There has been confusion over allocation of points and the issue of DO funding remains unresolved. But as the first CET cycle draws to a close, the profession is sanguine about a system aimed at enhancing the reputation of all practitioners. Shannon McKenzie reports
Continuing education and training, states the General Optical Council guidelines, is about the maintenance of up-to-date knowledge and skills for the safe exercise of professional activities. It is, in essence, about sustaining competent practice within the optical professions. A worthwhile pursuit, many would assume.
But while the vast majority of optical practitioners share this view and have eagerly participated in the CET scheme, not all have found it entirely straightforward. During the past three years there has been upset and renegotiation around how many points could be carried from the voluntary scheme to the statutory scheme, and there has been some confusion over double counting of specialist points. And, earlier this year, figures from Vantage revealed that not all GOC registrants had come to grips with the web-based technology used to administer the scheme.
Despite these teething problems, the majority of practitioners appear to have taken the statutory CET requirements in their stride. The latest figures from the GOC show that 76 per cent of optometrists, 64 per cent of dispensing opticians and 64 per cent of contact lens opticians have reached or exceeded their required points, well ahead of the initial December 31 deadline. Practitioners were recently afforded a 'period of grace', and now have until March 15 to collect their points.
These figures, argues GOC registrar Peter Coe, demonstrate that CET has been a 'resounding success' and reflects a 'hunger for personal learning within the professions'. There were, and continue to be, some vocal protesters, he says, but these only number a handful. 'You always hear about those that do not wish to partake, but the reality is that there were very few people in this category. Their views did not accurately reflect the views of the wider profession.'
Coe is also keen to dispel suggestions that a dislike of CET will prompt many practitioners to leave the profession, or will see dispensing opticians choose to deregister and continue to work in a more limited capacity. 'I think there are some people out there who will use this as an opportunity to change their career or retire,' he says, 'and these will be people who have been considering exiting for some time. I expect there will be several hundred people either retiring or taking a career break, and we will lose a small percentage of practitioners, but this is no different to any other year. On January 2 we will be analysing the details and writing to all of those registrants, reminding them they have a shortfall. We hope practitioners will make up their CET shortfall as quickly as possible in the new year.'
Gill Robinson, CET adviser for the Federation of Ophthalmic and Dispensing Opticians, also believes the system was a great success. 'I think this process demonstrated the good consultation that took place between all of the professional bodies and the GOC,' she says. 'Throughout, the GOC has made efforts to include positive improvements to make the guidelines as flexible as possible, and this has made life easier for many practitioners.'
GAINING CREDIBILITY
Association of Optometrists chief executive Bob Hughes is another great supporter of CET, arguing it is crucial to the reputation of the optical profession.
'This demonstrates that the profession keeps up-to-date with new and different skills. It gives the profession credibility,' he says. 'The CET scheme has gone so well because the profession as a whole has been willingly participating in CET for a long time, well before it became compulsory in 2005. And when the scheme did become compulsory, practitioners were not being asked to do anything more or less than what the vast majority were already doing.'
He too acknowledges there have been difficulties, but there was 'nothing that could not be resolved with the right amount of good will'. The new technology, he says, was a sticking point for some, and in recognition of this, over the summer the AOP embarked on a campaign to ensure all of its members were registered on the Vantage website.
There was 'no question' that the Association of British Dispensing Opticians was in favour of CET, says Paula Stevens, ABDO CET officer, as it was essential for public protection. However, there had been some problems with the scheme. 'The GOC introduced various elements which were intended to help with the crossover of the voluntary and statutory schemes, such as double counting and the increased "carry over" of CET points. But the different rules for the two periods produced much confusion. Hopefully the next period will be more straightforward,' Stevens says.
Stevens notes that at present it is difficult to predict the number of dispensing opticians who will not obtain enough points, particularly given current figures do not provide information on the number of practitioners who plan to submit their points to the GOC on paper, rather than the Vantage website. 'Nor do the figures take into account those who are no longer practising, those who are protesting, those who decide to work under supervision and those who will not be practising in the future due to retirement,' she says. She is unsure of the exact numbers of those protesting, but believes that 'nearly all will choose to remain registered'.
