In advance of writing this monthly column, it is natural to look around and see what is topical in the world of optics. Sometimes there is nothing particularly newsworthy and then this month, like a number 11 bus, a lot comes along all at once. Optical issues in the national news, College rebrand and General Ophthalmic Statistics, they all caught my eye.
In the media attention has been brought to the fact that more clinical commissioning groups (CCGs) have labelled cataracts as PLCV, ‘procedures of limited clinical value’. Never has it been more true that ‘a desk in an office is a dangerous place to make clinical decisions’. Have commissioners read the NHS five-year forward view and local strategic transformation plans, STPs, that both focus (excuse the pun) on the aspiration to have more people living independently, able to look after themselves? How anyone in a CCG can get the idea that ensuring good vision is not to the benefit of an individual is beyond me.
At least a light at the end of the tunnel is that there are rumours of CCGs disappearing to evolve into ‘accountable care systems’, that would see commissioners and providers taking joint responsibility for the health of a defined local population and the resources to deliver care services.
Sadly the story emerged in national newspapers of the tragic death of a three-year-old as a direct result of the dangerous driving of a 75-year-old man who had been told not to drive by his optometrist and ophthalmologist due to his poor vision. It is to the credit of the College that they have reiterated their advice to members that if the public interest outweighs the duty of confidentiality, then you should notify the appropriate authority, the patient’s GP and the patient themselves, in writing.
My concern with this is that people are unlikely to take responsibility to speak up and act on something they see is wrong. There is a general reluctance to get involved, perhaps hiding behind data protection or some other issue, when the reality is they will not take responsibility. Given this general nervousness, how many of us would have proactively contacted the appropriate authorities to report the individual in this tragic case. I think a lot would not, but we should.
The College has recently rebranded, which cannot have been a cheap exercise, but was it required? My first thought was that if the rebrand was aimed at their key audience of the optometry profession, surely they already know what the College is about? However, if the rebrand is aimed at the public, I doubt if the public would see a great difference between the old and the new? On reflection, anything that serves to raise the profile of the College in the minds of optometrists and reminds them that we must have a strong College has got to be a good thing.
Finally the national GOS statistics make fascinating reading – clearly I need to get out more – but, whatever your role in a practice, it is worth having a look to see what has happened over the past few years. Allowing for some rounding of the numbers, in England we now complete 13 million NHS sight tests, and there are 12,500 optometrists, of which 55% are female. If we add an estimation for the number of private sight tests, the total is likely to be around 18.8 million sight tests.
Ten years ago the numbers were 10.5 million NHS and 4.7 million private sight tests, 9,000 optometrists and a reverse of the current split as 55% were male. Simple maths tells is that each optometrist now does 1,500 sight tests per year or 33 per week over a 45-week year. Ten years ago the number would have been 1,700 per year or 37 per week.
This raises a whole set of questions regarding manpower numbers and whether there are enough, too many or about the right number of optometrists? The numbers suggest we are now producing more optometrists than are required. It was not an onerous weekly workload 10 years ago, even allowing for some contact lens or community eye health work, but the number of sight tests per week per optometrist has reduced.
However, of course what the raw numbers do not tell us is how the content of the sight test has changed and how many registered optometrists practice full time, part time or not at all. It may well be that different expectations of younger optometrists is to be more flexible with their work/life balance.
Together with increasing numbers of female practitioners, who will be more likely to be engaged with children at the expense of work, the increase in registered numbers may not translate to optometrists in practice.
