Optegra York
There has been a spate of openings by eye care clinics in the last year to meet a rise in the demand for secondary care services. Post-pandemic, these independent providers are in prime position to alleviate pressures on the NHS and offer patients local support. These openings have also created opportunities for primary care optical practices and optometrists to play a larger role in the patient journey beyond the referral.
Newmedica is one of the providers that has expanded its capacity for existing services with eight new dedicated eye clinics and surgery hubs since March 2022. The company says it is caring for more patients, rising from around 19,000 monthly appointments during 2022-23 to an average of more than 24,000, with a 50% rise on the previous 12-month period.
Rebecca Lythe, managing director at Newmedica, tells Optician: ‘More patients are choosing Newmedica because of our emphasis on providing exceptional personalised care, which makes them feel comfortable and at ease, plus short waiting times so they get their first appointment within a few weeks and surgery in less than six weeks for cataract surgery.’
Lythe says Newmedica is unique in the market because each of its clinics are owned and led by the consultant ophthalmologists providing patient care. ‘We build state-of-the-art facilities and choose to offer the highest quality lenses for NHS as well as private (self-pay and private medical insurance) cataract patients as we know this approach gets the best clinical results for patients,’ she explains.
The vast majority of Newmedica patients receive NHS care across a range of treatments, such as glaucoma, YAG laser, oculoplastics, age-related macular degeneration (AMD) and diabetic retinopathy. ‘We aim to have a strong working relationship with integrated care boards (ICBs).
'We want to partner with the ICBs, helping them and NHS trusts to provide the services their patients need and to tackle waiting times. Likewise, we engage regularly with the NHS through both direct channels and via our membership of the Independent Healthcare Providers Network (IHPN),’ Lythe says.
Lythe adds that optometrists are integral to the delivery of its ophthalmology services with involvement during pre and post-cataract assessments, as well as managing patients with glaucoma and wet-AMD.
‘The core skills of optometrists mean they are well placed to support ophthalmologists in delivering world-class care in local communities. Many of our services employ optometrists who want to use enhanced skills to expand their scope of practice as part of the outpatient clinic team.
‘We introduced a training programme to train optometrists on how to complete YAG capsulotomy and are sponsoring candidates to complete higher level glaucoma qualifications or independent prescriber qualifications too,’ she says.
Critical to this process, Lythe says, is building close relationships with optical practices in the community, particularly when a patient’s journey with Newmedica often starts from the point of referral. ‘Our service engagement leads speak to staff across hundreds of practices on a regular basis to understand how we can optimise our partnership and work more closely with them,’ Lythe adds.
Newmedica’s working relationships with optometrists is at the heart of enhancing patient care now and in the future, Lythe explains.
As demand increases, so too will the need for optometrist and ophthalmologist to work closely together, to ensure the best care for patients.
‘We will continue to support optometrists, so they have the tools they need to support patients through the stress and worry of being told they have an eye condition, and to provide ongoing assistance post any treatment.
‘We’re also committed to supporting the professional development of future optometrists and arranged, for example, hospital placements for more than 100 pre-registration optometrists in the past year, as well as providing CPD events for more than 1,000 optometrists.’
An ageing population is increasing the demand for eye care services and Lythe believes optometrists are well placed to diagnose and manage a broad range of ophthalmic conditions and help ease the pressure on ophthalmology services.
‘Higher qualifications elevate their level of clinical responsibility and allow them to deliver a much wider scope of care. The awareness of optometrists being the first port of call for all eye care problems will continue to increase among the general public,’ she adds.
New frontiers
Optegra is another provider that has grown over the past year with clinic openings across England from Newcastle to Brighton, as well as an expanded offering to meet demand at its existing sites with second theatres opening.
Richard Armitage, NHS director at Optegra Eye Health Care, tells Optician: ‘As well as our private provision growing year-on-year, including private cataract treatment with specialist lenses, and vision correction options; we have hugely increased our NHS provision.
We have gone from carrying out 3,000 NHS cataract operations in the year prior to Covid, to 30,000 in 2022. This increased to 47,000 in 2023 and we anticipate completing around 55,000 in 2024.
