Optometry Wales confirms future fees for clinical services

New clinical fees for optometrists in Wales were confirmed during a webinar on Monday night (26 September). 

The increased fees for clinical work are part of contract reforms for practitioners in Wales, and have been spearheaded by Optometry Wales.

David O’Sullivan, chief optometric adviser to the Welsh Government, confirmed that the new clinical fee structure will work on a tiered basis.

The Wales General Ophthalmic Service Level 1 tier will include core service provision, patient management plans, prevention and patient self-care, and domiciliary sight tests. The fee at Level 1 will be £43.

Level 2 includes Eye Health Examination Wales (EHEW) bands one, two and three. The band one fee will be £70, band two will be £53, and band three will be £26.

Level 2 will be the expected ‘baseline’ for optometry practices in Wales, with an EHEW accredited practitioner in every practice, Sali Davies, chief executive at Optometry Wales, told OT.

Level 3 includes Low Vision Service Wales appointments. Practitioners can expect £90 fees for a new patient, £43 for an eye examination, and £53 for an annual reassessment.

Level 4 includes higher qualifications, including professional certificates in medical retina and glaucoma, and will see fees for referral refinement and monitoring of £91 each.

Independent prescriber (IP) appointments and eye casualty cases in primary care are covered by Level 5, where fees will be £125 for a new IP patient, £94 for glaucoma monitoring, and £62 for a follow-up.

Legislation to confirm the reforms was signed off by the Welsh Health Minister last week, with changes expected to be rolled out by summer 2023.

Currently Wales has 112,610 ophthalmology patients, 70% of whom are at risk of irreversible sight loss, waiting longer than the clinically agreed date to be seen by secondary care, O’Sullivan said. Welsh optometrists currently make 100,000 referrals to secondary care per year.

O’Sullivan emphasised that the contract reforms have been designed to “utilise the available skills and resources in primary care.”

The changes are being made so that funding reflects the activity that is going on in practices and so that the optometry career ladder in Wales can allow clinical skills to develop and be adequately remunerated, O’Sullivan said. Training for practitioners will be provided.

“There is a need to upskill the profession, and we recognise that we have a multidisciplinary team within our primary care services,” O’Sullivan said.

“The more clinical services that are provided within a practice, the better the remuneration will be, and that’s in line with our shift of services [and] the change that we are looking for to drive those services in a clinical setting.”

Upskilling will include continued professional development payments for dispensing and contact lens opticians, in order to support them and recognise their value to the profession.

O’Sullivan added that Optometry Wales wants “health, wellbeing and prevention at the heart of everything,” with a reduction in referrals, increased follow-ups within the community, and hospitals being the final port of call.

Over 660 people joined Monday night’s webinar, Davis told OT. A frequently asked questions document, based on questions presented, is currently being created by Optometry Wales, and will be shared with practitioners in the near future.

The AOP’s response

The AOP has welcomed the announcement, but has highlighted its concerns over the funding model and asked for further reassurance on certain aspects of the reforms.

Adam Sampson, AOP Chief Executive, said: “We welcome the fee uplift which recognises the value of the clinical skills brought by optometry and the contribution of primary eye care to patient experience and outcomes.

“A move away from a reliance on retail to one of specialist clinical examinations is absolutely the right direction if we are to tackle the growing patient backlog in real terms. However, looking at the detail of the package presented there is some fundamental work that needs to be done to understand what the sector is being paid for, and whether that represents true value.”

Sampson added: “An increased fee for the current service delivery is welcome. Our concern is that the fee is intended to cover a greatly expanded service. We need assurance that is not the case.

“An additional area of concern is for those members providing domiciliary services and if they will benefit from the uplift, as this is yet to be revealed in the plans.

“The reduced voucher value for some patient groups also represents a retrograde step that limits patient choice and access to eye healthcare. This is deeply concerning at a time when people are already struggling to make ends meet in a cost of living crisis.”

OT will address the AOP’s concerns in a conversation with Optometry Wales chief executive, Sali Davis, which will be published soon.

This article was updated on 29 September to reflect the AOP’s statement on the reforms.