Primary eye care providers in England could be ‘better utilised’ to address the workforce issues in secondary care, says Dr Peter Hampson, clinical director at the Association of Optometrists (AOP).
‘There is a large, well trained, well equipped workforce that could help, but inconsistent commissioning of services that extend beyond the standard sight test are a limiting factor.
‘This approach would mean more care can take place in the community, where there is a workforce expertly trained to help, while reducing unnecessary hospital attendance where there is limited capacity,’ he said.
While optometrists perform sight tests and eye examinations, Dr Hampson says they are ‘qualified and equipped to provide a far wider range of services’.
‘Many have additional, higher qualifications, including the ability to prescribe medications, and even those without higher qualifications have an extensive portfolio of skills that are currently underutilised. It makes simple sense to utilise the full range of skills in optometry, so more care is managed in the community,’ he says.
Training and development opportunities, career progression and work-life balance are ‘the three most important factors students and graduates cite when considering their career options’, says Dr Hampson. ‘The ability to fully utilise the skills that students are taught at university in day-to-day practice would be a positive step,’ he says.
In his column for Healthcare Leader member of the DHSC advisory Eye Health Forum, David Hewlett echoes these sentiments.
‘A conservative estimate is that at least 30% of ophthalmology outpatients could be seen and managed closer to home in primary care in a sustainable way,’ he says. While clinical commissioning groups (CCGs) were too small to commission enhanced primary eye care services effectively or equitably across areas, Mr Hewlett says integrated care boards (ICBs) can fix that by commissioning services at pan-ICB and multiple ICB levels as part of strategic change.
Most sight-threatening eye pathology is age-related, and the need will continue to rise as the population ages. It is forecast that by 2030, without intervention, there will be 9 million ophthalmology outpatients a year, including 1.8 million for glaucoma alone.
‘The good news is that most of this risk can be managed with early diagnosis and treatment. But to do that, we need to transform the outpatient model of care as set out in the NHS Long-Term Plan,’ he adds.
The vehicle for change at an ICB level is locally commissioned enhanced primary eye care services (Level 3 of the national Primary Ophthalmic Services Framework). These services can help prevent referrals, retain more patients in primary eye care for treatment, monitoring and discharge, and provide further options for co-management out of hospital.
As hospital capacity is limited by workforce and estate constraints, it makes sense for ICBs to focus on utilising the available skill and facilities in primary eye care in this way.
Optometrists UK: 14,000
Primary care optical practices/opticians UK: 7,000
Primary care optical practices/opticians: 6,000.
Approximately 95% have an NHS contract, providing 13 million NHS funded sight tests each year.
Trainees: approx 700-800 start post degree pre-reg training each year
Source:Association of Optometrists (AOP).
Training and pay
According to the College of Optometrists, most optometrists complete a BSc in Optometry [at university – this takes four years], and then develop their practical skills through a year of assessed clinical training in practice, called the Scheme for Registration. If they pass the final assessment they are fully qualified and can register as an optometrist with the General Optical Council.
In terms of the NHS General Ophthalmic Services (GOS) contract there has been an ‘erosion of fees by inflation since 2010’, says Dr Hampson.
The GOS sight test fee in England was frozen for five years before a 1.9% increase in 2021, and even so ‘it remains far below the cost of delivering the sight test’, he says. ‘The fee is 25% lower in real terms than it was in 1948, while the test done is far more sophisticated and more costly to deliver than it was then.’