Domiciliary optometrists struggle to access care homes

Record daily case numbers following the outbreak of the Omicron variant in the UK has had a profound effect on the domiciliary sector.

The number of English care homes reporting at least one positive case of COVID-19 rose by 40% in the final week of 2021 compared to the week before Christmas.

Growing numbers of care homes entering lockdown have resulted in a diminished workload for many practitioners, while inflexible processes for delivering spectacles and rearranging care have created further hurdles for those working in the sector.

OT explores the issues facing domiciliary optometrists – and the work being carried out by the Domiciliary Eyecare Committee (DEC) to advocate for the profession.

1 Care homes in lockdown

In mid-January, members of the DEC were receiving regular calls from domiciliary providers reporting a drop in activity as growing numbers of care homes locked down.

Professional services director at Visioncall, Vic Khurana, shared that in December 2021 there were only three COVID-19 related cancellations of care home clinics recorded by the domiciliary eye care provider.

In contrast, the first week of January 2022 saw 45 care home clinics cancelled.

The message that we are trying to get across is that eye care is a necessary service

OT understands that in early January the majority of care homes were in lockdown within Warrington.

Parm Mund, owner of In-House Mobile Opticians, shared that optometrists would “need a crystal ball” to negotiate the uncertainty around entering care homes amid the Omicron outbreak.

“Booking care home appointments is a nightmare, especially when we have to give the NHS three weeks’ notice if we are seeing two or more residents in any one place without knowing if the care home will be able to allow us in,” he said.

Co-chair of the DEC, Gordon Ilett, shared that many domiciliary optometrists were reporting zero activity on some days and half of normal levels on others.

“Some companies are having to go to banks to get extensions on loans so that they can pay staff and continue to trade,” he shared.

Aside from the business impact of lockdowns, Ilett emphasised that not having access to eye care affected the quality of life of residents.

For example, they may not be able to see family members if they are using video calls to communicate with them.

“We are very conscious that we want to maintain people’s mental health,” Ilett emphasised.

2 Red tape to provide care

Requirements for patients to sign for spectacles and for NHS England to receive three-weeks’ notice of sight tests conducted in care homes has also created challenges.

Domiciliary optometrists have been unable to deliver spectacles to locked down care homes.

“Unlike delivering a parcel, where you can leave it at the door, we need to get the patient’s signature on the GOS 3 form. It is only really the patient who can do that unless they have given power of attorney to an individual,” Ilett highlighted.

Booking care home appointments is a nightmare, especially when we have to give the NHS three weeks’ notice

Rearranging appointments if a patient tests positive for COVID-19 is also challenging because of pre-notification requirements.

“If you have a waiting list of people, unlike in a fixed site practice where you could phone a patient and say ‘Pop in tomorrow – we’ve had a couple of cancellations,’ in domiciliary you have got to give three weeks’ notice to NHS England,” Ilett highlighted.

The DEC is calling for NHS England and the Department of Health and Social Care to temporarily suspend patient signature requirements and also pause the three-week notification requirement on a temporary basis.

“What we want is equality of treatment. We want a reduction in the restrictive burdens that are placed on domiciliary services that are not placed on High Street services,” Ilett said.

3 Misconceptions about the necessity of eye care

Khurana shared with OT that in some cases domiciliary optometrists have been denied access to care homes because they are seen as a non-essential service and will only be permitted to enter once Omicron cases subside.

He emphasised the importance of conveying the broader importance of domiciliary optometry – for example, in picking up systemic disease and reducing the risk of falls.

“It’s not just performing an eye test and sorting out spectacles, which I think is what some care homes might think when it comes to sight tests,” Khurana said.

Ilett said that while he can understand that care home staff are nervous about permitting visitors into care homes, the circumstances are different to the first wave of COVID-19.

“Now everyone has learned to work using personal protective equipment, domiciliary optometrists are testing every 72 hours and they are vaccinated,” he shared.

The DEC is calling for domiciliary optometrists to be treated in the same way as other healthcare providers when it comes to access to care homes.

“What we want is a level playing field. If a district nurse is able to go in, then the optometrist should be able to visit. The message that we are trying to get across is that eye care is a necessary service,” Ilett highlighted.