Optics could be 'flagship' for the rest of NHS

David Challinor reports on optometry's response to DoH questions on the GOS review

Optometry's comprehensive response to the GOS review by the profession underscores and adds to previous discussion about the immediate future of optometry in England.

The Department of Health received the optical bodies' report Primary Eyecare in England - A Vision for the Future in the autumn. That paper envisages that practitioners should be consulted on any changes during October-December this year, so these opening exchanges between optometry and Dr Dilip Chauhan, the project leader of the GOS review, will form important ground setting manoeuvres.

Dr Chauhan's questions clearly show the government's intentions are to focus on how the profession can help the Health Service, by improving patient care via breaking down barriers across the professions, and in so doing helping reduce pressures in secondary care. His questions have been published here before, though aside from the details in last year's report, optometry's representatives have not responded until now.

Optics has told the DoH that where given the opportunity  in Wales through Primary Eyecare Acute Referral Scheme (PEARS) and Glasgow via the Glasgow Integrated Eyecare Service  GPs have proved very willing to refer to optometrists.

'We believe that pressure on hospital eye departments can be relieved,' optometry's response states, 'by either diagnosing and managing the patient's condition in primary care, by transferring a patient's continuing care to community optometrists, or by acting as a triaging service; refined referrals would reduce the number of false positive presentations.'

The optical bodies suggest a PEARS-style scheme could treat conditions such as red eye, excessive tearing, dry eye and blepharitis, and that accredited optometrists could manage primary open-angle glaucoma, diabetic retinopathy, cataract and visual impairment due to age-related macular degeneration.

As to Dr Chauhan's question on how patients should access eye care services from various professionals, optics states that optometry is the natural primary care partner for ophthalmology, so a PEARS-style scheme is a strong possibility for England.

'There are no good reasons for GPs to act as a gatekeepers to these services,' the profession has responded. 'We believe this represents an unnecessary barrier to access and unnecessarily extends the patient pathway as GPs do not have the skills or instrumentation to assess ophthalmic problems.'

GPs should be informed of appointments and outcomes, but in many cases open access to services is beneficial, the profession says.
However, this will mean that England's eye care will be reorganised and expanded, and a 'realistic fee structure' required.

Nevertheless, the profession argues that a move from secondary to primary ophthalmic care could be a flagship for the reorganisation of the rest of the NHS, as it mirrors many of the government's aspirations for the Health Service.  

'There is a huge unmet need in ophthalmic care and this will never be addressed unless there is significant change to the provision of services in the community,' the profession claims.

Optometry has also asked that the unnecessary paperwork between optometrists and GPs when practitioners are required to write a letter of information to a doctor every time they see a patient with diabetes or diagnosed glaucoma  be dropped.

'Very many optometrists find themselves in a situation where they must either breach their terms of service by not sending the GP a report or risk upsetting a good working relationship with that GP by sending unwanted information,' the response tells the DoH.

Optometry has also laid its cards on the table over the profession's sometimes rocky relationship with ophthalmology, and emphasises that barriers in secondary care need to be overcome.

'There is anecdotal evidence from some areas of resistance to both the involvement of optometrists in the care of patients and the development of services in the community.'

Many ophthalmologists prefer to use hospital clinics to provide patient care, but the profession says that this attitude is changing, and local shared care and co-management schemes are increasingly giving ophthalmologists more confidence to utilise the skills of optometrists. 
The profession argues that direct referral has broken down some of the barriers Dr Chauhan refers to in his questions, but more needs to be done to keep optometrists 'in the loop', including connecting practices to NHSnet.

'We believe that a nationally agreed schemeÉincorporating connection to the NHSnetÉwould provide much needed structure and consistency.'
Optics suggests that barriers also exist because of the ignorance among the public and other health care professionals about the skills and services of optometrists and dispensing opticians. The response ambitiously concludes that 'an effective public information campaign' would be needed to accompany any significant change in service provision.

In their answer to Dr Chauhan's questions the optical bodies have given a strong summation that optometry deserves a seat at the table, equal alongside other health professions undergoing change. It certainly gives the doctor and his colleagues at the DoH a detailed picture of the perceived opportunities, and the gripes, optics in England has right now.

The postponement of the conference on the results of the eye care pathways into 2007 suggests there is enough time to debate these areas properly, but the clock for change is definitely ticking.