Five insights from the National Optical Conference

Local Optical Committee (LOC) members gathered for the annual National Optical Conference at Wyboston Lakes and Resort in Bedfordshire this week (13-14 November).

Alongside presentations from optical and NHS leaders, a series of workshops delved into topics from artificial intelligence, to health inequalities and navigating challenging conversations. Regional workshops provided a forum for LOC members to voice their views on the challenges and opportunities facing their area.

Below OT presents a selection of topics covered during the event.

1 LOCSU is developing a standard service specification for minor and urgent eye care

In her opening address, Local Optical Committee Support Unit (LOCSU) clinical director, Zoe Richmond, announced that LOCSU has been asked by the Department of Health and Social Care to develop a standard service specification for minor and urgent eye care.

Working alongside the Clinical Council for Eye Health Commissioning (CCEHC), the specification will build on the COVID-19 Urgent Eyecare Service (CUES) and Minor Eye Conditions Services that are already operating within England.

“The objective is to improve consistency and reduce the unwarranted variation that we currently have across England,” she said.

Richmond added that the service would reduce pressure on the hospital eye service, support general practice and be centred around the patient.

“Although we are tasked with delivering a national service specification, this will involve local commissioning,” she said.

LOCSU and the CCEHC have been tasked with delivering a draft of the service specification by Christmas.

“That sounds ambitious, but we are not starting from scratch. We have done this before,” Richmond said.

She highlighted that CUES had been developed through sector-wide collaboration under time pressure during the pandemic.

Currently, around 75% of the population in England has access to urgent eye care on their High Street through MECS or CUES.

“What is important is that a lot of these services were put in place in 2020 on two or three-year contracts, and many of these contracts are coming to an end. We need to make sure that we can continue to deliver these important services to local populations,” Richmond shared.

Lastly, Richmond emphasised the importance of gathering an evidence base for the services that are established.

The objective is to improve consistency and reduce the unwarranted variation that we currently have across England

She highlighted that the NOC will provide an opportunity to share insight from different regions.

“We know that there is rich data out there from across England. I am inviting you all to share your data – what is working well? What is not working very well?” Richmond emphasised.

2 NHS England chief strategy officer highlights the importance of addressing fragmentation– and shares his personal experience of eye care

  
In a video message, Chris Hopson, chief strategy officer of NHS England, highlighted the importance of viewing eye care as a whole pathway.

“If you are a patient who wants to have the best possible eye health then we absolutely need to provide a seamless pathway,” he said.

He added that there can be a tendency for elements of the patient journey to become segmented.

“One of the issues we have had within the NHS is the issue of fragmentation – individual institutions focused on their individual success rather than contributing to a joined-up pathway,” he said.

Hopson shared that the creation of integrated care boards offers an opportunity to address this fragmentation.

He emphasised the importance of ensuring that the optical workforce is able to work at the top of their licence.

However, Hopson acknowledged that there are a series of issues that need to be addressed in order to maximise the contribution that optometrists and other High Street practitioners can make.

“Do we want to have a single model that is adopted across the NHS? What degree of variation and opportunity for local innovation do we want to allow? I know that this will be a major feature of discussions over the next couple of days,” he said.

Another theme in Hopson’s presentation was the potential for digital advancements to transform the care that is provided.

“There is a fantastic opportunity that is coming our way… I think we need to work together collectively, with the appropriate investment, to take advantage of the opportunities that providing a seamless, data-driven pathway might provide,” he said.

I experienced first-hand the importance of the care that you provide

Hopson shared a personal story of his own care after an optometrist referred him to secondary care on noticing an abnormal growth at the back of his eye.

“Luckily, my particular case ended up being benign, but I experienced first-hand the importance of the care that you provide,” he said.

He shared his gratitude for the work that the optical workforce does within the community.

“I know that you are doing all that you can to provide the best possible care to anyone who needs it,” Hopson emphasised.

3 LOC case studies: atrial fibrillation, paediatric care and urgent care

  
Optometrist and member of Northumberland, Tyne and Wear LOC, Kaye Winship, shared her experience of improving access to eye care among children.

For the past 16 years, she has worked in South Shields in an area that is one of the 10 most deprived postcodes in the UK.

“During that time, I have learned a lot about health inequalities and I am passionate about addressing these issues,” Winship shared.

She observed that dealing with the needs of patients can be more challenging when there is high socioeconomic need.

“A child growing up in these areas may not have the same opportunities,” she said.

During the pandemic, a school vision screening service in South Tyneside was stopped – leading to LOC concerns about missing uncorrected refractive error and amblyopia in children.

Winship highlighted that this can lead to children disengaging with education and have flow-on effects to employment prospects and social mobility.

The LOC worked with stakeholders to relaunch the South Tyneside Paediatric service in 2022. However, the number of practices offering the service has reduced by a third – from 21 practices to 14.

“That is a real risk that we need to address going forward,” Winship said.

Dispensing optician and Cheshire LOC member, Jill Umpleby, described a service to screen for undiagnosed atrial fibrillation within optometry practices. 

Umpleby highlighted that the pilot, which involved five optometry practices, has the potential to flag cardiovascular risk in a location that is convenient for patients.

