“We know optometrists are ready and waiting to deliver more clinical care”
OT caught up with The Eyes Have It members Carolyn Ruston, policy director at the AOP, and Thom Renwick, therapy area lead for ophthalmology at Roche, to discuss nationally coordinated eye care, and how the improvements that matter most can be delivered
08 June 2023
In May, The Eyes Have It (TEHI) took part in a panel discussion on the pressures within the eye care sector at the Royal College of Ophthalmologists’ (RCOphth) Annual Congress.
What is The Eyes Have It?The Eyes Have It is a partnership of the AOP, the Royal College of Ophthalmologists, Fight for Sight, the Macular Society, the Royal National Institute of Blind People, and Roche.
The partnership was formed in 2021, to raise awareness of sight loss and to ensure that everyone can access the right care, in the right place and at the right time, in order to improve eye health.
Afterwards, OT caught up with TEHI members Thom Renwick, therapy area lead for ophthalmology at Roche, who spoke on the panel, and AOP policy director, Carolyn Ruston, for a deeper dive on the issues being discussed.
What are the key points that were discussed at TEHI’s panel at the RCOphth congress?Thom Renwick (TR): Following the appointment of Louisa Wickham as national clinical director for eye care, we have been advocating for system-wide steps to improve NHS eye care services. Louisa’s role is a major step forward, and we want to support her to ensure there is a nationally coordinated approach to addressing the challenges in eye care.
The panel discussion was about the different approaches to delivering that coordination, particularly to how Louisa’s thinking has developed over her first year in the role, what she is looking to achieve going forward, and how the sector can best support her.
Was there a singular message that you wanted to convey via the panel?TR: To meet the challenges facing eye care, we need the whole sector working together.
The discussion focused on ophthalmology and the role of our colleagues in secondary care, but it is essential that all clinicians involved in looking after the nation’s eye health, whether in primary care, hospitals, or the community, are engaged in ensuring that we have the best eye care system possible.
To meet the challenges facing eye care, we need the whole sector working together
What are the top three changes within eye health that TEHI would like to see in the medium-term?TR: It’s clear to anyone who looks at the scale of our waiting lists, that the eye care system has challenges – training more ophthalmologists is crucial to addressing this challenge, but we also need action now.
What we hear a lot from our colleagues in primary care roles is that they are willing and able to do more. We want the system to enable this, for example by upskilling primary care optometrists and their teams to deliver more care outside hospital, implementing high-quality technology and systems to enable better sharing of imaging and data between primary care and secondary care, and crucially, supporting and empowering patients as they move through the system.
Finally, we want to keep our gaze fixed on the future, investing in research to find the next generation of diagnostics and treatments, and ensuring that those new treatments can reach all patients.
Carolyn Ruston (CR): Addressing the backlog and capacity challenges in ophthalmology.
Solving the current connectivity and interoperability issues between optometry, secondary care and general practice – to enable quicker referrals, reduce unnecessary referrals, and enable greater clinical collaboration and joint decision making.
Thirdly, delivery of more care out of hospital and in community optometry settings.
If I can add a fourth – addressing inequality of access for all patients, including the most vulnerable and those in eye care who we find the hardest to reach.
What do you see as the biggest challenges to a potential nationally coordinated eye health plan?
CR: Again – solving the interoperability issues is key to delivering an integrated and coordinated eye care pathway. Ensuring as a sector we can come together to work with Integrated Care Systems (ICSs) to ensure that the future of eye care is commissioned and delivered in an accessible and consistent way, regardless of where you live.
TR: Louisa’s appointment as national clinical director [for eye care] is hugely positive, but in many ways, the general trend in healthcare provision at the moment is towards local planning and delivery through ICSs. ICSs bring big benefits in terms of planning care to meet specific local challenges, and improving the interface between primary and secondary care, but there is an inherent risk that this also leads to unwarranted variation, perhaps even a postcode lottery. We need to balance this local control with national accountability and standards.
Can optometrists in practice, including hospital optometrists, do anything to support a national eye care plan?
CR: Yes. I am delighted the AOP became a partner of TEHI last year, and we have taken great strides already in ensuring optometry and the views of our members are represented at government level through this coalition.
Last year so many of you contacted your MPs to encourage them to attend the Westminster Eye Health Day in October, which they did. We will be asking the same again of members this year, and I encourage members to utilise the excellent materials contained within the Sight won’t wait toolkit, which is available here.
Now is a real opportunity for us, collectively and individually, to raise the importance of eye care and the current eye care crisis to our local politicians in the lead up to the second reading of the national eye care strategy bill, led by Marsha de Cordova MP, in November 2023.
TR: Optometrists are essential in supporting coordinated national eye care. In practical terms, our colleagues in optometry deliver a significant proportion of all eye care and are a key part of the integrated care structures that would implement a national plan.
We’re proud that the AOP is part of TEHI. It is vital that we have the input of optometrists on the most effective ways to address the challenges in eye care.
Optometrists can make their own voices heard directly. The current bill going through parliament is in support of a national eye health strategy, so if this is something optometrists would like to see delivered, we encourage them to contact their MP to ask them to support the bill – more information on that can be found at eyeshaveit.co.uk.
