31 May 2023
19 June
is when the consultation on the new Wales GOS proposals closes. Have your say here.
Clinical aspects and voucher values
Increased funding for clinical services and a focus on voucher values are two key priorities that need to be focused on once the consultation has closed, optometrists believe.
Helen Tilley, a Hakim Group independent practice owner in Monmouth, near the English border, describes herself as “totally behind” the proposals.
Tilley, who is a former chair of Optometry Wales, hopes that the clinical aspects of the proposals will remain at the forefront when consultation responses are gathered and analysed.
“That’s what we've been pushing for, for many years now,” Tilley said.
Although she believes that certain proposed aspects may be subject to change before the proposals reach legislative stage, she remains extremely positive, she said.
Stephen Evans, optometrist-owner of Swansea’s Stephen Evans Optometrists, also a Hakim Group independent practice, told OT that a focus on vouchers needs to remain a priority.
“The vouchers for glasses have to be contributions towards glasses, rather than it being mandatory that you have to supply a pair of eyeglasses for the lower voucher values,” he said, adding: “I just don't think that is sustainable.”
A large number of Evans’ patients are children, he explained, and “the small frame supplement barely covers the cost of some of those glasses.”
He added: “If you’ve then only got a £22 voucher to supply the lenses, it’s 80% subsidised. That’s not sustainable going forward.”
Tilley, however, believes that the increase in sight care fees in the new contract will counteract the loss of income that may come from reducing the voucher values. “It’s the way forward,” she said, “because we shouldn’t be subsidising it [clinical care] by selling glasses.”
Tilley also highlighted issues that might arise in practices, like hers, which are close to the border. Monmouth is a mile from the English border and only three miles from Hereford, she explained.
“It’s going to create a problem if we’re not allowed to see English people, because they live literally a mile away,” Tilley said.
“The current Welsh Eye Care Scheme doesn’t address it unless people are on holiday. We can see them for sight tests currently, but we can't see them for Welsh Eye Care, low vision, or emergencies. So, it does need to be sorted out.”
Director of professional advancement at Specsavers, Paul Morris, who has two practices in Bridgend and one in Porthcawl, cautioned that “there is still a lot that we don't know.”
Morris said: “I'm assured that there are lots of working parties and groups which are engaged, working out those details, what will happen at the different bands and what will be required for optometrists, and the teams that support them and dispensing opticians, to do with this new contract.”
Most important changes
The most important aspect of the changes is that patient care will be brought into the community, Tilley said, helping to ease “ridiculous” waiting times in secondary care.
She added: “We’ll be able to actually utilise our skills, that we’ve been training for and capable of for many years.”
Evans also cites relieving the strain on secondary care as one of the most important factors, while acknowledging that solving the ophthalmology backlog will take time.
“There will be no quick fix on these things,” he said.
Evans believes that taking on work from hospitals is one of the proposals “primary focuses.”
“It means that you will be seeing more patients in primary care that you might have either referred to secondary care or that you will co-manage with secondary care,” he explained. “There is a will to do it on both sides, but it depends on your local hospital. Down here [in Swansea], certainly there is a will to do it on both sides.”
Evans continued: “We are picking up an awful lot of slack from the hospital now, but nobody is paying us for it. So, I think that’s a positive.”
He added that initial concerns that a small number of independent prescriber (IP) optometrists might end up “swamped” with referrals from other practices “and therefore not be able to do their core business of sight testing and retailing glasses” has been addressed.
“I’ve been reassured on that, because they are offering IP courses all the time,” Evans said. “There’s a continuous training course. I think there is going to be a good uptake on that.”
General sentiment
When OT asked Morris what the general sentiment towards the proposals is amongst Specsavers optometrists in Wales, he emphasised that optometry is a small community and that no part of the plans have come as a surprise.
“I’m a clinician and I’ve got three practices in Wales,” he said. “People are excited, on a clinical level, because they get to work at the top end of their licence, and they get to develop themselves in a way that probably they never thought they would before. And they’re being helped to do that by funding that has been made available. But there’s also that bit of nervousness.”
Funding for higher qualifications that has been released in recent years and a number of “pilot-style services” in Welsh health boards, which may now be rolled out nationally, has meant that most people are already engaged, he said.
“They know broadly what’s involved. There’s some excitement there. The people who want to be involved are running towards those qualifications and they will be a big part of it,” he said.
Morris acknowledged that “those who want to maintain their current scope of practice are free to do so,” but added: “I would be advising anyone in Wales to take advantage of these funding opportunities, because ultimately, it’ll be great development.”
