A final thought

“I would encourage the profession to carry on ‘up skilling,’ collaborating and working together as a team”

Domiciliary optometrist and AOP Councillor, Kamal Kalsi, reflects on the development of the new eye care contract in Wales, and what it means for the profession and patients

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Various parts of the UK are suffering due to the ongoing healthcare crisis, and Wales is unfortunately no different. It appears a cross party issue, with all political parties struggling to reduce secondary care patient waiting lists.

As a result, many patients are experiencing long waiting times for hospital eye appointments, some struggling with an undiagnosed or untreated condition. It is common knowledge, and true for various sectors, that some parts of the secondary care system simply do not have capacity to meet patient need.

However, we have optometrists up and down the country, on virtually every High Street, who are clinically trained and have embraced the new eye care contract since it was introduced in Wales last year, who are now able to work to help bring down patient waiting times.

We can say therefore that the Wales eye care contract reform aims to lessen the burden on NHS hospital eye departments as optometrists can see patients in the community, closer to home. This results in patients being seen more quickly as there is a requirement for practices to see patients within 24 hours of initial contact.

It is not only optometrists practising in High Street settings who can help with this: the new reform has also brought the domiciliary sector, where I work, in line with the High Street so we too can offer the same level of service.

In some instances, we have already been providing some of these services in domiciliary settings, however, the was no provision to claim additional payments from the NHS for these.

For example, recently I visited a patient, who I have seen in the past on a regular basis with ingrowing eyelashes. Previously I could not claim for the treatment, but now I get paid for the services I provide. The list of services in domiciliary eye care has always been expansive, therefore it is good that the reform has resulted in us being paid for what we do.

It is common knowledge, and true for various sectors, that some parts of the secondary care system simply do not have capacity to meet patient needs


Lessons from Wales

In my opinion, I cannot see why other nations would not adopt a similar approach to Wales. However, that said, one key issue with the reform is the voucher value set by Welsh Government for those who are entitled to financial assistance for their optical appliance.

We know that spiralling costs are causing worry for people and their families, forcing them to make difficult choices. Our research with the public (1000+ participants) indicates that a huge proportion of the population are neglecting their eye health. For example, two-thirds (62%) who wear glasses or contact lenses say they are currently “putting off going to the opticians” due to the cost of living crisis, and 36% are wearing out of date prescriptions.

It is further reported that 19% of people use glasses they have had to self-repair, and almost a third (31%) admit to wearing friends’ and family’s eyewear to avoid spending money.

Whilst the new Wales eye care contract is positive overall, a significant concern is that the new voucher value set by Welsh Government does not go far enough against inflation and the cost of living squeeze. It does not reflect the true value of the cost of the spectacles and does not help those struggling the most.

I would urge the other nations to think hard before they make any decisions on reducing the value of vouchers.

Therefore, if I could change one thing about the new Wales eye care contract, I would say the voucher value is a significant issue that should be reviewed going forward.

There are a few other things that I would like to see implemented too. For example, I would like us to go ‘paperless’ when it comes to NHS forms. This would be a great start, especially when the Welsh Government is encouraging all businesses to recycle appropriately, added to the fact in Wales every form is provided in both English and Welsh, for obvious reasons, and as the two are attached with each test, one of the forms has to be thrown away.

In addition, I would like us to have a better dialogue with secondary care, especially when we are helping them reduce patient waiting times. If we were to have a more integrated platform, with better IT connectivity for the whole of Wales, that enabled optometrists to access patient records, referrals to GPs or ophthalmology departments, then I believe this would improve communication.

In Wales, there is a great on-going dialogue between Optometry Wales (OW), Welsh Government and the profession, who all want eye care to be delivered much quicker and more effectively to the patient


Other nation envy

Reflecting on the delivery of eye care across the other nations, I recall that when I first moved from London to Cardiff, after finishing my studies at City, University of London, I questioned leaving the capital and the opportunities it may offer (as well of leaving my colleagues and friends behind). However, after many years of being based in Wales, I am happy to say I made the right choice.

In my current domiciliary role I see patients in both England and Wales, but in England the sector does not benefit from reforms such as the claims we can now make if we provide additional services to patients. It’s not just the reforms that have changed. Wales is focused on improving patient care and we are already looking at glaucoma and macular services in the community too.

When it comes to ensuring that the Government prioritises eye health in the future, I believe that the profession must ensure it continues to deliver excellent service, with patient care as its upmost priority. I would encourage the profession to carry on up- skilling, collaborating and working together as a team.

We need to carry on campaigning to the UK Government to prioritise eye health care, and get that message over to the general population. There are over two million people in the UK living with sight loss; over 24,000 people are given a Certificate of Vision Impairment each year in England and Wales, and every day 240 people start to lose their sight in the UK, according to the Royal National Institute of Blind People.

Vulnerable adults who cannot leave their own homes often have falls or accidents at home as a result of poor eyesight. It could be that they are either wearing the wrong (or old) spectacles, or have not had their eyes examined because they do not know how to access domiciliary services. In order to address this nationally, we need to ensure the Government is aware of this so that these people do not miss out and the correct level of funding will ensure that they can afford to have the glasses they need.

In Wales, there is a great on-going dialogue between Optometry Wales (OW), Welsh Government and the profession, who all want eye care to be delivered much more quickly and more effectively to the patient. All bodies thinking and wanting the same is the key element, and this led to some of the successes of the reforms.

However, we didn’t get here overnight. A lot went into developing and agreeing the terms of the reforms and the new NHS contract for optometry services in Wales.

We at the Association of Optometrists previously had some very serious concerns over the provision set out for domiciliary providers, resulting in OW putting these to the Welsh Government.

One of the concerns was that the original proposals looked to cut the fee for domiciliary providers making some tests financially unviable. We were worried that this may result in a reduction in choice for patients or, in extreme cases, no access to services at home at all if providers could no longer afford to run them, for example, in rural locations in Wales, of which there are many.

There was a lot of hard work from all the UK bodies, feeding back to OW regarding the changes. OW went back to Welsh Government, the concerns were listened to and thankfully changes implemented.

About the author

Kamal Kalsi is a domiciliary optometrist. He is also an AOP Councillor.