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LOCSU has been pivotal in developing enhanced service pathways for conditions such as glaucoma and diabetes. Its accredited pathways give LOCs the tools to use in their negotiations with their local commissioning groups. The research, supported by an educational grant from Novartis Pharmaceuticals UK, was designed to measure the involvement of practices in schemes, determine how decisions to take part are made and establish awareness of the lead bodies involved.
In July of this year 450 respondents in England with an average of 10.5 years of experience completed the questionnaire. Independent practices made up 61 per cent of respondents, multiples 21 per cent, franchises 10 per cent and supermarkets 3 per cent of the sample. Of those taking part optometrists accounted for 68 per cent, dispensing opticians 24 per cent and contact lens opticians 8 per cent.
Positive attitudes
Attitudes towards community eye care services are generally positive with a little over one half of practices already involved in a scheme. The choice not to participate has been made by just 2 per cent of those quizzed. Around 10 per cent said they would participate in a scheme if one existed in their area, another 8 per cent is still waiting to make a decision and 14 per cent admitted to not knowing anything about the community services on offer.
Among those not currently participating in a scheme, half said they would like to get more involved but they were not the decision-maker in their practice. Just under a quarter said they saw no benefit in terms of income or footfall to set up a scheme. The proportions not sure why their practice wasn’t in a scheme or didn’t understand community services both stood at 13 per cent, while the remainder offered other reasons for not taking part in enhanced services.
The decision-maker on the involvement in schemes was the practice owner in 68 per cent of cases, head office in 11 per cent and an optometrist other than the owner in 10 per cent of practices. Dispensing opticians not owning the practice or regional manager made the decision in 3 per cent of cases.
The benefits to the practice of participating in a community service was recognised by 43 per cent as improving the profile of eye care services and the profession, while a quarter saw it as an opportunity to use clinical skills and a fifth saw the benefits as customer retention and increased business.
Other benefits suggested by respondents included a faster and better service for patients, a greater variety of work for eye care professionals and its role as a practice building exercise. Less positive comments included the expense of supplying services and being coerced into providing community services for fear of losing patients.
Overall favourable opinion towards community eye care was strong. When asked about eye care in their region 18 per cent were very positive, 36 per cent fairly and 29 per cent neither positive of negative. While 7 per cent didn’t know anything about services just 9 per cent were fairly or very negative about them.
Barriers and threats
When asked about the barriers to the development of community eye care the threat of cheaper services being offered by competitors was cited by 36 per cent. Objections from ophthalmologists or other stakeholders was suggested by 34 per cent and lack of interest among commissioners by 31 per cent. A similar proportion saw lack of buy-in from the profession as a barrier while a quarter said lack of interest from practice managers. Lack of skills was suggested by just 16 per cent. Verbatim comments from respondents pointed to issues such as lack of knowledge among GPs or lack of communication.
Understanding of the changes which took place to the way the NHS commissions healthcare and scrapping of the primary care trusts was very strong. An overwhelming eight in 10 were aware of April’s reforms to the way in which the NHS commissions community services and most respondents saw these changes as an opportunity. Awareness of the NHS reforms is greatest among practice owners and optometrists but optometrists and DO saw the potential opportunities brought about by the changes. The pressure on budgets may mean more commissioners considering community services said 45 per cent with optometrists holding this view most strongly. Optometrists also lead the 28 per cent who saw the NHS reforms as an opportunity to start fresh negotiations with commissioners. The financial benefits and retention were seen by 22 per cent with a greater number of DOs reporting this view. The same percentage didn’t expect any benefits to flow.
When asked where they find information about community eye services, half said they would use publications, such as Optician, while 39 per cent would look to LOCSU. LOCs were the information source for 35 per cent while 35 per cent would use optical industry websites.
To aid understanding respondents’ involvement in their LOC was established and the research showed that of those taking part in the survey 17 per cent were committee members, 80 per cent were not committee members and 3 per cent didn’t know what an LOC was. Among committee members most were practice owners, independents and optometrists.
The perception of LOCs showed that 41 per cent considered them inclusive and representative with this view being most prevalent among independents and optometrists. Verbatim comments showed some misunderstanding about the nature of LOCs. Comments suggested that LOCs were considered to be mainly for independent practitioners (34 per cent), a misapprehension more likely to be held by those working in multiples (47 per cent) than independents (27 per cent).
Around a fifth (19 per cent) said they thought LOCs were not for DOs, this was a view much more likely to be held by DO themselves (51 per cent) with just 8 per cent of optometrists suggesting LOCs were not for dispensing opticians.
Those taking part were also asked about their awareness of the public health indicator for eye health which will measure the rate of preventable sight loss for the three main causes of glaucoma AMD and diabetic retinopathy. A sizeable 38 per cent had never heard of it, 31 per cent had heard of it but didn’t know what it was and 24 per cent were aware but had no plans to make teams aware. Just 7 per cent were aware of the PHI and were actively involved with their LOC making public health team aware.
A round table to discuss these findings and attitudes towards community services will be held by Optician on September 19. ?