“Everything is about collaboration”

NHS Greater Manchester launched a five-year plan in autumn 2023, to improve access to primary care services.

The Greater Manchester Primary Care Blueprint was developed jointly by NHS Greater Manchester and the Primary Care Provider Board and includes ambitions to ensure same-day access to general practice in cases of urgent need, improve GP appointment booking systems, facilitate easier access to NHS dentistry, and develop pharmacy services. 

The blueprint also sets out a goal of ensuring that people can access the Community Urgent Eye Care service, as well as a range of initiatives to improve and enhance eye care.

In a statement, NHS Greater Manchester shared that 1800 primary care services provide the first point of contact for patients in Greater Manchester. This includes 345 optometry providers.

In addition to the key goals, the blueprint also describes measures relating to the implementation of four enablers across digital, estates, workforce, and quality, improvement and innovation.

The blueprint sets out headline deliverables for disciplines across primary care, with focuses on integrated working, reducing health inequalities, and supporting health prevention.

OT sought to understand how the blueprint was formed, how optometry is embedded in the goals, and some of the key ambitions for optometry in Greater Manchester.

 

What does the blueprint seek to address? How has optometry been involved in its formation?

Rob Bellingham (RB), director of primary care and strategic commissioning, NHS Greater Manchester: The primary care blueprint in Greater Manchester is a plan for the whole of primary care. It is a response to the Integrated Care Partnership Strategy for Greater Manchester, which sets out our ambition for population health improvement, and which talks to all of our professional disciplines.

We’ve developed this as a partnership between providers and commissioners; NHS Greater Manchester and primary care provider colleagues, but also across the four disciplines of primary care. That has been written into the model from day one, and now that the blueprint has been approved, having developed it together, we are mobilising and delivering it together.

We called it a blueprint very deliberately, rather than a strategy, because we have done the diagnosis on a lot of occasions and what we really need is the prescription. For me, a blueprint enables you to focus on delivery. You will notice that at the end of every chapter there are specific deliverables broken down by discipline, so relating to optometry, pharmacy, dentistry or general practice.

Julia Maiden (JM) optical lead for the optometry provider board, and optometrist: We have been lucky in Greater Manchester for a long time that we, as optometry, have been in the middle of primary care and have worked very collaboratively with the other three disciplines.

We see the blueprint as looking at our challenges in the vision for the future across the whole of primary care, but also within optometry, supporting on health inequalities, quality and access. The leads on different aspects of the blueprint have come from different aspects of the system: commissioners, local place leads, and primary care providers, all working together collaboratively to make sure it is something that can be delivered. We can come up with these plans, but we need the providers to agree that this is something that can be done.

The primary care blueprint in Greater Manchester is a plan for the whole of primary care

The blueprint emphasises a goal of increasing awareness of urgent eye care services. Could you comment on this as a focus of the blueprint? How might the public be informed of the most appropriate avenues for different healthcare needs?

Ben Squires (BS), head of primary care operations, Greater Manchester: Part of the purpose of the blueprint is recognition of the contribution that primary care makes to the wider system. Primary care is not an add-on, it's an integral part – particularly when we recognise that it's not just the General Ophthalmic Services (GOS) sight test that optometry has to offer.

We know that patients have a default setting to A&E when it comes to urgent care. We might be lucky enough to divert them somewhere else, but it is about communicating to the public the appropriate services that are available to them. The Urgent Eyecare Service is the starting point of that. Our ambition is much broader, recognising the wider opportunities of working with and through our optometry providers. But the starting point for the majority of the public is urgent access, so the Urgent Eyecare Service is that stepping stone. We have some really good engagement across Greater Manchester already to be able to build on.

JM: Everything is about collaboration. We did a piece of work with NHS Greater Manchester, the optometry provider board, the local optical committees (LOCs), and our provider company Primary Eyecare Services, to run a Get to know where to go campaign. One of the LOC members created a video about how the Urgent Eyecare Service works and how to access it, and we also created an animation. Word is going out through GP practices.

We are embarking on piece of work in the next few months with NHS 111 to ensure that the redirection to the Urgent Eyecare Service is really embedded, making sure those patients go to Optometry First, rather than other pathways. We are making sure that the first thought in the patient’s mind is: ‘optometry is where I go.’

