Our response to the UK COVID-19 Inquiry

The Association of Optometrists (AOP) is the leading representative membership organisation for optometrists in the UK. We support over 82% of practising optometrists to fulfil their professional roles to protect the nation’s eye health. The AOP has a core purpose to serve, protect and promote the interests of our members and, through them the nation’s eye health. A key part of our work is in ensuring the AOP is a leader and catalyst of improvement and change across the UK within a changing landscape of healthcare commissioning and delivery, and the increasing challenges around health inequalities and long terms conditions.

A. Responses to the pandemic - what went well and what did not go well

The COVID-19 pandemic has and continues to be a challenge for the entire UK population. The demand on healthcare systems across the UK was unprecedented and the impact it had is still challenging the delivery of timely treatment and care today. Like all parts of the system, optometry services and optometrists flexed their delivery models to treat patients and address the backlog of care. This was informed by a range of guidance and operating procedures produced to reflect commissioning and operating differences across the four UK nations.

We responded to a significant increase in enquiries from members on a wide range of topics including PPE, infection control, testing times, the furlough scheme, and other employment issues such as redundancy. Many members required advice on an ongoing basis, due to changes to the landscape as matters developed, including to government schemes. We have picked up some of these issues in our response below.

What worked well

Clinical delivery - When routine sight testing stopped there was a need to understand the impact on the public, and on our patients. Due to the government policy on financial support and ongoing NHS funding for community optometry services, the position taken was for practices to remain open, with some modifications for urgent and emergency care.

However, initially due to issues around availability of appropriate PPE, most care was delivered via the telephone and video call. Once PPE became available, optometrists went back to seeing patients face to face where they required urgent, emergency or essential care. This included key workers, who needed the provision of optical appliances to fulfil their vital role.

In Scotland and Wales, healthcare systems were swifter in adapting access to optometric care, moving to a ‘hub’ based system of clinical delivery. There is a general view from the AOP and our members that Scottish and Welsh governments reacted more quickly and put support in place faster, while practices in England were ‘in the dark’ and quite scared at times, both by the risks to the pandemic and the impact on their practices/businesses.

It should be acknowledged, however, that the hub-based system had its own advantages and disadvantages and this model would have been difficult to replicate exactly in England.

COVID-19 Urgent Eyecare Services (CUES) - Remote consultation was already in use, albeit in a limited way, by optical practices. During the pandemic, the sector ‘paced’ this approach and co-developed the COVID-19 Urgent Eyecare Service (CUES). In England CUES allowed the primary eye care services to operate in a more networked way by allowing practitioners to co-manage patients in a way which was not previously possible. This has had a longer-term benefit with remote triage and care being used more, allowing clinicians to work more easily together.

What didn’t go well

Patient safety - One of the fundamental problems for optometry practices during COVID was timely access to PPE. Initially optometry was not included in the government’s PPE provision policy despite optometry being an established part of primary care. The impact of this was a delay in practices’ ability to see patients face to face, which not only posed an immediate health risk to patients but also resulted in downstream delays in diagnosis and treatment delays in both optometry and secondary care ophthalmology.

Financial/economic risk – There were significant issues in the sector caused by delays from NHS England in the establishment of appropriate funding mechanisms that supported the essential infrastructure required to provide payment for services not delivered through the ‘usual’ route. This delay caused a significant risk to primary care infrastructure and clinical delivery. Had the sector not come together to ensure NHS England rectified this issue, there could have been permanent damage to the profession and community eye care service delivery. In stark contrast, systems in Scotland and Wales moved much more quickly in establishing and rolling out financial support for optometry infrastructure (the hub-based model).

