What a strange world we live in at the moment. Not a day seems to go by without the NHS Catherine wheel of desperation spitting out another set of ‘radical’ ideas to save the fast-sinking ship of UK healthcare.
The one area that seems to be conspicuously quiet, however, is eye care. This is made all the more curious by the fact that we are the only sector who is happy with its lot. Every other facet of the system seems either to be on strike, threatening to go on strike or balloting its members about going on strike.
So, why is it that we are so content? Surely it cannot be because we are being paid sufficiently for our NHS services? Is it because we are happy with the contract we have with the NHS? I find that hard to believe.
Why then are we seemingly so complacent? It is the promise we have been given of great clinical strides lying just around the corner that will revolutionise primary eye health care. It would now appear that the pharmacy sector can save the whole of primary care with the government announcing that millions of GP appointments a year will be freed up as patients are re-routed to see their high street pharmacist.
Doubtless, this now means that it will not only be GPs sending their patients ‘to just get your eye pressure tested’ among other spurious things that lie outside the scope of an NHS sight test. It was with these thoughts to the fore when I received notification that funding for the Leicestershire Ophthalmology Triage Service (LOTS) and the Leicestershire Urgent Eye Care Service (LUECS) was to be withdrawn from a scheme in Leicestershire.
The announcement was made in typical NHS managerial speak with comments such as ‘funding to support the LOTS and LUECS was only secured until the end of March 2023 and there is currently no allocated funding to continue into the new fiscal year. Consequently, a decision has been made to temporarily pause this service until future funding arrangements have been agreed. Transforming Ophthalmology Services based on Optometry First will remain a priority for [community interest company] LLR during 2023-24 and we will continue to work on a business case to develop an urgent and minor eye care service. We are grateful for all the support from our community optometrists and will continue to keep you updated as our plans progress.’
The local ophthalmologist has advised in the announcement that, going forward: ‘Emergency eye presentations should be referred to eye casualty as before,’ and ‘All other referrals or patients with urgent eye presentations should be referred to their GP.’
Interestingly, the GPs privy to this announcement gave assurance that ‘the workload of LOTS and LUECS will be absorbed by primary care GP practices.’
As the Local Optical Committee (LOC) pointed out to its members: ‘Under our General Ophthalmic Services contract, many symptoms do not qualify for us to carry out a sight test. Many of us may be seeing patients with, for example, flashes and floaters, epiphora, dry eye, red eye, ocular pain, etc. However, these should really be seen under a commissioned service (such as Mecs). These types of patients who present at your practice or contact you should be signposted to their GP until a commissioned service becomes available.’
This whole situation reflects, very accurately, the parlous state of affairs that exists in reality across our sector. We have little or no representation at a local level across the country when it comes to sensible commissioning of eye care services, despite what we may hear and read.
The simple fact is that, although we can and would, if given the chance, solve a vast array of eye care issues that exist in primary and secondary care, those that should be commissioning these novel services are just ignorant of how to do so and even what optometry is and does.
Even now, the NHS is running education seminars for commissioners on what the eye care sector is and does because they are ignorant of it. That is just how far we are from getting services commissioned locally or nationally.
It seems easier for many commissioners to withdraw funding from successful schemes rather than understand what these schemes are. That GPs think they understand any better also does not help. Given that, in Leicestershire, all optometrists will now be sending every red, sore and irritable eye, etc, to their GPs, I only hope that they have enough hours in the day to cope with this onslaught.
In the meantime, we should take the example from Leicestershire and genuinely work to the strict terms of our NHS contract and see how long it takes the local commissioners to see how vital we are in delivering high quality primary eye healthcare. Maybe then they will see how useless our existing NHS contract is and how essential it is they commission economically viable primary eye care services run by those who have the relevant expertise.