“Optometry has a critical part to play in helping the NHS tackle the backlog”

These columns are another such marker. Every couple of months, I receive a polite reminder of the deadline, followed by a series of slightly less polite reminders as successive deadlines pass. Then, when guilt overcomes me, I sit down and crank something out which I send into the ether and move onto the next pressing action.

Somehow, in that process, I forget that somewhere, sometime, someone may actually read what I write. So, it came as a slight shock recently when I got an email regarding my description of local opticians “doing a decent trade” in my last column. My correspondent, an experienced and influential individual, gently questioned the effect such wording may have on the sector’s drive to extend the clinical reach of their activity.

He had a point. One of the key battles over the next few years is to persuade government that optometrists are a key part of the primary, and acute, healthcare system, trained medical professionals to be valued alongside dentists, pharmacists and GPs. It is not for nothing that the AOP fought to get optometrists priority access to vaccination and personal protective equipment during the early days of the pandemic. We are now pressing to see proper representation as part of the primary care networks in the new commissioning structures created by the Health and Social Care Act.

With optometrists available on every High Street and little or no waiting lists for community eye care services, it makes simple sense that routine cataract follow-ups and the like are done in a local optical practice rather than in an overcrowded and expensive hospital setting

As this edition of OT discusses, optometry has a critical part to play in helping the NHS tackle the backlog of need created by the pandemic over the past two years. Given the shortage of ophthalmologists and the size of hospital waiting lists, it is essential that we find ways of channelling clinical work out of secondary care and into the community eye health system. With optometrists available on every High Street and little or no waiting lists for community eye care services, it makes simple sense that routine cataract follow-ups and the like are done in a local optical practice rather than in an overcrowded and expensive hospital setting.

But – and this is where the word “trade” perhaps does make sense – it is important to remember that optometry is predominantly a private sector profession, and that the community eye health system is largely paid for, not by NHS funds, but by the profit made by optometrists’ retail activity. Much of the clinical work undertaken by optometrists is either done at cost or, in the case of general ophthalmic services (GOS) sight tests, massively subsidised by the sale of spectacles. The vision of optometry moving from a predominantly retail model to a more clinical one is by no means universally shared across the profession; there are still a significant number of optometrists who tell me that they have no real interest in doing more clinical work. For them, the costs of moving to a more clinical model are too high and the potential rewards too low to justify the risk of change.

If the sector is to continue to thrive and flourish in the coming years, diversifying income away from a pure dependence on retail will be vital

In the short term, that may be a tenable view. However, given the rise of online retail and artificial intelligence-enabled refraction, one has to wonder how long the retail model will hold. Yes, there will always be a market for a bespoke, high-end service. But it is no surprise to see one large multiple moving towards a more clinical model, with senior leaders in the sector also throwing their weight behind Optometry First’s three test sites in in Sefton, Bassetlaw and the Isle of Wight. They know that, if the sector is to continue to thrive and flourish in the coming years, diversifying income away from a pure dependence on retail will be vital. At the moment, it is still reasonable to talk of opticians “trading.” In years to come, I hope that word may become far less appropriate.