try to see and embrace its benefits and not run scared from it. Artificial intelligence, for example, has significant potential to offer optometry valuable ways to support the detection and treatment of eye disease. Where we need to place ourselves is as the clinician who is integrating and interpreting all of that information – making clinical decisions and communicating that to our patients.
The lack of connectivity between High Street practice and the NHS is still an issue and one that is holding us back. This issue has existed for a long time now and the NHS is still finding integration difficult. This shouldn’t be the case anymore as the technology is there. When you consider the advances that occurred across technology during the pandemic, for example with remote consultation, how can connectivity still be an issue?
I also think that the profession is being held back by the postcode lottery of extended services, and the fact that we don’t have a real clear pathway that is similar across the country. In fact, we are getting increasingly more fragmented pathways appearing across England, never mind what happens in the devolved nations, in which quite different things are being done. This makes it ever-increasingly difficult to get a clear picture of what eye care is across the whole of the UK.
When considering a national route, it is hard to look past Scotland in terms of the range of extended care services available through the optometrist – the way the profession is delivering on acute eye care, as well as shared care for more chronic conditions, and how this has evolved in partnership with ophthalmology and secondary care. Nothing is perfect, but I think there are real successes in the Scottish model. The exciting thing also is that it is not standing still – it is constantly assessing and progressing. The low vision scheme in Wales is also a really lovely example of how, as a nation, it has gone out, assessed, developed and solved a problem through the harnessing of primary eye care.
Like everything, nothing is perfect, but I think there are real successes in the Scottish model. The exciting thing also is that it is not standing still – it is constantly assessing and progressing
General Ophthalmic Services: the fee
It has to be said from the outset that the General Ophthalmic Services (GOS) fee has been chronically underfunded for a long time. The profession is really in an impossible position with government now when it comes to trying to move the line on fees because there is not a waiting list for eye examinations, and patients have options available across primary care to be able to access eye care. As a result, from their point of view, there is no perceived shortfall or issue with service delivery. However, as a profession we know that the service we deliver goes far beyond GOS. What saddens me the most, because we are such a small part of the puzzle, is how little NHS England knows about optometry: how practice owners employ a suite of clinical and support staff from their local communities, and fund all of their own equipment because, essentially, they wanted to deliver high quality eye care services for their patients, overriding the paltry fee that is offered. That shift or disconnect from the NHS’ point of view between shared care services and sight tests is really sad, and it would be much better if there was a more joined up view and understanding of GOS and those other enhanced services.
It has been very interesting to see more practice owners choosing to opt out of GOS and go exclusively private over the last two years. However, for many people in terms of locality, that is not an option they can consider. And ultimately, we live and work in a country that has a national health service that should be providing eye care services to all members of society. So, I think there is an important balance to be struck here.
About the author
Dr Julie-Anne Little is an optometrist, chairman of the AOP Board and a senior lecturer in optometry and vision science at Ulster University