The Glaucoma Enhanced Referral service (GERS) is also flagged in the report as an area for intended expansion. What does GERS look like currently in Greater Manchester? How would you like to see this grow?

JM: We have had a GERS in central Manchester for a while. It is a key filtering pathway, managing demand on the hospital service, and because we know that services are stretched, it was agreed that this was a core pathway that we wanted across Greater Manchester. We have had a phased implementation process because we needed to ensure the workforce and capacity was in place.

More recently, we have implemented a single point of access, so that when a patient is referred into the service, it goes through our electronic referral system to one point, and the patient is then contacted and offered a practice. Not only does that make it easier for the patient, but it makes sure that practices can manage their capacity and have less of the admin burden.

BS: As a Greater Manchester system, part of our challenge is about delivering consistency. The services were previously commissioned separately by 10 different clinical commissioning groups. So, it’s about how we take the best and drive that forward in a consistent manner across Greater Manchester to make better use of the workforce. You can’t do it all at once, but actually, in rolling it out we can achieve that consistent offer.

The report outlines ambitions to address health inequalities. How can optometry collaborate with other professions within primary care to deliver this?

RB: There is a lot that we think we can do around health inequalities within this area. For example, we have the Easy Eyecare Service, an enhanced sight testing service for patients with a learning disability or autism. That is a very practical example of a particular service that's been designed for a cohort of people that may otherwise struggle to get best outcome from services.

We’re looking at the thousands of contacts per day that optometry services make and how to make the most of those opportunities or teachable moments to make every contact count. We're exploring how services can be delivered in a way that makes access easier. Point of care testing, for example, could be something that we look at.

JM: We all know that health inequalities after the pandemic have widened and it’s really at the forefront of the blueprint to ensure that we address those. We’re in a very unique place in optometry because we see a lot of people who think they are well, though they may not be – and it’s a unique opportunity to make that interaction count and improve the quality of that person's life.

These interactions are not only in a sight test, but contact lens fits, or when someone breaks their glasses, or pops in to collect solution or dry eye drops. We also have a wide variety of people in the practice team: our front of house staff, dispensing opticians, contact lens opticians, who can all be utilised to support these interactions.

We’ve been looking at how we might support with cardiovascular disease detection, so blood pressure and atrial fibrillation pathways, discussing with pharmacy and general practice colleagues on the Primary Care Provider Board. Our end aim is, ultimately, to give the patient the best opportunity to make those health changes, to give them the best outcomes in life.

That is all work under the Healthy Living Optical Practice framework. We have the healthy living practice framework in dentistry across Greater Manchester, and in pharmacy, and that is something we are working towards in optometry, subject to funding and implementation.

BS: One consideration is to not be restricted by traditional views of services and recognising that making the most of those contacts is not limited to sight tests and dispensing spectacles but making use of our clinical themes in a different way. There are clinical priorities across Greater Manchester that optometrists can contribute to through those points of contact.

The blueprint outlines ambitions to enhance the use of digital and connectivity in primary care through the Electronic Eyecare Referral System (EERS), and the GM Care Record. How might this help to support shared care?

BS: We all recognise the challenge that, nationally, NHS digital provision has been focused on medical services and actually, a lot of clinical information is gathered by our other services. We’re looking at how we can develop the care record, so that optometrists are able to both contribute to it, but also refer to it in their encounters and appointments with patients.

This is important for the patient experience; ensuring information is accurate and not duplicated, but it also helps in risk management. If something is identified by the optometrist, that can support the GP and other colleagues in provision of care to patients.

The electronic referral system has enabled a lot more versatility in how services are able to be delivered. It is about how we build on that so that our optometry services are part of the digital network, rather than sitting outside of that. That’s a principle that applies across our primary care disciplines: dentists have similar challenges, but we have similar ambitions.

JM: Connectivity has been a challenge for a long time, but I feel we are breaking down barriers in Greater Manchester. We have the EERS programme through Opera, which enables us to transfer images directly to secondary care. That has been a game changer. It enables the hospital to triage more fully and see those critical patients more quickly.

We’ve had a great uptake in Greater Manchester – virtually everybody is on board. We've had tens of thousands of referrals already going through that system. It has made a massive difference, but the next step is the shared care record.

I think the shared care record will enable us to integrate and make sure that the patient does not have duplicate referrals for conditions that have already been assessed. It means making sure the IT systems for use within our GOS core contract integrates with our extended services, so it is all one system and all works and flows. We need to focus on making sure that it is sustainable, because you need the funding background to continue and in Greater Manchester, we work together to do that.