In June 2022, the AOP responded to the Government’s consultation on Economic impact of coronavirus: Gaps in support. While the measures put in place by Government to provide financial support to businesses there were flaws in their policy. The AOP highlighted groups of Optometrists’ issues that have negatively impacted on the optometric profession:

1. Self-employed people who have not been self-employed for long enough to qualify for the scheme but now have no work because of COVID-19
2. Self-employed people with incomes just above the £50k ceiling for support, who get no help at all as a result
3. Company directors who route part of their income via dividends, even if that income is the result of work rather than unearned investments
4. Employed people who have just changed jobs or were in the process of changing jobs
5. People with "portfolio careers" who derive their incomes from both employed and self-employed work. If their self-employed income was less than 50% of their total income during the qualifying period, they are unable to benefit from the support to self-employed people

B. Examples of how particular healthcare systems worked effectively and efficiently

COVID-19 Urgent Eye Care Services (CUES) – As referenced above, the design and delivery of a new CUES service was established to take pressure away from secondary care, where clinicians had been redeployed and reduce risk for patients.

Supporting key and essential workers – Following the roll out of PPE, optometry practices worked to maintain the vital infrastructure of key and essential workers across the UK by ensuring people had the necessary optical appliances to carry out their job and do so safely. For example – some patients’ were fitted with contact lenses as they were unable to wear their usual spectacles under PPE. Lorry drivers had their spectacles repaired or replaced so they could continue to drive and help with logistics, an essential part of COVID-19 responsiveness. Optometrists also visited elderly patients, repairing spectacles on their
doorstep while the patient maintained shielding or isolation.

C. Examples of how particular healthcare systems were adversely affected

There are a number of examples of where primary optometry services and their patients were adversely impacted by the COVID-19 pandemic and associated policies and plans set out initially by Government and NHS England including:

• Lack of PPE – This prevented access to optometry practices, and increased pressure in secondary care and general practice
• Access to residential homes - Care homes were refusing access to patients as optometrists/eyecare weren’t considered as essential for residents
• Care home operating procedures – Some care homes failed to operate hot and cold entrances, or to permit access to areas with no Covid cases
• Cancellations policies – Linked to the above point, care homes often cancelled patient appointments last minute; indeed, in some cases, just one case in the home would prevent all access as all residents were in effect ‘locked down’. This denied thousands of elderly patients access to eyecare and optical appliances and made it problematic for optometrists safely to care for patients

D. How particular groups of people or geographical areas were affected

Domiciliary Eye Care – The elderly and most vulnerable patients especially those in residential care homes were often the most at risk and the most disadvantaged during the pandemic. In terms of access to eye care, there were a number of issues that increased the health and wellbeing of this patient cohort during the pandemic caused by the lack of access to optometry care.

This lack of ability to access also had a knock-on impact for our optometric workforce, particularly domiciliary optometrists.

An ageing population has heightened the demand for domiciliary services and increased awareness of the important role domiciliary optometrists play. Domiciliary optometrists deliver eye care services to people in their own homes, or residential care when patients can’t get to a high street practice. The COVID-19 pandemic and associated shielding guidance for the vulnerable and for key workers made it problematic to deliver domiciliary eye care services to a group of patients whose eye health is key to ensuring early diagnosis to eye conditions often associated with ageing as well as preventing accidents and injuries caused by slips, trips and falls due to poor or failing sight.

As COVID restrictions were relaxed, there were delays and confusion caused by lack of clarity and guidance from NHS England and Public Health England (now the UK Health Security Agency). This led to a significant negative financial impact for domiciliary eye care providers, given by this point government financial support and furlough schemes had ceased. Furthermore we heard anecdotally that care homes were logging higher than usual levels of falls due to vision impairment but optometrists were being refused access.

Based on the examples provided above we would suggest the following issues should be taken into account for future pandemic planning and response activity:

• The inclusion of PPE for all areas of healthcare with safeguards to ensure primary care services are not missed
• A standard requirement (UK wide) for demand modelling and stockpiles to ensure timely and sufficient throughput into community-based settings such as optometry
• A requirement for planned fiscal support measures for primary care contractor professions to prevent the delays experienced during the last pandemic and that required fast paced development in an environment of significant pressures and redeployment within NHS England

All weblinks have been provided within each section above.

All weblinks have been provided within each section above.

We have nothing further to add at this stage, but please feel free to reach out for further information on any of the issues we have raised if it is helpful.