Independent prescribing (IP) is steadily growing in popularity as more practitioners embrace the opportunity to provide enhanced services to patients in practice. The qualification enables optometrists to clinically assess patients, establish a diagnosis, determine the clinical management and prescribe licensed medicines for conditions affecting the eye and tissues around the eye, within their area of expertise. Latest figures from the General Optical Council (GOC) reveal that the number of registrants on the Independent Prescribing Specialty register has increased from 611 in March 2018 to 1,344 in July 2022.
‘The increase in optometrists with IP qualifications may be due to the greater role the profession is fulfilling, particularly within new integrated eye care services, increasing availability of emergency eye care pathways and enhanced or supplementary care schemes,’ says Professor Lizzy Ostler (pictured below), director of education at the College of Optometrists. ‘Optometrists are increasingly involved in managing patients with more complex needs that would have previously been managed by other healthcare professionals in hospital eye care services,’ she says.
Increased funding for places on academic courses, particularly in Wales and Scotland, may also explain the rise. Changes to the education and training requirements for independent prescribing, announced in January by the GOC, will make the qualification even more accessible for optometrists. Trainees no longer need to have been practising for two years, they will acquire a single qualification rather than two and they may be supervised in practice by an approved and registered IP practitioner, rather than an ophthalmologist.
Career progression
As well as boosting practitioners’ confidence and better supporting patients, gaining an IP qualification can also lead to opportunities for career progression. According to Paul Morris, Specsavers’ director of professional advancement, achieving an IP qualification is increasingly likely to be a ‘differentiator that makes individuals more attractive to employers’. The IP qualification is part of Specsavers’ career pathway and available to all optometrists. ‘We invest in our colleagues, supporting higher qualifications extensively. We take great pride in enabling our clinicians to fulfil their career goals,’ he says. In Scotland, Morris says that independent prescribing is ‘undoubtedly’ the standard and in Northern Ireland and Wales, it is ‘becoming the norm’. ‘If eye care commissioning proceeds as it should, then it follows that this will also be true in England,’ he adds.
Optical Express, in partnership with Glasgow Caledonian University (GCU), fully funds the IP qualification for its optometrists, which includes the final assessment fee. GCU has enhanced its course to include distance learning and Optical Express also hosts the next-step clinical placements at its clinics, where practitioners receive support from a network of ophthalmologists and IP qualified optometrists.
Almost 100 Optical Express optometrists have successfully completed the independent prescribing course. Stephen Hannan (right), clinical services director at Optical Express, says: ‘For optometrists, becoming IP qualified is a logical next step in their career progression. As the industry continues to evolve and with the increasing workload of the NHS causing even greater waiting times for patients, optometrists are aware that they need to deal with and treat more conditions in the community. In our view, being IP qualified will soon be the norm for all optometrists.’
Top of the licence
Locum optometrist Kiran Pannu-Dhillon (left) will sit the final module exam of City University’s independent prescribing course in October. Pannu-Dhillon, an optometrist at Maverick and Wolf in Chiswick, has worked in optics for 12 years. ‘I’m both ambitious and keen to learn and upskill myself. The course has enhanced my understanding of ocular diseases, anterior segment diseases, glaucoma, red eye and the management for these conditions. Understanding the pharmacological management has been key. It also enhances knowledge of secondary care and the treatments an ophthalmologist could offer, which gives practitioners a better understanding of what will be involved once a patient is referred into secondary care,’ she says. The course and materials provided are ‘worth the cost endured’.
Director optometrist Sachin Patel studied to become an independent prescriber at Aston University in 2018, having worked in practice for 18 years. Afterwards, he moved from a multiple to the independent, Safarian and Simon Opticians in St John’s Wood. ‘As an independent, we have more flexibility. I find it hard to imagine working in a multiple and using my IP skillset versus the commercial needs of the manager,’ he says. Patel felt that the cost of the course was ‘a small amount, given the benefits’, while time management was easy due to being able to work online. Gaining the IP qualification has been ‘hugely’ beneficial for Patel, increasing his confidence in managing patients, treating them ‘on the spot’ rather than referring them and attracting new patients to the practice. Patel believes that practitioners need to have gained ‘a few years’ experience in practice before doing the independent prescribing course and urges them to use the qualification to its full potential: ‘Some IP optometrists prescribe very little, so they lose confidence over time. I would suggest new IP optometrists make sure they use it daily.’
Ceri Probert, (pictured right) specialist IP optometrist and director at Probert and Williams Eye Care in Aberystwyth, worked in practice for seven years before taking the independent prescribing course at Cardiff University (the first intake year) and qualified in 2018. ‘The course provided a solid grounding in evaluating clinical evidence in a way that the undergraduate course does not come close to,’ he says. Probert thinks local healthcare practitioners ‘really appreciate the local independent prescribing optometry service (IPOS) because it takes some of the burden off them and allows patients to be seen by the right person with the right equipment and knowledge at the right time’. The IPOS is also popular with patients: ‘We can see them, give them a prescription and follow up, if necessary, all funded by the NHS, meaning they don’t have to travel to an eye clinic – a four hour round trip for some of our patients – or take time off work,’ he says.
During Covid, Probert says the service ‘came into its own’. ‘In the first lockdown, the local clinic was closed and a lot of patients were concerned about going to hospitals. We treated countless problems that would have perhaps been referred to secondary care in normal times,’ he says. The benefits of gaining an independent prescribing qualification ‘massively’ outweigh the time and effort it takes to qualify. ‘You’re pushing yourself clinically, working to the top of your licence, you’re always learning something new and most importantly you’re providing a better service for your patients,’ he adds.