Let’s talk about hospital optometry

Hospital Optometrist Committee secretary, Andrew Tompkin

Pay

There is no doubt that hospital service work is professionally rewarding in many ways, but some may have thought it necessary to make financial sacrifice to work there.

The 2018 Agenda for Change NHS contract refresh led to agreement to reform NHS pay scales over a three-year period from 2018 to 2020.

A graduate entering the hospital service in 2018 as a pre-reg optometrist (Band 4) will earn £20,150 on entry and this will rise to £21,892 for the 2020 intake.   

A recently qualified optometrist colleague will currently be on (Band 6) scale £28,050–£36.444 rising to £31,365–£37,890 in 2020. 

The experienced (Band 7) specialist optometrist will currently be on scale £33,222–£43,041 increasing to £38,890–£44,503 in 2020. 

Service leads/heads of smaller units (Band 8A/8B) currently £42,414–£59.964 rising to £45,753–£62,001 in 2020. 

Senior managers (Band 8C/8D) currently £59,090–£85,333 rising to £63,751–£87,754 in 2020.   

In addition, High Cost Area Supplements apply for inner London (up to 20%), outer London (up to 15%) and fringe (up to 5%).

Pay reform has reduced number of increments allowing much quicker progress through pay scales. 

Paid annual leave is 27 days per year plus eight bank holidays increasing to 29 days after five years and 33 days after 10 years. All posts are also eligible for NHS pensions.

Full details are available on the NHS website.

Manchester Royal Eye Hospital optometrist, Sophie Harper

Flexibility

I have now worked in the Hospital Eye Service (HES) for over 20 years and I have been incredibly lucky so far in how flexible my career has been.

Initially, as a pre-registration hospital optometrist, I worked full time. Subsequently, as my career continued, I worked both full time and part time, with this change fitting in very well with other professional commitments and with having a family.

Now, although I am working as lead assessor for the College of Optometrists, I still maintain some managerial and clinical roles within the hospital environment one day each week.

Evening/weekend work

Personally, I have done relatively little clinical work in the evenings and weekends, although some of my other roles have required work outside office hours. Some of my colleagues have chosen to work longer days, allowing them to have some time off during the regular working week which may fit in with other commitments they have. In the future, it seems likely that there will be more weekend work, but hopefully if this activity is spread amongst a team of people there should always be choice.

Pressures 

One of the greatest pressures with work in the HES is the busy out-patient setting. Clinical work in extended roles, as well as regular core services clinics, can be very demanding, although working as part of a team is a great bonus. 

Guy’s and St Thomas’ NHS Foundation Trust optometrist, Peter Campbell

Part-time working

I have worked part time as a hospital optometrist on and off for the last 17 years. This role gives me an opportunity to work alongside other optometrists and ophthalmologists in a multi-disciplinary team.

I currently work one day a week in a glaucoma clinic at St Thomas’ hospital. We only had two optometrists in the glaucoma team when I started nine years ago and now there are five other optometrists also working part-time in the clinic. Some combine a day in glaucoma with other hospital sessions, such as contact lenses and paediatrics, others continue to work in community practice.

There is sometimes a lack of communication between hospital eye clinics and community optometry practice, particularly when referring a patient and not receiving any information back.

Combining part time work in hospital with community work has given me a better insight into what happens to patients when they are referred. This has helped me better inform patients on what to expect when they go to the eye clinic.

Doncaster Royal Infirmary hospital optometrist, Andrew Elder Smith

Clinical rewards

I think a lot of optometrists feel that in order to work in a hospital you need skills and knowledge over and above the core competencies for High Street practice. Whilst there are undoubtedly some skills that need honing and the chance to expand into ‘non-core’ areas the majority of work falls within the skill set of any optometrist. It is surprising how quickly you improve when you are doing something very frequently. Working as a team ensures that there is always professional support when you need it.

I started working part time in the hospital eye service to widen my experience and learn more about the management of patients once I had referred them. In those days there were only general clinics, so we did a bit of everything. Technology and professional development has changed the role of a hospital optometrist but the opportunity to learn and develop skills has not.

I am currently a contact lens specialist optometrist one day a week. It is a busy clinic but the smile on a patient’s face when you give them clear vision for the first time in many years gives you tremendous job satisfaction.

Buckinghamshire Healthcare optometrist, David Sculfor

Career structure

Traditionally, the route into hospital optometry has been through a pre-registration year in an eye department, but increasingly optometrists are choosing to develop their career after gaining General Ophthalmic Services experience, taking on hospital work part-time and retaining some community employment.

Working in a hospital eye department is an exceptionally rewarding experience. The case load is, by its nature, complex and challenging but is manageable within the structure of a multi-disciplinary team and training. Core hospital optometry roles include low vision assessments, paediatric and adult refraction and specialist contact lens fitting. For many years optometrists have performed extended roles in clinics alongside their medical colleagues in myriad clinics ranging from YAG laser through medical retina to glaucoma, and are very much a respected part of the team

The roles usually evolve with trainees working alongside senior optometrists or ophthalmologists while working towards higher level qualifications.  Far from being expected to “know everything,” the optometrist’s clinical responsibility will match their developing skills and result in a final competency sign-off in a new clinical skill. 

Hospital optometrists have a clear career structure set out under the NHS Agenda for Change scheme. This lays down the terms and conditions for most non-medical NHS employees. Job descriptions are evaluated and banded 1–8 according to the skills, qualifications and responsibility required, making it possible to compare posts across different disciplines. Details and pay scales can be found on the NHS Employers website. The minimum grade for qualified optometrists carrying our core hospital optometry clinics is currently Band 6. Further responsibility in extended clinical roles leads to Specialist Optometrist (Band 7). The addition of management responsibility allows promotion to principal optometrist (Low band 8) and ultimately consultant optometrist and head of department (High band 8).