“There is an optical practice in every town,” she said.

“Cardiovascular disease prevention builds on the principles of Optometry First. It makes every contact count,” Umpleby emphasised.

Through the pilot, 9% of patients were referred to a GP practice for suspected atrial fibrillation.

Umpleby shared that a patient brought chocolates and flowers to the practice after he had attended his GP practice on the same day and was immediately prescribed medication.

“That feeling is really good so hopefully more people will offer the service,” she said

Hampshire LOC chair, Bryony Allen, outlined how CUES has reduced the burden on the hospital eye service.

As one of the early adopters of Optometry First, Allen highlighted that embedding an urgent eye care service and cataract service proved challenging at times.

“There was often slow progress. It sometimes felt like we were trying to reinvent the wheel,” she said.

However, the services have resulted in significant improvements in care – with hospital eye service statistics for 2022/2023 showing that emergency department activity was down to 71% of pre-pandemic levels. This represents a decrease of 178 appointments.

Kevin Liu, of Manchester, Salford and Trafford LOC, outlined how a single point of access had helped to reduce the administrative burden on practices offering extended services.

Liu highlighted that as the Glaucoma Enhanced Referral Service expanded in Greater Manchester, it began to put pressure on the capacity of optometry practices.

“There were limited numbers of practices delivering the service, and they were becoming overwhelmed,” he said.

Liu shared that providing a single point of access means that patients can access care in a more timely manner.

“It has helped to streamline the process so our patients can be seen more efficiently and effectively,” he said.

For optometry practices considering whether to sign up to extended services, the single point of access had eased any potential concerns about capacity.

“Because of this improvement, rather than dwindling practices and practices dropping away, it has encouraged practices to sign up,” Liu shared.

Prakash Rughani, of North East London LOC, described how a single point of access had unfolded within his area.

A single point of access was introduced by the integrated care board in July 2023 in response to operational guidance recommending electronic referrals between primary eye care and secondary care.

“It is in its early stages. We as an LOC have been involved in the design process. We have weekly meetings with the commissioner to give a primary care point of view,” Rughani shared.

He added that since July there have been 3500 referrals through the single point of access.

Rughani emphasised the importance of the primary care perspective being taken into account when designing a single point of access.

“If there is one message that I would give to you starting this process, it would be to be at the table,” he said.

4 Life lessons from a judo champion

  
Motivational speaker and paralympic athlete, Ian Rose, delivered an after-dinner address on Monday at the NOC.

When Rose was six months old, he was diagnosed with retinoblastoma and his eyeball was removed. Rose shared his experience of bullying growing up.

“I was being teased about the one thing that I couldn’t change – the way I looked. I was going home most afternoons in tears,” he said.

His father, a former wrestler, took Rose to his first judo class hoping that it would boost his son’s self-esteem.

You’re going to have some fantastic days in your life. You’re also going to have some bad days. Here is the trick – they are your days

Rose said that he had his first experience of fight or flight walking into the sports hall.

“I wanted to turn around and run. Frankly, the sport looked like it hurt,” he said.

“My dad turned around and said to me ‘How do you know you can’t do this unless you give it a go?” Rose recalled.

He added that three months after he started judo, all of the teasing at school stopped – not as a result of fighting, but as an effect of the change in the way he saw himself.

After watching the Paralympic Games on television as a 16-year-old, Rose was inspired to train to become a world champion.

He went on to win a bronze medal at the Atlanta Paralympic Games in 1996 and silver at the Athens Paralympic Games in 2004, alongside a host of World Championship and European Championship medals.

Recounting the difference that optometrists have made in his life, Rose shared that up until the age of 25 his thick spectacles set him apart from his peers.

He remembers the first optometrist who asked him what he wanted from his spectacles.

“I said, ‘I want to look normal’,” Rose said.

A new pair of spectacles with thinner lenses made a big difference to Rose’s confidence.

“I started feeling human. I want to say thank you to everyone in this room for affecting people’s lives in such a positive way,” Rose shared.

Rose shared that his parents’ positive outlook has informed his approach to challenges within his own life.

“You’re going to have some fantastic days in your life. You’re also going to have some bad days. Here is the trick – they are your days. How are you going to make the most of them?” he concluded.

5 Janice Foster: “We can pave the way for others”

In her closing remarks, LOCSU chief executive, Janice Foster, shared her experience of growing up with hip dysplasia and being told that she would not be able to participate in sport. Foster went on to take up horse riding and compete at a high level.

She shared with delegates that whenever she is told that she cannot do something, it fuels her motivation.

“The message is that we should never give up and we should always keep pushing forward,” Foster emphasised.

She used the story of the first person to run a mile in under four-minutes as an example of someone who achieved a seemingly insurmountable feat – only for this record to be swiftly broken.

“Others fell in those footsteps and thought ‘It is no longer impossible’,” she said.

In a similar vein, she shared that an overarching theme of NOC conversations has been professionals breaking down barriers in order for others to follow.

“It is important that we continue to do that. We want to transform the ideas that people have about what is possible within eye care,” she concluded.

Main image: A video message from Chris Hopson, chief strategy officer of NHS England, is played at the National Optical Conference.