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Perspectives

“The wellbeing of our colleagues must remain an absolute priority”

Birmingham and Midland Eye Centre’s Dr Waheeda Illahi, Rosie Auld, Dr Emma Berrow and Dr Peter Good on the Delta variant, COVID-19 fatigue, and managing backlogs on the ground

Waheeda and Emma

The Delta variant of COVID-19 poses a potential risk of a third wave in the UK as the transmission rate increases within the community. As Heads of Service (HoS) at the Birmingham and Midland Eye Centre (BMEC), we are not dreading the looming wave, but are rather weary of the consequences. From a service delivery perspective, the pandemic has given us a crash course on crisis management as we have led our services and supported our colleagues through the most challenging of times.

It has been well documented that the morale of NHS staff who have worked under sustained pressure throughout the pandemic has been affected, and the strain of COVID-19 fatigue is creeping into hospitals across the country as the long road to recovery continues amidst uncertainties. Our hospital is no exception to this.

BMEC has always been a close-knit community, providing specialist tertiary level care in the West Midlands as well as a vibrant hub for teaching and training in ophthalmology services. Team spirit has been high, with close interactions between departments and multidisciplinary teams. Seventeen months into the pandemic, with the constant wearing of masks and social distancing, as well as conversion of almost all teaching programmes to online webinars, the dynamics in our hospital have visibly altered.

Professional boundaries between ophthalmologists, optometrists, orthoptists and other allied health professionals have become less relevant, and colleagues continue to show tremendous camaraderie and support

 

On the one hand, professional boundaries between ophthalmologists, optometrists, orthoptists and other allied health professionals have become less relevant, and colleagues continue to show tremendous camaraderie and support. Contrastingly, departments are becoming more insular as the focus on clearing backlogs has increased, and there is less time for interaction between departments. We are very hopeful that the former pre-COVID-19 era BMEC close-knit community feeling will return.

In terms of patients, the recovery of our services continues to gather pace, and the demand for specialist ophthalmic services is ever-increasing. Committed teams and good forward planning are enabling our current recovery plans for the optometry, orthoptic and visual function services to remain reasonably well on track.

COVID-19 Pathway Improvement Programmes have been launched with NHS England/Improvement, focusing resources on a small number of specialities in order to streamline outpatient services in the post-COVID-19 era. The new programmes incorporate work carried out by key bodies who have contributed to The National Eye Care Recovery and Transformation programme, including the Local Optical Committee Support Unit, the College of Optometrists, the Royal College of Ophthalmologists, British and Irish Orthoptic Society, the RNIB, as well as the Getting It Right First Time national programme and other stakeholders.

The key principles in the programme to restore eye care services include: optimising the use of the primary care optometry workforce; referral filtering; risk stratification and clinical prioritisation of patients; the scaled use of digital enablers (connectivity, virtual and video consultations); and monitoring and managing lower risk patients in the community through primary care optometry and diagnostic treatment hubs. In order to deal with ophthalmology backlogs, there is work on establishing high volume cataract hubs as well as high volume, low complexity diagnostics hubs.

Managing backlogs on the ground and the return of training

There is increasing evidence-based literature highlighting the impact of COVID-19 on various disciplines and subspecialties within ophthalmology services. The need for virtual and video consultations has been accepted as a norm in reducing the number of patient visits to hospitals. Virtual consultations are invaluable in specialities such as the low vision services. However, they are of limited value in complex contact lens fitting or vitreoretinal clinics where a physical examination is necessary.

Our Trust is already outsourcing some ophthalmic services, with the emphasis on those with the longest waiting times: glaucoma and medical retina. The safety of both of these services will depend on the quality and reliability of the diagnostic tests. Robust audit and governance processes are essential to ensure that tests performed in high volume diagnostic hubs are reliable.

Virtual consultations that are followed up with a letter to the patient and their GP do not give patients as much opportunity to express their concerns or ask questions. Telephone consultations post virtual review are a better option, but they are more time-consuming, and are therefore less favoured in the newly designed pathways.

In our first article in the series with OT, we explained that paediatric patients tend to be afraid of staff in uniform.

We now notice that children in all age groups including new-borns and six-month-olds seem to accept masks as the norm. The Primary Vision Screening service was significantly affected by school closures for children other than those of key workers and then by schools being unable to provide access on the grounds of potential infection spread. Screening ceased in March 2020 and did not resume until late October 2020. This resulted in children being screened in year one rather than in reception – that is to say, at an older age. It is possible that the delay in detection and treatment may have an adverse effect on visual outcome. In order to ‘catch up’ and manage the backlog, orthoptic staff had to be moved from other services to support the screening. Referrals would normally be fairly consistent throughout the academic year. The impact of increased screening capacity has led to a surge in referrals in a short time period.

Large scale research trials involving optometrists, orthoptists and other members of multi-disciplinary teams are resuming. Some of our research is based on the impact of COVID-19 by comparing patients presenting to our emergency department with neurogenic ocular motility defects prior to and since the first wave of the COVID-19 pandemic.

Independent prescriber optometry placements are planned to resume from October 2021, and orthoptic trainees have already returned for onsite training. In the visual function department, the scientific trainee practitioner training support is now back to pre-COVID-19 levels and we are fully supporting our medical teams in training junior doctors.

As HoS, we continuously try to protect our team members from working extended days and weekends, which has benefitted staff morale after such a tough year

 

Making every contact count

Patients who have been under the hospital eye service long-term often present varying accounts of the information they have heard in the news or on social media in relation to COVID-19 when attending for their appointments. As professionals, it presents us with opportunities to re-enforce the importance of vaccination and how they should remain mindful of the risks posed by COVID-19. We also remind them they should continue to follow the existing rules and infection control and prevention guidance.

As HoS, we continuously try to protect our team members from working extended days and weekends, which has benefitted staff morale after such a tough year. For small, specialised departments such as visual function, it would be a struggle to stretch over evenings and weekends, especially alongside sick leave and annual leave cover.

As demand is expected to surge, lower banded bank staff may be employed to cover more basic skills, freeing up experienced staff to pick up complex electrophysiology and ophthalmic imaging work.

As HoS, our greatest asset is our staff. An essential part of the COVID-19 recovery process within the tertiary centre setting is not only to consider the length of our waiting lists and to come up with solutions using existing staff, but also to acknowledge that the wellbeing of our colleagues must remain an absolute priority as we learn to live with varying forms of the virus.

About the authors

Dr Waheeda Illahi is a consultant optometrist and head of optometry services, Rosie Auld CBE is head of orthoptic services, Dr Emma Berrow is consultant ophthalmic electrophysiologist and head of visual function, and Dr Peter Good is a consultant neurophysiologist at the Birmingham & Midland Eye Centre.