He continued: “Being a relatively small community of optometrists in Wales, people talk to each other. Finding out those people who are in the IP services or the medical retina services and talking about their experiences is very healthy, and I think most people feel, ‘I could do that.’ That’s what we want. We want everyone to aspire to work as much towards the top of their licence as they possibly can.”
Morris added: “As with any change process, there are those that are really excited, and those who are in the middle, and then those who are dreading it. I’d implore people to have an open mind and if they are responding to the consultation, which I’d encourage them to do, to do it in a balanced way, and to remember that the Welsh Government have generally always been very good to optometry.
“I think people would look across the bridge from England with great envy at the things Wales has achieved in the profession, for patient benefit but also for optometry. I think they are on the right track and it’s our job to be supportive of everything that they are trying to do, to help us to craft a future together that is balanced and well informed, and to make sure we’re working collaboratively on it.”
As an independent practice owner, Evans agreed with Morris’ sentiment, while acknowledging that reform is unlikely to be a fast or straightforward process.
“This reform is very much needed,” he said. “It’s something that should have been done years and years ago. As optometrists, we’re doing the work most of the time anyway, but we’re doing it for nothing. Here, we’re going to get recognition. There’s going to be an upskilling of the workforce, which I think is very positive. And I think it’s important for the patients, because it’s going to be difficult for secondary care alone to meet the increasing demands on it’s ophthalmology services.”
Evans added: “Of course it has its challenges. As practice owners, we will have to think about how we arrange our appointments and things like that. But it is going to be implemented slowly, in parts. It’s not going to be rushed in all at once.”
He continued: “Nobody is going to get this right first time. We have to understand that. That doesn’t happen in the real world. Because they are going to implement it slowly and quietly, it will give them a chance to get it running, find out what’s not working, and improve upon it. We’ve had reassurance that that process is going to happen. It’s not going to be presented as a done deal: hard luck, just take it as it is. I’m thrilled by that.”
I think people would look across the bridge from England with great envy at the things Wales has achieved in the profession, for patient benefit but also for optometry
Importance of responding to the consultation
Morris emphasised that the consultation exists to allow optometrists to work with those that represent them, including Optometry Wales, the Welsh Government, and other stakeholders, and to ask the questions that will inform the decision-making process.
“It’ll let them know what questions remain to be answered and what things they might need to look at again, in terms of setting up the contract, or in renegotiation of it,” he said. “There is a period of reflection, now, where people can air their concerns constructively.”
Evans also encouraged optometrists working in Wales to have their say.
“This is such a super, big change in the way optometry works. It’s a fantastic opportunity, and if we want it to work the way we want it to work, we have to have a say on it,” he said. “We can’t ignore it. You can’t complain afterwards if you haven’t put in the effort. It’s a bit like not voting and then complaining about the government.”
Morris would like to remind optometrists of the positive relationship that the Welsh Government has with the profession.
“There’s a really good relationship and a healthy respect between the profession in Wales and Welsh Government, and vice versa,” he said. “The principles are the right ones. It is optometrists working to a higher level, fairer reimbursement for professional fees, and different scales dependent on the level of qualification and the effort involved.”
This is such a super, big change in the way optometry works. It’s a fantastic opportunity, and if we want it to work the way we want it to work, we have to have a say on it
Morris continued: “It is really important that registrants are responding to consultations. We should applaud the thinking that is good, and we should raise questions about thinking that we consider might need some further work or points of clarification.
“The tendency for most is to rail against the things that they don’t like, but we’re very privileged in Wales to have a progressive government, who are moving in the right direction in many aspects.”
It is also important to remember that the process is ongoing and there will be further negotiations, Morris added.
The consultation, he believes, is “a great exercise, not just to inform the thinking the Welsh Government, but also for the profession to show what it is that they would like to be considered and the gaps in their knowledge or the communications.”
He is looking forward to seeing the details that will allow clinicians and business owners to really begin to plan, he said.
He added: “There will be lots of time in the future for us to build and negotiate, and to make sure other elements come in in a way that serves not only the needs of Welsh Government and our communities, but also the profession, so everyone wins.
“Having your thoughts in there is only going to help that. It’s only going to help fuel that thinking for now, and for the future.”
Evans echoed the sentiment: “We have to wait and see this pan out,” he said. “We have to run with it as it goes along, and be prepared to adapt.”
He added: “The greatest quality of human beings is our ability to adapt. We can’t stay in the past. We can’t do what we've always done. Change is important, and we do have to adapt, and we will have to continue to adapt, so we have to be prepared to do that in the future.”
Lead image: Stephen Evans performing a sight test in his Swansea practice
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