BS: We would hope to be able to influence national policy in that direction. The worst thing would be that we develop something that works, but national direction then goes in a different tangential. We hope this is something that is seen as being beneficial nationally, as well as locally.

JM: In Greater Manchester we have an optometry excellence scheme. It is early days for the project, but within that we have an optometry referral improvement programme. We will look at the data to see where we can help our colleagues using the system. We are looking at getting a digital enablement officer to help practices that struggle with integration, or even at the secondary care level, making sure those integration points are working throughout the system.

BS: On the back of what Julia is describing, it is recognising that the best people to support providers are our providers. Rather than being a paternalistic kind of commissioner saying: ‘This is what you should be doing,’ it is about how we work together so that our providers support each other.

We hope this is something that is seen as being beneficial nationally, as well as locally

 

How will practices be supported to deliver these services? What do you think these plans will bring to practices in Greater Manchester?

JM: With regard to funding, because the Primary Care Provider Board, optometry provider board, and the LOCs across Greater Manchester, work together so collaboratively, we ensure that this discussion happens straightaway. I think because we're integrated in the discussions early on, and things aren't built and pushed on us, we make sure that those discussions have happened where they need to happen.

I’ve found that practices have really enjoyed the improvements that we’ve made across Greater Manchester. We’re getting greater integration, we have a lot of people wanting to upskill, there are independent prescriber courses and College of Optometrist professional certifications that are being funded through the system. That engagement in upskilling shows that optometry is willing and here to support the system.

Optometry excellence is one of our work programmes. It is important to make sure that the workforce is supported. Health and wellbeing are important, particularly post-COVID-19, along with workforce development, and practical support.

BS: I think that is key, because, hopefully with this ambition, enthusiasm, and innovation, we're able to attract people into working in Greater Manchester. This is supportive for individuals as well as exciting and that makes a difference in the day to day lives of our workforce, and therefore the day to day lives of our patients.

At the end of the day, it has always got to be in the best interest of our citizens across Greater Manchester, reducing inequalities and improving health outcomes

 

How do you feel following the launch of the blueprint, and as this project moves through implementation?

RB: From my point of view, it’s really exciting. It is a great place to be in, to mobilise around the blueprint. But also, more importantly, is to have the relationship because it feels like such a great opportunity to work in this way.

Although the blueprint has been signed off and approved, we haven't waited for it to get approved before cracking on with things, we have been working together in this way for a period of years, and we're continuing to do that. What this has given us is almost a renewed impetus and a renewed focus rather than firing the starting pistol.

Importantly, looking across the whole of the primary care system, and across the whole of the Greater Manchester Integrated Care System, people know about the blueprint. One of the signs I have that something has taken root is when I’m not the first person to mention it – when somebody else, not directly connected to it, is talking about the blueprint. That happens quite a lot now, and that is really gratifying, because it tells me that we’ve taken root. That’s important because that means that primary care is in the forefront of people’s minds. Optometry, in this conversation, is at the forefront of people’s minds. Therefore, we’ve built ourselves a platform to drive forward the vision, the shared ambition, and the mission that we all have.

BS: All too often when people talk about primary care, they actually mean general practice. But I believe that through the blueprint, people are recognising it and taking it to heart, so that when people talk about primary care now, they truly mean primary care including optometry, dentistry and community pharmacy.

That is a reflection of the collaboration and the focus throughout the blueprint on reflecting all parts of primary care. You are able to see optometry throughout the blueprint, rather than just a mention here and there.

JB: For me, it is when I go into a meeting with dentistry, pharmacy, general practice, and people from different levels within the system, and somebody says primary care, and the GP steps in to say: ‘Excuse me, do you mean GP, or the whole of primary care?’ It is wonderful that they pull people up and make sure they are using the correct terminology. Primary care is all of our four disciplines.

Through the blueprint, I think we’re aiming for sustainability, an integrated primary care system, and the working together of the four disciplines. At the end of the day, it has always got to be in the best interest of our citizens across Greater Manchester, reducing inequalities and improving health outcomes. We are all care professionals; that is what we all aim for. Hopefully, if we do this, we will also make Greater Manchester the place to work for optometrists and wider primary care.