Optical practices all over the UK took extraordinary measures to provide essential eye care services during the months of strict nationwide lockdown due to the Covid-19 pandemic. More recently practice life has changed again with greater daily footfall due to non-urgent patients being allowed once more. The current status quo is distinct from both the lockdown and the pre-Covid-19 era; a new normal, albeit one that will likely keep evolving for the foreseeable future.
Before looking at the current operation of three independents, it is worth taking a moment to recall how these practices coped as the pandemic took hold.
Catherine McNamara, director and optometrist at Liverton Opticians, Newport, comments: ‘At the onset of this pandemic it was vital to provide as much reassurance to patients that needed to be seen in order to avoid any irreversible sight loss. Patients were understandably very anxious and often slightly conflicted because they were equally concerned about the risk of catching Covid-19 as they were with their eye problems. After triaging the patients to ensure that we only had contact with those necessary, patients were reassured that all precautions would be taken.’
‘Having furloughed all of the staff, I was the person solely responsible for essential eye care,’ says Nigel Robinson, co-owner and optometrist at Robinsons Optometrists, in Whitley Bay.
Nigel Robinson, Robinsons Optometrists
‘At first this was purely triage, working in conjunction with the Royal Victoria Infirmary in Newcastle and GPs. However, one email from a patient led to a late night call to a patient’s home as she described what appeared to be orbital cellulitis.’
Lynne Fernandes director and optometrist at Lynne Fernandes Optometrists, in Bristol, notes that non-furloughed staff were extraordinarily busy. ‘We became very proficient at telephone triage,’ she says. ‘The patients we did see in practice were hugely grateful and needed to be seen. As the eye hospital was quiet, patients referred there were seen quickly and efficiently. We hand delivered contact lenses, glasses, dry eye products, drug prescriptions and milk. It was a lovely reconnection that took us back to the early days of the practice when we personally knew every patient.’
A message created by Camilla LaPorta, optometrist at Lynne Fernandes Optometrists, for the practice’s patients during the lockdown
Asked how operations have changed since the return to a wider offering of eye care, Fernandes sounds a cautious note.
‘There is a difference between being able to offer routine care and it being the right thing to do. We only have two patients in the practice at any time and maintain an appointment only policy for everything from collections to repairs and adjustments.
‘We decided to aim for a contact time with the optometrist of 15 minutes. This encourages the optometrists to be clinicians and decide what is appropriate to do in a test. The dispensing opticians pre-select frames and allow themselves 15 minutes with a patient.’
Changing landscape
Comparing the new normal to the pre-Covid era, Robinson reveals his practice is open significantly longer hours to help deal with the backlog and also highlights longer appointment times, with an additional 20 minutes scheduled per appointment.
‘There’s more emphasis on uptake of advanced examination techniques such as OCT,’ he comments. ‘Our optometrists are presently undertaking their own pre-screening though we plan to move on from this in the next month. The practice is open from 9am until 8pm for four nights of the week to help deal with the backlog.’
The key for McNamara in ramping up attendance is patient confidence. ‘This is paramount and all practices will adopt their own protocol,’ she says. ‘We continue to operate an appointment only practice with a closed door policy. All patients – whether examinations or collections – are given appointments to ensure we minimise numbers in the practice and we can sanitise efficiently between patients. Patients are very receptive to the changing landscape and are happy and reassured to know they are the only people in the practice at any time. This is an advantage of operating a small independent business.’
Liverton Opticians
Of course patients need to have changes in their experience in practice flagged up beforehand.
‘We are very clear about what will happen when an appointment is booked, when a patient arrives and during the appointment itself,’ says Fernandes. ‘The patient is advised of changes, we take history and symptoms by email, scan every patient with an OCT and plan each clinic in detail. During appointments we are being far more directive. Patients have infection checks before they enter, they have to wear a face mask – we provide one if they don’t have one – and have to understand controlling contact time is key.’
Now with patient numbers increasing, furloughed staff are returning to practices, which bring some challenges.
Robinson explains how his managerial team applied risk assessment to individual circumstances so that they could understand the needs of team members and see the bigger picture. ‘We emphasised it was important to not compare circumstances as everyone’s needs are different,’ he notes.
‘The facility to bring back staff part time has helped ease team members back into the workplace,’ says McNamara. ‘We have access to excellent advice and guidance from WOPEC [Wales Optometry Postgraduate Education Centre] and the College of Optometrists to ensure that everyone is fully competent with PPE and our new way of working. Despite this remaining a very difficult and worrying time for patients, practitioners and their families, people have all pulled together and the sense of community spirit has been wonderful. The joined up working with GPs and hospital eye services has been effective and the optometric community has worked quickly and efficiently in proving how adaptable we can be in times of difficulty.’