“We stepped in to try to help, assess and manage those patients”

AOP chairman, Dr Julie-Anne Little, speaks to OT  about the progression that has been made in the relationship between primary and secondary care, cataract wait lists, and the absence of appropriate funding

Getty/Malte Mueller

Pre-pandemic, I felt like secondary care was quite ingrained in what secondary care did, and while there were a lot of pockets of activity within primary care where locally commissioned services were in place, the structure of what was possible in secondary care felt quite set. As a result, some of the things that were done in primary care were done in an ad hoc way and were not necessarily funded. I think it was these set ways and the following of traditional processes in secondary care that were the barriers holding change back pre-pandemic.

An example of this is an eye casualty telephone triage service, which works great from the perspective of secondary care, but for many optometrists in primary care is difficult to connect to, and often disruptive to the optometrists working day trying to get through, juggle other appointments and manage the expectations for the patient they are calling about.

The progress

The disruptor that has been COVID-19 has forced both primary and secondary care to get much more comfortable with virtual and digital processes. By this, I don’t just mean teleophthalmology, but also the way in which we send and share information. This held optometry back before, but the pandemic has forced this into a reality and created a sense of understanding that we actually might have to, and can, view this information virtually too.

Before the pandemic, I think a national acute eye care service would have been hugely beneficial. This would have enabled better signposting from GPs and pharmacies into optometry as the first port of call for minor eye problems. To me, it feels that this type of service would have been something that could have overnight hugely influenced not just those who were presenting to their GP with minor eye problems, but also those who were turning up at Accident & Emergency. I think that sort of service, dealing with acute but minor eye problems, would have been a really important shift.

The last two years have helped improve the relationship between optometrists and ophthalmologists. Ophthalmologists appreciated that it wasn’t always possible or easy for patients to go into hospital during the pandemic, but their ability to access eye care in the community and the ability for both professionals to triangulate and work together was important. This also really helped ophthalmologists – a dialogue would be established between the ophthalmologist and the optometrist, enabling them to remain involved in their patients’ care and treatment. They could also work with independent prescribing optometrists to change the treatment for patients. There are no doubt practitioners with many great examples of working together at a local level during the pandemic.

This has in turn led to the establishment of more trust in optometrists dealing with a range of eye-related problems, as well as for the sharing of patients between primary and secondary care. We were the ones who turned up, and who still had our practices open. During the pandemic there were many patients who were seeking advice as they were not having their usual outpatient appointments for things like stable glaucoma monitoring, and they began presenting to their optometrist. Despite not formally being part of their care, we didn’t turn them away as that’s not in our nature. We stepped in to try to help, assess and manage those patients.

The future

I think there is still a way to go with the development of this relationship. Ophthalmology needs to better understand how optometry is funded and what they are asking optometrists to do without any means to get paid for it. It is an ongoing issue about being appropriately remunerated and one that is not easily solved. Consequently, optometry is vulnerable. When we say, ‘oh yes we can do that,’ with no appropriate funding in place, that can set a precedent for doing it and not getting paid. But I know that it is never fun to say that it is not in my gift to do something when you know it would be helpful. Ophthalmologists, by the nature of working in the NHS, often do not realise the challenges of running a viable community eyecare practice.

In order to keep the progress that has been made between primary and secondary care going, there has to be some central momentum built with the Royal College of Ophthalmologists, as well as at a national level, in order to really bolster and formalise some of those informal pathways that have been achieved so successfully over the last two years. This would also involve pushing for commissioned services, such as the COVID-19 Urgent Eyecare Service, to be available across a much more comprehensive bunch of postcodes.

Today I think it is incumbent upon us to keep the conversations that were had with secondary care during the pandemic going. Whether that’s through your local optical committee, or another route, we must work to keep those lines of communications open and not forget all of the good work and the inroads that have been made. We must remember what has worked well and try to grow that. We have demonstrated that the delivery of eye care in the community can play a really important role in supporting ophthalmology. We also know that patients like and value being managed in the community, and do not like having to go to a hospital unless they need to do so. Therefore, if we can shift more secondary care services into primary care in order to release resources and enable secondary care to target waiting lists for surgeries, for example, we should.

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.

  • As told to Emily McCormick.