In the wake of the pandemic and first UK lockdown, as hospital clinics were being cancelled and community services inundated with acute appointments, I was busy building a new practice.
Unbeknown to me at the time, this was to become the first independent practice in the UK to offer a combination of high end optical retail, specialist optometry services, community ophthalmology delivered by independent prescribing optometrists, private ophthalmology services delivered by consultant ophthalmologists, ophthalmic procedures and hearing care.
Beginnings
When I opened my first practice five years ago, starting from scratch, I aimed to build a premium practice with specialist optometry services and high end optical retail. That said, I had not really thought much beyond opening and surviving the dreaded first two years. I certainly had not envisaged that year five would see us trading as Kent Ophthalmology and offering multi-specialty clinical and surgical procedures.
While I was still working part-time across the East Sussex hospitals, I realised there might be a significant demand for ophthalmology services outside the hospital environment and in the heart of the community. With this in mind, I approached the consultant in my hospital clinic to discuss whether we could start an ophthalmology service at my practice. Mr Kashif Qureshi, or Kash to his colleagues, is a friend and someone whose opinion I truly respect, so I felt I could not really go wrong.
With Kash’s support for my idea, we started with one session a month of general ophthalmology, glaucoma and medical retina clinics. This slowly built up to multiple sessions per week and soon we introduced several ophthalmic procedures to be carried out in the community practice. These included laser treatments and intravitreal injections (IVT) at our new practice in the village of Headcorn, near Maidstone in Kent.
Headcorn Eye Centre
Headcorn Eye Centre was built during the first lockdown and opened in September 2020. It is a multi-disciplinary practice offering an ‘end-to-end’ service from optical retail to ophthalmic surgery. The practice has a retail space, two waiting areas, a diagnostics room, three consultation rooms and a clean room for laser and surgical procedures.
Like most optometry practices, it offers several optician-led optical services alongside specialist optometry services, such as colorimetry and myopia control. But that only caters for around 25% of the patients seen at the centre. The remaining 75% are ophthalmology patients, seen as NHS or private consultations.
In Kent, after a decade of hard work by esteemed colleagues, several IP optometrists are engaged in the delivery of community ophthalmology services, for acute and chronic conditions. We see patients referred to us by optometry colleagues, GPs, hospitals and ophthalmologists. In particular, since the pandemic, we have had many referrals from the 111 telephone service, accident and emergency clinics and via the Rapid Access scheme.
We see patients of all ages with a huge variety of conditions, ranging from dry eye to trauma, chemical burns, anterior and posterior chamber inflammation, retinal tears detachment and many more. Manish Patel and Dr Deacon Harle, both part of the Kent community ophthalmology team, published some data last year showing that our onward referral rate was around 4%. These onward referrals were mainly conditions requiring further laser or surgical intervention.
This service at Headcorn is delivered by Niall O’Kane and myself, both IP optometrists and part of the cohort of 25 optometrists recently trained and certified on surgical and laser procedures (see Optician 14.01.22). We are joined by four consultant ophthalmologists to make up the complete team, with Kent Ophthalmology being used as the trading name for the private ophthalmology services offered at Headcorn Eye Centre.
Being part of a multi-specialty team allows us to offer a more comprehensive service and bounce ideas off each other. We have a team of experienced consultants in medical retina, cornea and cornea-plastics, laser refractive surgery and vitreoretinal surgery. Susan Sarangapani, who consults in oculoplastics and adnexal plastic reconstruction, has recently also joined the team.
The practice is Care Quality Commission registered for surgical procedures to be undertaken on the premises. There is a full surgical suite kitted out with a reclining chair/bed, operating microscope, laser (for YAG procedures and vitrolysis) and a YAG-SLT combo for selective laser trabeculoplasty. We have installed a clean-air system, non-porous walls and clean flooring, things that are likely to become essential in all clinics post-pandemic. All of these investments allow us to now provide treatments such as IVT, persistent chalazia excision, pterygium surgery, corneal collagen cross linking, reconstructive lid surgery, cosmetic oculoplastic surgery, YAG capsulotomy, SLT and many more.
In order to offer this comprehensive service, the practice is also equipped with Spectralis OCT, PentaCam, IOL Master, Haag Imaging Slit-Lamps and a fully-equipped dry eye service clinic which offers IPL, TearLab, Blephex and TruLids.
Future Plans
The procedures suite in Headcorn is a little too small for phacoemulsification of cataracts and vitreoretinal surgery. So, we are now in the process of building a complete operating theatre off-site. The new era of true multidisciplinary eye care in the community has dawned.
- Elion Hyseni is an independent prescribing optometrist and managing director of the Gold Optical group.