It was with an air of disbelief that I read in the June 7 Days news section that ‘Optical bodies welcome primary care report.’ I had read this report in full on the day it was published and, the more I read, the more my heart sank. Having seen this apparent endorsement of the report by the optical bodies I re-read it just in case I had got things wrong. Sadly, my first reading was indeed accurate. The biggest problem with the whole report is that the term ‘primary care’ in the very greater part means the GP sector of primary care.
Given that the report is written by a GP, it may come as no surprise to many that most of it focuses on GP care and GP structures. Repeated references are made to changing primary care structures, but this means changing GP primary care structures. Opticians get a mention in the first paragraph of the introduction, where they are grouped with a few other ‘dedicated staff’. This is where my worries were ignited. The fact that the term ‘optician’ was used showed an immediate lack of understanding of our status. As we all know, the title optician is not a protected title, and at best could only refer to ophthalmic opticians. Did this mean that, from the outset, there was a fundamental lack of knowledge of our role?
There is only one other direct mention of a possible role for us on page 15, under the heading of ‘preventative healthcare’, where it talks about the role of ‘the wider primary care team’ in prevention. It suggests we have a role on aiding ‘positive lifestyle choices’ where it says, ‘eye checks where people are offered brief advice on alcohol and smoking and referred for smoking cessation as appropriate.’ And that is it.
There is nothing in the report about how optometry can and does currently play a massive role in deflecting masses of work away from GP practices under models of care such as Minor Eye Conditions Services, and Covid-19 Urgent Eye Services. It would appear we can talk about alcohol and smoking, with no mention of funding models of course, and that is your lot. Optometry does not get a single look in within the examples of best practice used anywhere in the document and yet, as we all know, there are some excellent models of care where optometry plays a pivotal role throughout the country.
Most alarmingly, there’s a significant amount of talk about the need for integrated data systems and how integrated primary care will only work with proper information sharing. This might sound like a good thing, but having read the document twice now, it is clear that this is referring to how GPs (meaning primary care) can communicate more effectively with secondary care. There is a lot of talk about improving links between primary care (meaning GPs) and secondary care in the acute and emergency sector, while being unaware of the great systems optometry has already put in place for eye emergencies. There is no mention of how this model developed so rapidly through Covid and continues to work well.
Optometry has led the way in these models of care in so many ways, and yet is unmentioned. The fear is that, if data systems are developed between GPs and secondary care and optometry is excluded, we may well find ourselves in the situation where we then must refer patients to their GP to access secondary care eye services. Where does that leave all the cataract and macula services?
There is a lot of talk in the report about new funding, but it clearly relates to the way GPs are funded, so don’t expect anything to be coming our way anytime soon. There is much on recruitment and retention of the workforce and incentivisation for that, but again it clearly only relates to GP practices. There is also a lot on estates and how to manage and fund those, but again nothing about eye care services and premises.
In conclusion, this is a report written about the state of NHS GP services and how they need to modernise, with suggested steps to achieve that. It is written by a doctor and is clearly biased towards GP service provision and, from the point of view of primary eye care services, shows scant regard other than allowing us to talk to smokers and drinkers about how they ought to change their ways.
The biggest worry is that it has been signed off and welcomed by the leads in the new NHS structures who will implement the reforms in which we do not feature. Worst of all, it has been endorsed by our optical bodies, where they should have been screaming from the rooftops about how we should be the model for much of what was in the report as we have already implemented many changes along the lines of what is suggested, and that we must be front and centre in all reforms involving eye healthcare. Currently, if this report is anything to go by, we stand to miss out massively in this latest round of reforms.