These are interesting times for primary care optometry. Increasing pressures on the secondary care services, increasing awareness of the potential expanded role of eye care practitioners, and continuing development of specialist skills means we are seeing an extension in the activities in community practices.
In communities with a disparate patient base, perhaps with limited access to secondary care, optical practices able to offer a range of services are taking great strides forward. An excellent example of this is the Specsavers practice in Haverfordwest, where, since taking over in 2006, the director team of Andy Britton and Paul Skoczek have worked hard to embrace all possible enhanced service options available locally and have been heavily involved in the integration of new schemes. I managed to catch up with Andy recently who took time out between his local hospital macula clinic session and practice duties to show me around.
The practice
Career development has always been at the heart of Andy Britton’s approach to practice. After qualification, he worked as a clinical tutor in New Zealand where he routinely honed lesser used skills such as gonioscopy and contact fundus viewing lens use, all of which set him in good stead when returning to the UK and becoming one of the first PEARS accredited optometrists in Wales.
Since then, he has completed his postgraduate diploma in clinical optometry and is currently undertaking IP training, with funding provided by his Local Health Board. Similarly, co-director Paul Skoczek is accredited to undertake services under the Welsh Low Vision scheme. This ethos is passed on to all their staff who are encouraged to take further qualifications, ranging from PEARS/WECE accreditation, through higher diplomas to IP accreditation. One of their dispensing opticians came to the practice from working at the local Morrisons supermarket. Her ability was recognised and she was encouraged and supported to achieve her current position.
The practice has relocated and expanded, and now boasts six consulting rooms, all fully occupied, with four full time optometrists (all EHEW accredited), two pre-registration optometrists, three regular locums, and three dispensing opticians, two of whom provide low vision services. The staff have access to the latest technology with a full range of clinical instrumentation and networking facilities with the wider health care community.
Enhanced services
The practice offers seven-day support for primary care enhanced services, many of which Andy Britton was instrumental in developing. This includes the triaging of eye concerns. ‘We have always stepped up to the plate when making clinical decisions to avoid unnecessary referrals to secondary care,’ he explained, ‘which in many cases would involve a trip in excess of 50 miles.
We routinely remove corneal foreign bodies, eyelashes as well as diagnosing and suggesting treatment plans for the variety of red eyes that present. We also have the necessary skills and experience to safely manage patients presenting with flashes and floaters.’
The team has worked closely with other local practices and the Local Health Board to help manage an overdue appointments triage list of around 3,000 patients who have not been seen in the HES. Bitton’s interest and experience in the hospital macula clinic has led to the practice being instrumental in a local pilot scheme ‘where designated optometrists, under the supervision of a consultant ophthalmologist, perform an OCT-guided review of stable wet AMD patients in primary care. The optometrists make a decision as to whether further anti-VEGF injections are required and refer or review as indicated.
It goes without saying that Haverfordwest Specsavers also offers glaucoma referral refinement and cataract services, the latter including a full pre-operative dilated assessment of the patient with ‘a full explanation of the procedure, risks and an exploration of the lifestyle implications prior to referral to avoid unnecessary HES appointments and to assist in prioritising those in urgent need.’
The community
I believe one of the ways that primary care eye health services in Wales and Scotland are making clear advances is in improving awareness of what is offered by high street practices, both among the public and other eye care professionals. Too often in England, the public think the best place to first present with an eye problem is at their GP or even the local hospital. Andy Britton has taken on the role of community optometrist locality lead for North Pembrokeshire – this is a position that assists with the promotion of the role of optometrists to the local GP clusters and facilitates better working relationships and understanding of each other roles.
He also undertakes lectures to local doctors so all know what services are on offer and can ensure the efficient pathways are adhered to. And, with expansion over the past few years, the practice is very much viewed by the local community as a centre for eye health expertise.
Optician will feature a number of clinical case studies from Specsavers Haverfordwest in the coming months