A final thought

Community first

AOP chair, Emma Spofforth, on patient-driven change and advancements for the profession

Illustration on people looking at an eye

As the profession goes through a period of change, the biggest advancement that I have observed over the last four years is the increase in optometrists taking further qualifications. In many areas, this is complemented by more enhanced services being commissioned. This will be accelerated further still by the new university teaching schedules that are currently being developed and introduced as part of the General Optical Council’s (GOC) Education Training Requirements.

I am also proud of the profession’s growing use of technology in relation to eye care, which is also starting to enable better communication and data sharing between primary care optometry and secondary care eye services. Huge numbers of practices now have technology to enable more detailed assessments of their patients eyes.

Together, these advancements enable patients to receive the right care from the right healthcare practitioner in an easy to access environment close to home.

It is really all about the patients. Patients really appreciate being able to attend their local optometrists on the High Street for all of their eye care needs and want to be able to receive more services still, removing the need to attend already over stretched hospitals or GP practices where possible.

For the practitioner who wants to be able to deliver enhanced services in the community, to upskill and embrace technology in order to treat the patient in addition to providing the diagnosis, will no doubt lead to a high level of career satisfaction for those optometrists.

The wheels moving forward

The pandemic helped drive the profession forward in terms of being able to respond to patients who want easy access for all eye care needs in an environment that is close to home. We hear about the huge hospital waiting lists for appointments in many areas of the UK, that have been generated by the intermittent suspension of eye care services in secondary care at various times during the pandemic. This is paired with a desire not to spend huge amounts of time at a GP surgery unnecessarily. I think it is those elements that are making the biggest difference within optometry right now enabling us to provide easier access to care, working with patients and not passing the burden on to other healthcare professionals. We just need to ensure the funding is right for these services.

As part of the roll out of these services, governance is certainly an element in practice that we, as a profession, are having to embrace.

Governance is something that we’ve not had to deal with in the past to the same degree.

And while it’s one thing undertaking the extra qualifications especially when you see the personal, professional and patient benefits of doing so, it’s quite another to navigate the rules and regulations that come with the suite of commissioned enhanced services.

Commissioning new services is something that few optometrists have had to do to deal with in the past and it can be a challenge: from clarifying the need for services to the commissioners in different areas, to explaining why these particular activities are not covered under General Ophthalmic Services (GOS), and then ensuring services are properly funded. In order to keep on top of this and resolve problems as they emerge, it’s important to reach out for support – from peers in other LOCs as well as professional organisations.

As well as being an optometrist and AOP chairman, I am a clinical lead for my local optical committee (LOC) – Essex LOC – and I would encourage practitioners seeking to deliver enhanced eye care pathways to reach out to their LOC for information on what is available in their area.

Our LOC tries to make practitioners more aware of the support that the LOC can provide when navigating the governance associated to the commissioning and delivery of enhanced services – we support optometrists and contractors wherever possible during these processes. Other LOCs can do the same for all.

However, as more enhanced services are commissioned, it shines a light on the importance of them being delivered at a national level rather than local. Currently, for example, as an LOC, we not only have to deal with multiple Integrated Care Systems (ICSs) but also other LOCs where the commissioning area covers at least two LOCs, who may have different views on the commissioning process. If we could have universal commissioning of the same services, this would make a big difference to the implementation of these pathways as well as making life easier for those delivering them. National commissioning would also support both locuming and cross border working, preventing the requirements for a locum to gain multiple accreditations for the same pathway, due to working across different borders. As an LOC, it would stop repeated and often wasted conversations with people who often do not understand Primary Care Optometry.

A future eye care model

In terms of where I would like the profession to be in 10 years and how we get there, I think the UK’s model will be delivered in a similar format to the US, where optometrists are called doctors: we’re recognised for the skill set that we’ve got and more optometrists are providing advanced eye care routinely. IP optometrists with NHS funded services and FP10s will be widespread.

We’re just starting to become the first port of call for eye problems in primary care, according to the recent GOC public perceptions data, but these statistics need to grow further still.

However, for those practitioners who simply want to undertake sight tests and sell amazing eyewear or fit contact lenses, rather than provide additional clinical services, that should and will be an option too. My dream would be specialist branches of eye care will emerge, from the Optometry Doctors running clinical only community eye care clinics through to those performing sight tests for traditional Optometry clinics. We should have a broad range of business options.

About the author

Emma Spofforth is is an optometrist, chairman of the AOP Board, and a member of Essex LOC.