It is vital that we have the input of optometrists on the most effective ways to address the challenges in eye care
If fragmentation and differing priorities are a challenge to progress, how can they be addressed effectively?
CR: Talking to members, I don’t feel there is fragmentation of opinion about the need to reform and change the way eye care services are delivered. Whilst much of this is England-focussed, these issues relate across our UK nations, something the AOP will be working on through the development of our four nations strategy later this year. I believe fundamentally we all start on the same page: that any change or reform needs to start and end with delivering better outcomes for patients.
TR: The great strength of TEHI is that it brings together different voices to build consensus on tackling the challenges in the eye care system. We want to see this approach implemented across the sector. For our part, that means engaging widely, but it also means NHS England needs to lead from the front, using their authority and convening power to ensure everyone is singing from the same hymn sheet.
I believe fundamentally we all start on the same page: that any change or reform needs to start and end with delivering better outcomes for patients
How can policy level thinking and practical, actionable measures work in harmony?
TR: I think it can be easy to spend huge amounts of time and capital developing well-researched, detailed policy documents with hundreds of references, which bear little resemblance to the day-to-day experience of clinicians.
For example, when we talk about enabling optometrists to deliver more care outside hospital, we need to understand what the barriers or drawbacks are – do clinicians have the skills, digital tools, or the physical space to deliver this? If not, what can we do about that? That means we need input from the people at the heart of the system from the outset, which is why engaging through sessions like this [at the RCOphth congress] are so important.
Is TEHI planning to use the financial argument (for example, that eye disease costs the UK economy £25 billion annually) to lobby government?
CR: Yes, we are really keen to be able to not only evidence the current impact sight loss has to the economy but also demonstrate through economic modelling where there are significant opportunities to deliver health care services in a more accessible and efficient way through greater use of primary care optometry on the High Street.
We know optometrists are ready and waiting to deliver more clinical care, and it is important for government to not only see evidence of improvements to patient care but also the financial impact of optometry-led eye care and wider health prevention model.
TR: We know sight loss has a big impact on the UK’s finances – our partners at Fight for Sight project that by 2050, sight loss will be costing the UK £33.5 billion.
Of course, these are figures that we highlight to Government, but they are also only a part of the picture. We are all here, not because we are concerned by the economic impact of sight loss, but because we know the impact it has on individual lives. Patients are always at the heart of our work, and that includes [in] the conversations we have with Government.
Do you have any thoughts on the recently published plan to change the way GP appointments are accessed and how that might impact eye health?
TR: General practice is a core part of the UK’s health system and, when one part of the system is under pressure, that inevitably has effects downstream and upstream. The proposals to fund care navigators could be particularly helpful in supporting patients to access the right care in the right place.
That said, the document claims to be a plan for recovering access to primary care. With just two references to optometry in the whole document, Government has missed the opportunity to support the whole primary care landscape. We hope that, as this plan is implemented, its learnings can be applied across the whole landscape.
CR: I agree wholeheartedly with Thom: lack of reference to optometry within the primary care recovery plan was disappointing. The Clare Fuller Stocktake set out the change and associated mechanisms needed to deliver a truly integrated health and care system that would transform access and delivery of patient care, yet parity of esteem across all primary care professions is still missing.
We hope that working with the NHS Confederation as part of the primary care network will begin to change this at policy and decision-making level. Clinically, again there are real opportunities to reduce backlog issues in GPs through ensuring our highly skilled optometric workforce are used correctly and optimally, for example by GPs referring patients to an optometrist if they have an eye complaint and vice versa optometrists being able to early detect health conditions such as diabetes, dementia, high blood pressure, and provide health prevention advice and signposting such as smoking cessation. All of this frees up GPs’ capacity, working together to ensure that ‘every patient contact counts.’
There is a time sensitivity to these issues – how can we emphasise urgency to those with the power to make budgeting or commissioning decisions?
TR: That’s such an important point. As we speak, over 600,000 people are waiting for specialist eye care in England alone, and the longer they wait, the more likely they are to experience irreversible, but entirely avoidable, sight loss. And of course, poor eye health has wider implications for health and wellbeing. I think AOP’s recent Sight Won’t Wait campaign with the Macular Society made this point incredibly eloquently.
CR: We know that ophthalmology has overtaken orthopaedics as the biggest outpatient speciality, and is predicted to continue to rise over the next 20–30 years, due to an aging society and increasing levels of health and socio-economic inequalities, which we know have an impact on eye health and can lead to preventable but irreversible sight loss.
Coupled with this is the significant and long-standing backlog in ophthalmology as a result of a national workforce shortage in ophthalmologists, something that, whilst seeing some investment, is not a ‘quick fix’ given the length of time it takes to train.
As highlighted in the AOP’s Sight won’t wait campaign, clinicians have reported more than 200 cases of people losing their vision due to treatment delays since 2019. Therefore, it is vital that we have a national eye care strategy that can enable a pathway and commissioning model that positions optometry to be able to alleviate this burden through regular, enhanced and urgent eye care services.