“Optometry Wales will continue to support the profession through this time of continuous change”
Optometrist and Optometry Wales clinical adviser, Sharon Beatty, reflects on the evolution of eye care delivery across Wales that has culminated in the introduction of Optometry Contract Reform
30 December 2023
When I qualified as an optometrist in 1994, my working day consisted of sight tests and contact lens assessments. Fast forward almost 30 years and I find myself working today in a Hydroxychloroquine Retinopathy Monitoring Service pilot in a Cardiff University primary care clinic. This involves collaborating with ophthalmology colleagues via OpenEyes, a shared electronic patient eye care record. It is one of many new services that are being rolled out nationally across Wales as part of the exciting Optometry Contract Reform developments in 2023–2024.
It is all down to the dedication of the profession in taking on more clinical responsibility, obtaining higher qualifications, and piloting local enhanced services over recent years
The evolutionI clearly remember my excitement when seeing a presentation in a lecture theatre in 2002 about a new service called Primary Eyecare Acute Referral Scheme (PEARS). I jumped at the chance to provide the service even though I had to undergo some training and assessment.
This service brought huge benefits immediately in that I could manage urgent eye conditions without the patient needing to go to their GP or to hospital. A year later I signed up to the new Low Vision Service Wales (LVSW) that fostered new relationships between our practice and local support services, which was a lifeline for some patients. With Contract Reform, this now includes the offer of Certification of Vision Impairment for patients with bilateral dry age-related macular degeneration (AMD).
It didn’t take long before we became the first port of call for all eye problems. Optometry Wales galvanised the Regional Optical Committees (ROC) to provide the leadership required in order to expand our offer of what we can deliver as optometrists and dispensing opticians. The Welsh Government provided essential support and published the Eye Health Care Plan in 2013, setting out a clear vision of how the profession would collaborate with ophthalmology partners for the benefit of patient care. PEARS evolved into Eye Health Examination Wales (EHEW) and by 2016, practices across Wales were delivering repeat measures for suspect glaucoma/OHT, and cataract pre- and post-operative assessments. Dispensing opticians were also delivering the LVSW, and contact lens opticians commenced delivery of urgent care for anterior eye problems as part of EHEW.
With ROC support, enhanced services were also developing in some local health boards for glaucoma, wet AMD and diabetic retinopathy, with hospital waiting lists consistently reduced in those areas. When the pandemic struck in 2020, the Independent Prescribing Optometry Service demonstrated that independent prescribing optometrists could manage 92% of urgent eye care problems that came through our doors, aligning with the Welsh Government policy of ‘care closer to home’ and Prudent Healthcare.
There is still much to do, but I know that Optometry Wales will continue to support the profession through this time of continuous change
ReformOn 20 October this year, the last two decades of work culminated in Optometry Contract Reform, which will ensure that optometrists and dispensing opticians can work at the top of their clinical license.
The Welsh Government’s crucial additional investment to support delivery of five levels of NHS-funded clinical service will support a sustainable solution for the eye care demands in Wales. Our ophthalmology partners have positively supported with progressing our new ways of working. Practitioners have embraced the additional clinical responsibility and obtained higher qualifications in independent prescribing, medical retina and glaucoma to be able to provide these additional services.
As we see in the New Year, I will raise my glass to everyone who has worked tirelessly to make this happen and look forward to the final implementation of all five levels of service by March 2024. There is still much to do, but I know that Optometry Wales will continue to support the profession through this time of continuous change. This revolution in eye care is world-leading and will continue to evolve to meet the ever-increasing needs of the citizens of Wales.
About the author
Sharon Beatty is an optometrist, and clinical adviser of Optometry Wales.