Independent prescribing

Optometry should play a wider role in the delivery of eye care, a route towards achieving this is through optometrists qualifying in Independent Prescribing (IP). 

The Independent Prescribing qualification equips optometrists to expand their role to provide safe and convenient access to medicines in the community, research suggests there is support in the profession to play this extended role¹ and IP is a motivating and fulfilling career pathway for optometrists,  which is why we're encouraging more optometrists to consider taking the additional training and qualify.

Barriers to attaining IP qualifications

Qualifications and education

Universities should consider, as educational providers, to incorporate the Additional Supply (AS) qualification into optometry programmes to provide a stepping stone towards IP. As well as innovative educational provision for IP programmes to improve accessibility for optometrists. 

The AS qualification should be re-evaluated for use within MECS with an appropriate list of restricted list of drugs, which should be readily achievable by the majority of optometrists and easy to deliver, furthering optometrists to achieve the full IP qualification.

We understand that the General Optical Council (GOC) is reviewing its standards and rules for IP in 2016, and that the Royal Pharmaceutical Society (RPS) is managing a review of the NICE single competency framework for prescribers². We hope these reviews will provide an opportunity to improve the pathways for IP qualification, and look forward to contributing to this work. 

We run a range of CET accredited courses designed for IP-qualified optometrists. We also run Therapeutics London event that is aimed at the needs of IP-qualified optometrists and those considering training in IP. 

NHS service commissioning 

The ageing population, with its accompanying eye-related issues, makes it inevitable that more services should be moved, as appropriate, out of hospital settings and into primary care. Equipping the optometric workforce to service the needs of the population is a logical step. More ways of using skills post-qualification would be a great incentive to would-be IPs. And commissioned services and issuing of FP10s (prescription forms) would go a long way towards the encouragement of optometrists to undertake the training. 

We urge the NHS, ideally at a national level, to consider commissioning services from community optometrists. This would make use of IP-qualified optometrists for the benefit of patients and for the added benefit to hospital eye clinics in reduced numbers of referrals and the management of patients within the community. This would help to address current capacity issues within Hospital Eye Services (HES) and assist the right care programme.

NHS bodies, which fund and oversee training and workforce issues (such as Health Education England), should support practitioners who wish to train as IP optometrists. 

Sufficient funding 

More investment is needed by the NHS in England, Wales and Northern Ireland to enable a suitable workforce, this kind of investment has been shown to be successful in Scotland.

NHS Education Scotland is already investing in the training of IP qualified optometrists, with an ambitious plan to have Glasgow Caledonian University turning out IP-qualified optometrists within 10 years. That vision for the future of optometry is admirable. Elsewhere in the UK costs to attain the IP qualification are often borne by individual practitioners. We recommend that health education funders in the other nations of the UK develop their own models for training IP-qualified optometrists to meet healthcare needs. Increasing the numbers of IP-qualified optometrists should help increase the number of services commissioned by clinical commissioning groups that utilise their skills. 

Mentors

There are needs to be mentorship and professional support post-qualification, but there are considerable issues finding consultant ophthalmologists willing and able to provide suitable clinical placements, another barrier to optometrists wishing to qualify. There is no formal placement programme for the provision of mentors and because ophthalmologists already have training within their profession it is difficult for optometrists to find placements with them. Allowing experienced IP-qualified optometrists, working in a suitable clinical environment, to mentor aspiring IPs would be a safe and effective way of removing a block in the current system. 

We urge the GOC to consider allowing the clinical placement to take place under the supervision and mentoring of either an ophthalmologist or an appropriately qualified and experienced IP optometrist working in a suitable clinical environment. 

With our partners Local Optical Committee Support Unit (LOCSU) we actively promote the commissioning of community services that can utilise the skills of IP-qualified optometrists to deliver enhanced eye care in the community, and we encourage better training and mentoring to ease the load on providing eye care.

Using core skills or with appropriate additional training, optometrists can provide valuable services to patients and to the NHS in the detection, diagnosis, management and treatment of eye conditions. Recently, legislation has been passed leading to the regulation of the role of independent prescribing by the GOC who have established the only specialist register for optometrists. However, to enable a sufficient cohort of Independent Prescribing (IP) qualified optometrists for the NHS to benefit from, a number of barriers for optometrists seeking the qualification need to be overcome: 

• There is a lack of suitably commissioned services, such as Minor Eye Conditions Services (MECS) within the NHS, hence insufficient prescribing opportunities exist to fully utilise the IP qualification
• Optometrists wishing to become IP qualified do not receive enough financial support
• Not enough training placements are available to provide experience in a clinical setting
• There is a lack of a support network for IP optometrists
• The list of medicines on the exemptions list that can be sold and supplied by all optometrists needs to be re-evaluated

References

1. Needle JJ, Petchey R, & Lawrenson JG (2008) A survey of the scope of therapeutic practice by UK optometrists and their attitudes to an extended prescribing role. Ophthalmic and Physiological Optics, 28(3), 193-203
2. Royal Pharmaceutical Society (2015) Prescribing competency framework

Read the rest of the AOP position statements.