Will 2016 be the year that optometry breaks into the mainstream of eyecare in the eyes of patients, doctors, politicians and, heaven forbid, optometry itself?
A recent piece by Trevor Warburton in the January LOCSU newsletter (bit.ly/1nkTLGL) highlights the importance of terminology by making the call for the ‘accreditation’ that has become commonplace amongst first PCTs and now CCGs to be termed ‘validation’. He says, paraphrasing, that optometrists weren’t and aren’t incompetent but they are maybe occasionally rusty for contractual reasons.
The whole concept of accreditation has been suffused with ignorance and a failure to recognise and speak up for what optometrists and DO’s can do with one voice. At present optometry and dispensing optics are competency-based professions and have been for 15 years or more. That’s at least half of us in practice.
In spite of this, hundreds are being asked to re-prove competence in areas already tested as competent. Countless students are registering with the GOC only to find they are neither equipped nor trusted to deliver the skills they have been trained in.
Nowhere is this more evident than in the plethora of repeat pressure schemes that has subtly masked the latest proposed interpretation that entry level registered optometrists can no longer be deemed capable of glaucoma referral refinement because the RCOphth says gonioscopy is now needed for that.
This all arises because of the steadfast refusal of the NHS (in whatever guise, DoH, DH, Clinical Commissioning) to entertain any notion that the GOS can be used, adapted or developed into a meaningful primary care tool.
Ultimately, this has led to conflating the argument that because many optometrists didn’t use Goldmann tonometers and because optometrists didn’t bring people back for repeat fields, repeat tonometry, low vision assessment, convergence training or blepharitis treatment, then they were somehow not competent in these areas.
This is in spite of all of this being well inside core competence. Unfortunately, the ignorance of many hospital-based ophthalmologists still occasionally prevails; ‘shared care in diabetes is all about making my patients hang around longer so they can be sold more glasses whilst dilating’ is not an imagined quote.
It is at least arguable that the multiple sector business model recognised the gross limitations of the scope of the NHS Sight Test. Although they weren’t the only ones to take the line of least resistance and just refer patients perfectly capable of being managed in practice (and within GOC Rules), they did recognise that there was simply no income stream.
With a business model that does not recognise a means for payment between loss leading, driven-down sight tests (and private ST have kept a worse pace with inflation than the NHS) and retail sales, it is hardly any wonder that our clinical masters confused contractual capability with clinical competence when cosying up to the RCOphth and saw an opportunity to conflate ‘validation’ with ‘accreditation’.
This has now permeated through to the highest levels so that every step already within competence has to be proved again and again, right down to local level. However, the services needed are simple in the first instance and the case for not moving towards national commissioning is specious and politically biased.
One of the biggest areas of contention that has vexed the optical world in England has been the management of glaucoma. Expanding from NICE CG85, the College of Optometrists in particular, with the technical input of HES optometrists, has made a strong case for the involvement of optometrists in glaucoma.
Unfortunately, the standard being advocated has been confused with the contract vs competence debate and this has led to a detailed Optical Confederation rebuttal (http://bit.ly/1Tl7nhN) of proposals by the Royal College of Ophthalmologists in commissioning guidance on glaucoma.
The RCOphth document has completely ignored experiences in other developed areas, especially Scotland, and it has tiered levels of complexity into entry level glaucoma refinement and stable glaucoma OHT monitoring. Although the College of Optometrists has been critical in parts, in general it appears to have toed the HES line that in reality glaucoma is really too hard to be left to optometrists in the community.
There is strong disagreement with the Confederation over the tiers of competence with the likelihood that, if adopted, the input of community optometrics would be very limited at a time when the HES is struggling to cope. Letting go is so very hard to do. In fact, the document is quite hard hitting, even questioning whether the College has a direct and undeclared conflict of interest in establishing and promoting its highly unusual (in an international context) concept of three-tiered higher qualifications.
Which brings me back to the barriers to further progress; chiefly the fact that we can’t work together. Perhaps what might help, if there were a new CEO, is if the College joined the Confederation.