I had hoped to finish this year on an optimistic note about our future within the NHS. However, I am beginning to wonder if there really is any future at all for what we currently know as General Ophthalmic Services within the NHS.
This is backed up by the results of a recent survey carried out by Graham Hutchison at the Independent Marketing Partnership showing that 20% of independent optical practices were definitely or seriously considering ending their supply of NHS services and going fully private within three years. Will this affect government thinking towards primary eye care services in this country? My bet is that they could not care less.
The problem is that the Department for Health (DfH) and Social Services does not seem prepared to recognise optometry and the services that this eye health care sector provides even to the smallest degree. This is made worse by a succession of Secretaries of State who seem utterly unaware that these services even exist. Let’s just take a look at two of the latest pronouncements from that department.
Firstly, all NHS front line workers will need to have received two doses of Covid vaccine by April 1 next year to continue face to face work with patients. Reading on, a front-line NHS worker is defined as one who works in an area that comes under the auspices of the Care Quality Commission (CQC). While thankfully, due to the DfH’s lack of understanding of eye care services in this country, we are not burdened by the CQC yet this means optometrists, dispensing opticians and their practice staff will all be exempt from this ruling. However, in a dental surgery they will all be subject to these requirements. This is absurd. Surely someone in the DfH understands the risks posed both by and for optometrists when seeing patients. Is there some kind of magic that prevents an optometrist who is carrying out multiple sight tests in a care home from transmitting Covid-19 to residents or staff in that home?
The edict is crass and shows a total lack of understanding both by the Secretary of State and the whole of the DfH. But is that the only bit of nonsense announced recently? Sadly not. In an effort to relieve the referral burden into overstretched hospital out-patients departments the Secretary of State (is there a coincidence that title can be shortened to SOS?) announced a system known as A&G, or Advice and Guidance. Taken directly from the NHS website under the heading of the ‘Elective Care Transformation Programme – best practice solutions’ in answer to the question why use Advice and Guidance? The answer is: ‘Mobilising A&G services will help transform the way referrals are managed by improving the interface and facilitating shared decision making between primary and secondary care. Through better enabled communication, A&G provides GPs with access to consultant advice on investigations, interventions and potential referrals. This helps manage non-urgent (elective) patients in the most appropriate setting, helping reduce unnecessary referrals into secondary care.’
Yet again the DfH and the NHS show little or no understanding of primary care and the role optometry plays in it, still choosing to believe the NHS only consists of doctors, nurses and hospitals. GPs will be expected to drastically cut referrals to secondary care across a range of disciplines, including ophthalmology. This will be done by, as pointed out in Pulse Magazine, ‘accessing specialist advice by telephone or IT platforms rather than referring patients for a hospital investigation.’ One London CCG aims to reduce the number of referrals by 65% by this method. Naturally local medical committees have immediately said they want to be paid extra for this service! At least another £12.50 per episode. But where does that leave optometry? Yet again the DfH and the Secretary of State appear to have no understanding whatsoever of how the NHS works. Literally thousands of referrals are made by optometrists each year to their local eye clinics. Under this system, either massive investments in IT platforms and time will be needed by optometrists seeking to speak to overworked ophthalmologists prior to referral, none of which will be funded. Or we will need to revert to referring those thousands of referrals back to their GP who will need to go through the A&G process with the patient using their massive knowledge of eye care conditions. Can you imagine the reaction of GPs when faced with thousands or referrals that, until this new idea was brought in, were managed perfectly by optometrists?
These two examples show the ongoing nonsense towards eye care services in this country shown by the DfH. Until the DfH and the Secretary of State are prepared to acknowledge the role optometrists and other primary care clinicians play in making the NHS work maybe the time has come to walk away from the NHS altogether. Many optometrists have begun to realise this. Perhaps 2022 should be the year where top of your New Year resolutions should be to quit the NHS and GOS services altogether and start to offer proper effective eye health care services for your patients.