‘Our new clinics are proving very successful and have been well received by community optometrists and patients alike as we can provide local, high-quality treatment with a short wait time of just six weeks from referral to treatment.’
Armitage explains demand for NHS cataract surgery increased as the nation continued to face extensive waiting lists, which Optegra responded to by building relationships with ICBs and NHS Trusts. ‘In addition, we are seeing a steady growth in demand for our vision correction procedures as these sophisticated treatments allow more and more people to be spectacle free,’ Armitage adds.
As well as alleviating resource and finance pressures on the NHS, Armitage says patients are increasingly aware that they have a choice when it comes to their treatment. ‘They can ask their community optometrist what the options are in terms of location and wait times and we can deliver speedy excellent outcomes so many are choosing to come to Optegra,’ he says.
Optegra completed 47,000 NHS cataract surgeries across the group in 2023 and 10,000 AMD treatments at its Manchester and Yorkshire clinics. Optometrists are essential to the success of Optegra’s business and provide vital clinical contributions during the patient journey, Armitage says.
‘We have identified that there are opportunities to increase their responsibilities, with the full support of the clinical team and relevant training, which enables them to have a larger role in the patient journey, and hence free up surgeon time to treat more patients.
‘Optegra’s optometrists conduct all the pre-op diagnostic tests and make recommendations on whether a patient is suitable for surgery, cover consent and post-op checks. Our optometrists have also been trained to provide YAG laser capsulotomy. The most common post-op complication is the lens becoming a little opaque in the months or even years after surgery.
'This is corrected by YAG laser treatment, which was previously conducted by surgeons – and indeed it still is throughout the NHS – but at Optegra, our optometrists have been fully trained and upskilled to perform this procedure, to fantastic outcomes. Optometrist-led YAG clinics are a safe and efficient way to ease the NHS waiting lists for treating posterior capsular opacification.’
Optegra optometrists can also undertake the independent prescribing qualification and the group recognises that optometrists are extremely effective in new frontiers of practice traditionally occupied by ophthalmologists, Armitage adds. Optegra also works with optical practices via a shared care programme, which affords patients the convenience of being seen locally at their opticians for post-operative checks after NHS cataract surgery.
‘As technology advances, the administrative process is getting easier, more efficient and safer, so that will also help to speed up the interactions as demand continues to grow. We have recently launched Open Eyes electronic medical record system, which will allow easier sharing of patient information,’ Armitage says.
Additional responsibilities
SpaMedica opened seven clinics in 2023, including its 50th site in total, in North Tyneside, which chief medical officer Alexander Silvester says was a big milestone for the provider.
‘Launching in new locations has allowed us to provide exceptional care to more patients as demand for services increases and to support the NHS in reducing surgery waiting times, as well as helping minimise health inequality across different regions.
‘Our focus on bringing care closer to home is more aligned than ever with the NHS objectives of delivering the best possible care to local communities,’ he tells Optician.
Silvester says an ageing population is driving demand for cataract services and ‘tens of thousands of NHS patients’ have received care at SpaMedica with nine of its clinics also offering private cataract surgery. ‘We have an excellent working relationship with the NHS and are privileged to be able to work closely with ICBs across the country to provide patients with the best possible care and alleviate the pressure on local services in the aftermath of the pandemic,’ he adds.
SpaMedica employs 100 optometrists nationwide, who all have roles in pre-operative assessments and post-operative consultations in cases where the patient’s referring optometrist does not have the necessary training to do so.
‘The role of a SpaMedica optometrist is varied. Once they’ve completed our extended training programme where they learn additional theoretical and practical skills, they have the opportunity to work across our cataract, medical retina and YAG services. We also have a number of senior optometrists who manage our regional teams,’ Silvester says.
Silvester shares that by working with optical practices in the community, patients can receive a fully joined-up experience with lower waiting times than the national average. When asked how the role of optometrists will change, Silvester notes that no two days are the same at SpaMedica and there is scope to take on additional responsibilities.
‘All of our optometrists learn their craft in the cataract service. From there, they have the opportunity to train in medical retina reviewing, AMD injecting, YAG theatre and independent prescribing. They are also able to work from home, triaging patients who are calling in with clinical queries,’ he adds.
