Over the next four months, optician will be publishing a series of dedicated issues looking at the potential impact of the proposed eye care pathways on the future of the eye care professions. Irrelevant side issue or the start of proper funding for an integrated eye care service with practitioners at last being recognised and remunerated for the professional services they offer?
Here, Bill Harvey explains the reasoning behind this series and introduces some of the highlights to come
Over the last few years there has been a continual trickle of news items describing the so-called eye care pathways which, it has been argued, will encourage the best use of resources for primary care trusts to improve access to and standard of eye health provision throughout the community.
There are several points raised by these proposals which are worth consideration. First, some money, albeit inadequate in many people's eyes, has been earmarked by government to promote better eye health. Second, the role of optometrists and opticians in the community as specialised eye professionals is being acknowledged at levels of government previously apparently unaware of the very existence of such practitioners.
As changes to the legal framework under which optometrists and opticians work take place in the coming months, the pathways illustrate one of the areas where the role of practitioners may well change, and their involvement in managing various patients becomes more significant. A cynic might argue that the pathways are a 'sticking plaster' remedy for an overburdened health service unable to cope with the demands of an expanding and increasingly elderly population. A more positive view might be that current eye care provision does not make best use of available resources resulting in poor access to hospital departments, specialised professionals and continuity of care, and that new approaches are imperative.
In the coming months we will be looking at each of the pathways in turn, beginning this week with visual impairment. This will be followed by cataract, then macular degeneration and finally glaucoma. Each issue will include a GOC-accredited CET article, and articles by professionals, politicians and patients themselves in an attempt to paint as broad a view of the proposals as possible. Major players in ophthalmology, optometry and politics will be included to help build a picture of the various ways eye disease may be better tackled within the communities with optometrists and opticians involved throughout.
This week we include a short article by minister for health Rosie Winterton who describes the Government's view and reasoning for the cash injection. Geoff Roberson outlines the role of PCTs and underlines why, if our profession is to play an influential role in the development of new eye care pathways, we need to understand the political structures to allow this. There is an outline of the low vision scheme introduced in Wales (funded by the Assembly) which serves as an excellent example of how great an impact a well structured and resourced approach to community eye care may benefit a great many people.
Visual Impairment
A visual impairment pathway is long overdue if the 'fragmented' approach to vision care for the impaired much reported on in this journal is to be improved upon. There is already a very disjointed availability of low vision aids and help throughout the UK, some areas already providing an excellent service while others, more typically, are serving a less useful function (see panel).
One major development has been recognition of the importance of interaction between professionals if appropriate management is to be introduced. An optometrist or, indeed, an optician is in a good position to prescribe and advise upon magnifying devices. However, there is a move, at last, away from viewing people as 'human ray diagrams', with an assumption that knowing their level of vision and what they wish to achieve will allow a magnifying device to sort out all their problems. Social and psychological factors are at last being recognised as important, as well as the need for an integrated approach to follow-up and training and therapy if required. For this to be effective, a number of different professionals needs to be involved, including rehabilitation workers, social workers, qualified teachers of the visually impaired (to name but a few), as well as optometrists and ophthalmologists. The more progressive schemes already in operation have recognised this and involve a variety of professionals.
One of the pilot schemes currently under development is one for the Wandsworth, Sutton and Merton PCT (in which optician is located). Like most of the pathway pilots, the scheme is currently being introduced and the first results are expected mid-2005 with a view to add to the date being collated by the end of the year for assessment of the success or otherwise of all the pathway pilot projects.
The pilot has developed from an original scheme employing five local practitioners funded by the PCT to provide a more dedicated low vision assessment to patients highlighted as needing such. In the pilot scheme, a much greater number of community optometrists will sign up to identify patients among their base who might benefit from further assessment. They will also issue a leaflet to the patient of what services and help are available, an appropriate RNIB information booklet and a declaration for transfer of records to be signed by the patient. They will then be referred to one of several dedicated local resource centres where a more in-depth low vision assessment will be carried out and aids loaned and advice and help offered if needed. Both OOs and DOs will be trained to carry out the assessments - a full eye examination having already been carried out by the referring optometrist who must also have decided whether medical intervention is needed. The first referrals are expected mid-February this year.
Some typical comments of patients seen at the Visual Impairment Clinic at City University in recent years