If these things really are cyclical, then we appear to be currently on a down curve towards further devolution and segmentation, inter-regional identity differences, and a questionable move away from unified, flexible and cohesive eye care provision.
This week we publish a short paper looking at how successfully a Welsh government-funded service has improved patient access to care while reducing the load upon expensive (and often inappropriate) medical resources.
But is there geographical variation in patient need or demand? The Welsh service offers clear benefits of efficiency in care for a rural and disparate population. This is a localised logistical advantage which, in a populous yet small island like ours, should never override the obvious need to be able to offer similar eye care provision across the nation. The eye problems challenging the public mainly reflect age and wealth distribution. Local oddities can buck the trend (has anyone out there heard of the Polo mint-shaped Orkney cataract?), but gene pool fluidity has pushed these firmly into the curiosity corner.
So unified services must be fought for. The moves in Wales and Scotland should be recognised and praised as the way forward. CCGs restating the tired mantra of ‘that model simply will not work in England’ must hang their heads in shame – then start fighting for a better deal for eye care services both from fund holders and allied professionals (do all GPs and pharmacists know what we do yet?).
And to emphasise how all change is cyclical, the likely outcome of service unity might be, at last, a more systematic approach to the segmentation of our profession into the optical/refractive and the therapeutic, all a bit of a muddle at the moment.