Training IP optometrists in glaucoma management in Scotland

1. NHS Education Scotland Glaucoma Award Training (NESGAT) has been designed to equip independent prescriber optometrists with the knowledge and skills to extend their remit to support the shift of appropriate eye care out of hospitals and into the community.

The qualification is delivered within the optometry team at NHS Education for Scotland (NES), with new project leads coming on board at the end of 2021, Madeline Harvey-Brown and Dr Alice McTrusty. The COVID-19 pandemic impacted particularly on our 2020–2021 pilot year of NESGAT, as placement delivery was stalled. We quickly worked to support outcomes being signed off via a mix of remote, simulation-based scenarios and some community shared care work. Whilst August 2021 saw the return of face-to-face clinics, many of the changes we had introduced proved to work very well, so we revised our online delivery to better support future cohorts.

2. The pilot year ran from 2020–2021, and the qualification was awarded to 16 practitioners from four health boards.

The second cohort, in 2021–2022, consisted of 45 practitioners from all across Scotland, necessitating NES building relationships with secondary care colleagues in new health boards.

Moving from the first to the second cohort involved significant evaluation. We gained feedback on the experience of the first cohort of learners, as well as gaining feedback from the educators and supervisors: supporting the NES culture of quality improvement, with feedback guiding improvements.

Feedback so far has highlighted wide benefits from NESGAT, with many practitioners reporting overall changes to how they approach their professional practice

Throughout, NES has benefitted from excellent support from secondary care colleagues: specialist optometrists and consultant ophthalmologists have supported delivery of placements and the generation of learning and assessment material, as well as taking on supervisor and assessor roles. Their involvement has ensured high standards, but also given further opportunity to strengthen the relationship between primary and secondary eye care delivery in Scotland. This has added to the confidence around primary care optometry being a safe and efficient place to support care of appropriate cases of ocular hypertension and glaucoma.

3. A significant change from the pilot year was the introduction of an educational supervisor for each learner.

These are experienced (glaucoma) optometrists who guide the NESGAT optometrists’ training and assess their development overall throughout the duration of the training programme.

NES strongly supports development around the pillars of advanced practice, which can be categorised as clinical practice, facilitating learning, leadership and evidence, and research and development. This led to us engaging with the NESGAT pilot year graduates, encouraging them to support education around glaucoma care. For example, at our 2021 NES Prescribers Conference NESGAT optometrists presented a session on cases they had managed in the community. They also support the delivery of webinars.

4. 2021 saw the introduction of a new workstream in NES, mentoring for NESGAT qualified optometrists.

This work, led by Yvonne McTaggart, has supported proposals on developing a network of mentors within the community setting.

Aside from opening opportunities to practitioners for services that discharge care to community practices, feedback so far has highlighted wide benefits from NESGAT, with many practitioners reporting overall changes to how they approach their professional practice. As such, NES will look to continue delivery, perhaps widening the audience for elements of the training.

NESGAT has led to glaucoma specific teach and treat clinics, which are proving invaluable continuing professional development and a further chance to strengthen relationships between primary and secondary care. NES will be looking at ways to continue these valuable clinics, as well as continuing our work on mentoring for NESGAT optometrists and providing them with opportunity to develop their pillars of advanced practice.

5. The NES optometry team has learnt a lot through the delivery of NESGAT.

We are currently using our learnings to guide the design and delivery of a new education programme to support the care of patients with low vision in the community, as well as a course to support the management of adults with incapacity.