The specialist optometrist

Professor Ram Dhillon and consultant ophthalmologists Christopher Bentley and Philip Bloom outline a new training opportunity addressing the future demand for specialised optoms

Although ophthalmology does not feature in the national enhanced clinical areas, it is, for many PCTs, a major local problem. Management of cataract has, however, been given central funding and is a priority for local health economies.

PCTs can include ophthalmology as part of their local delivery plans (LDPs) as a local enhanced service, to enable to deliver the care required particularly in the areas mentioned previously. However, where are the trained healthcare professionals going to appear from in order to manage these services? An opportunity exists for optometrists trained in focused aspects of ophthalmology to offer their services to primary care organisations.

By December 2005 all PCTs should have at least five providers for each speciality from which a patient can choose, if a specialist opinion is required. The Government has also indicated that 8 per cent of such referrals must be to the independent sector.

It is likely that ophthalmologists will form consortia or chambers to bid for this work. This may offer an opportunity for optometrists and ophthalmologists to group together and offer PCTs a comprehensive specialist service out of the NHS.

The caveat is that the optometrists must be suitably trained in those clinical areas in ophthalmology which they will be asked to deliver.

This policy, rather similar to patient choice, will allow money to follow patients. More importantly, general medical practitioners will lead the commissioning, as they did in the far flung days of Fund Holding. The need to access enhanced services will be considerable, with ophthalmology being a major requirement.

Here again a professional link between optometrists and ophthalmologists would provide a strong contender to bid for work. The base requirement will be that the individuals have the requisite skills to deliver the skills. Optometrists will have to have specific ophthalmological skills. The most difficult component to find in all this is the individual who has the skills to work in new ways and under novel circumstances.

Apart from the limited number with the required experience and/or training, there is a severe national shortage of manpower.

Practising in new ways must adhere to the standards of clinical expertise, clinical governance, accountability, audit and many other aspects of modern clinical practice. It would appear sensible and financially prudent to encourage those with a wealth of experience in eye care - optometrists - to engage in some additional training in ophthalmology to assist in filling this large skills gap.

What is required to be a practitioner with a special interest in ophthalmology?

The Royal College of General Practitioners (RCGP) indicated that for GPs this would be the possession of a set of skills that would allow management of care over and above that which is normally delivered. This could be in the area of diagnostics or may be procedural-based skills. For optometrists the same definition would apply if they wished to work as a practitioner with a special interest. These special skills would have to be demonstrated by suitable documentation if based on experience or evidence submitted on completion of an accredited training programme.

It is paramount that any practitioner delivering care at this intermediate tier level has in place a robust clinical governance framework. This is best achieved by locking into systems already established by colleagues in the local acute sector provider. This will also maintain the essential clinical links and allow access to continuing professional development opportunities.

To date, defence unions have not required a hike in fees as the delivery of care should be provided to a level comparable to other clinicians practising at the same level. That is the same parameter that is already used in relation to clinical practice across all professional groups.