I do hope you will take time to read the latest issue of Optometry in Practice. Dedicated to Public Health Optometry, it has some great papers and I am sure you will find something of interest whatever your sphere of working.
What is apparent as you read through, is that optometry is advancing on so many fronts and as optometrists, we have the skills and manpower to do more. Much of what we could do to improve the quality of eye care is within core competency areas. It just needs smarter commissioning and contracting for us to be able to improve patient care and increase efficiency in the NHS. However, some of the more innovative services require optometrists to further develop their skills, knowledge and experience.
The paper I and my colleagues authored, ‘The developing role of optometrists as part of the NHS primary care team’, was extremely interesting to research. Examining how optometry was organised and delivered in all the UK nations, I was particularly struck by the numerous examples of good practice around the UK that involve optometrists in helping to manage more patients in the community. It is true that some nations are further ahead than others, but we are all learning. In England, because of the size and complexity, different models have evolved across the country in response to local need and sometimes leadership. However, the main issue here remains; the lack of IT connectivity – something that the other nations are at different stages in addressing, recognising this is clearly a major barrier to more joined up working.
Collectively, we need to be thinking about whole pathways of care and how each part interacts. We urgently need to address capacity issues in the Hospital Eye Service so that patients are not delayed or lost to follow up. In many areas, there is a lack of community provision to be able to discharge low risk patients and new service models may need to be developed. One simple thing which could make a big difference now is providing referral feedback to all optometrists. This system is already in place, along with the piloting of an advice line, at Moorfields in Bedford and has demonstrated a significant improvement in quality of referrals.
National contracts across Scotland and Wales mean that all optometrists working there are commissioned to do more accurate diagnostic tests, recall patients for repeat tests and manage patients with non-sight threatening urgent conditions. In Wales, optometrists lead low vision services to increase access and in Scotland many optometrists are now qualified independent prescribers. Change has happened in Scotland and Wales, through commissioning at scale for their 3-5 million populations. England needs to work out how to commission at a similar scale.
Improving patient access is another issue and we all know that there are groups of people who find it hard to access eye care or who start getting their treatment too late. That includes people with dementia, people in deprived areas, homeless people and others. We need to do much more to help these people access eye care but in the knowledge that, if successful,, we will inevitably increase demand further.
This is an area the College of Optometrists is doing further work on, by reviewing the evidence between uncorrected refractive error and access issues in deprived areas. It is intended that it will recommend some practical steps towards overcoming some of the barriers to the number of people in the “at risk” groups accessing primary eye care.
My congratulations go to all the authors of the OiP and to Dave Edgar and Jonathan Jackson for co-editing this enlightening issue. Finally, I would like to thank my co-writers, Ray Curran, Janet Pooley and Barbara Ryan. It was a team effort and hopefully in a year or so, we will have more to say!