The optometric profession has a chance to move forward and play a far greater role in patient care, delegates at the National Optometric Conference in Birmingham were told last week. Changes within NHS primary care, while disruptive, were creating opportunities for individual practitioners and local optometric committees alike.
Addressing delegates, Chris Town, acting chief executive for Cambridgeshire Primary Care Trust, explained the rationale behind the changes. Despite increased investment, Town said there were still rising deficits and duplication of effort among PCTs. The 'transformational changes' that the government envisaged had not happened.
The far-reaching changes would make PCTs the custodians of the health care budget, and their focus would shift to commissioning health services, rather than providing them. Within the PCTs, practice-based commissioners would be looking to 'buy' community-based services that would prevent hospital admissions. Such changes presented both challenges and opportunities for optometrists, Town said. The biggest challenge, he said, would be making PCTs aware of the role and capabilities of optometrists.
'I don't think very many PCTs would have any idea of the skills and training optometrists have and what you can offer them. What optometry needs is some champions to change this,' Town said. 'Particularly you need to tell them how you can prevent hospital admissions. They are looking for this because every time someone is admitted to hospital it costs them money.'
Stephen Vernon, consultant at University Hospital Nottingham illustrated how optometrists can prevent hospital admissions, through involvement in the new care pathways in glaucoma. There were an estimated 380,000 glaucoma patients, the vast majority of whom were managed by ophthalmologists within hospital eye services. But, Vernon said, this was not a sustainable situation, given the ageing population and the low ophthalmologist-patient ratio. Shifting glaucoma patient care from hospital into primary care locations would have significant benefits. Not only would it reduce workloads for ophthalmologists but it would also improve patients' quality of life through shorter waiting times and less travel. PCTs, he noted, would benefit from less hospital admissions, and lower costs.
With suitable training and accreditation, optometrists and ophthalmic medical practitioners could become specialists and treat 'straightforward' glaucoma patients in the community. They could also use set protocols to refine who is referred on to the hospital eye services. Hospitals in turn could use these practitioners to assist in glaucoma care within the hospital. In Nottingham, where specially trained optometrists were involved in a pilot care pathway, there was only a 6 per cent re-referral rate to the hospital, which Vernon said was 'much lower than in other areas'.
Pathway pilots
Andrew Kent, who leads the NHS eye care services programme, and Anita Lightstone, head of service development and research at the Royal National Institute of the Blind, provided delegates with a summary of the new NHS eye care pathway pilots for glaucoma, cataracts, low vision and age-related macular degeneration (AMD). The pilots have been established by the national eye care steering group to develop innovative approaches to eye care and to provide services where and when patients can easily access them. 'The idea is to decrease the number of steps for a patient in receiving eye care, so we get them through as early and as quickly as possible,' Lightstone said.
Some of the programmes had gone beyond the pilot stage and were now part of the relevant PCT's mainstream services. The patient benefits were clear, said Kent, but there were also significant benefits for those optometrists who chose to take an active role in the new pathways. 'There are opportunities for optometrists to develop their skills through working with the secondary care sector to deliver specialist services,' Kent said. 'And of course optometrists involved in providing these services are getting proper recompense for their work.'
An external evaluation of the pilots will be carried out by the end of the year and the findings published in a report early next year. However, there was already some anecdotal evidence that the most successful pilots had a local champion to drive the programme - and in some cases this was in fact a local charity organisation. Patient involvement was also crucial, Kent said. The general ophthalmic services review, they noted, would follow the pilot care pathways review.
Such a review has already taken place in Scotland, noted Hal Rollason, former chair of Optometry Scotland, and as a result, optometrists are now contributing far more to patient eye care. Eye examinations are being carried out more quickly and the diagnosis, treatment and referral process is much faster. There has been a reduction in inappropriate hospital referrals and referrals to hospital were of better quality, Rollason said. All of this was important in helping to reduce preventable blindness. Optometrists were playing a greater role in the management of cataracts, glaucoma, AMD and red and uncomfortable eyes and were also more involved in screening of children, diabetic retinal screening and specialist contact lens work.
At the close of the day, Donald Cameron, past chair of the Association of Optometrists, encouraged practitioners to be more adventurous in their work. 'There are areas of optometry which optometrists are not exploring, not discovering, and that is a tragedy,' Cameron said. 'We are over-referring to hospitals and GPs when we can handle these conditions ourselves. We need to educate ourselves and our profession so that we are ready to make decisions about our own patients.'