FUNDING
CET funding remains a contentious issue for both professions. Under current arrangements, optometrists are allocated £425 to cover the costs of attending events and training. However, dispensing opticians are allocated nothing, despite being expected to obtain the same number of points, or in the case of contact lens opticians, an additional 18 points. The government has, to date, maintained funding is unavailable. 'It is totally iniquitous that dispensing opticians have no funding for their CET, yet are still expected to comply with the GOC regulations in the same way as optometrists,' argues Stevens. 'We have stated our case to the Department of Health continuously since the issue began, and it is extremely disappointing that, so far, the department has failed to respond.'
Coe sympathises with dispensing opticians, and notes that the funding inequity is 'unfortunate'. And, in light of the lack of funding, he is quick to commend the commitment of dispensing opticians to CET. 'It does seem slightly unfair that there are two professional groups, and only one gets central support,' he says. 'It does send an unfortunate message to dispensing opticians. Yet despite that message this group are still out there learning and attaining points, and this is a credit to them. The contact lens opticians have had to get even more points, and they have still responded to that with great enthusiasm.'
The AOP is also dissatisfied with the current funding package and is likely to start negotiating a higher CET payment.
CET PROVISION
For CET providers, the statutory system, while not yet perfected, has been a success. The Vantage system has proven easy to use, and providers have praised the effort and commitment that has been put into rectifying any 'glitches'.
'CET accreditation has been simple and easy to follow, and any issues regarding accreditation or using the Vantage system have always been dealt with swiftly, in my experience,' says Jane Macnaughton, director of Clearview Training. 'Any new system of this size and complexity will take time to bed in, and there are bound to be glitches. However, anything that we have come across has been relatively small and appears, in the main, to have been resolved.'
However, Macnaughton says there is one ongoing issue around advertising. Some providers advertise events as 'CET applied for' before the presentations have been approved by Vantage. 'Although this is not against GOC rules, I think these providers put pressure on Vantage to approve an event that they may not have normally agreed to approve,' she says.
Providers agree that the new CET cycle, beginning January 1, is bound to prompt more change and challenges, particularly given changes to the rules on workshops and target audiences. Starting next year, workshops can only be classified as such - and therefore only attract a higher number of CET points - if there is one leader for every six delegates. According to Scott Mackie, course chair at Eyecare 3000, many providers will not have the resources to meet that requirement, meaning workshops may become far less common.
'Workshops usually attract more CET points because they are assumed to be a more intense learning environment,' Mackie said. 'A lot of providers will have a problem meeting that 6:1 ratio. We have actually made a decision not to hold any more workshops, and will be holding mini-symposiums instead.'
The new division between specialist and general points may also mean new challenges, particularly for those optometrists specialising in therapeutics. In the new CET cycle, explains Peter Charlesworth, managing director of Replay Learning, providers must specify whether the training has a general or specialised focus. 'From now on we will never get training that is a specialist and a generalist point at the same time,' says Charlesworth. 'It can only be one or the other. There is a new specialist list for optometry, for those optometrists who have an extra qualification in therapeutics. There is also a specialist list for dispensing opticians who have a contact lens qualification. Next year practitioners will have to start acquiring therapeutics or contact lens points separate to their general points. Learning about therapeutics, for example, would most likely benefit general optometrists, but given they can't get any points by undertaking the training, as it is a specialist point, I am unsure how many would be interested. Also, there are so few people who have that therapeutics qualification. It may not be worth a provider's while to hold events for such a small group.'
POINT COUNTING
The focus on CET points, however, appears to have had an unexpected side-effect. According to CET providers, many practitioners stopped attending events and training once they acquired their points. The GOC disputes this and Coe notes that there are many practitioners who have attained more than 100 points. He also says that there have always been 'periods of high CET activity and low CET activity'.
But Macnaughton, Mackie and Charlesworth all say there has been a noticeable drop in delegate numbers at events which have previously been very well attended. Macnaughton notes that her company, Clearview Training, made a decision earlier this year not to host any public CET events in the last half of 2006.
Charlesworth notes the shift has come about since the scheme changed from the voluntary system to the statutory. 'I would think that some of these people who do have their points might be put off attending more because the points they earn do not count towards anything. This is a shame because some of these events could have been useful to them,' he says. 'I have spoken to people throughout the year who have told me that there is no point in them doing any more CET this year, as they have already collected their points.'
This could perhaps be remedied, he suggests, by the GOC emphasising that the requirements are only the minimum. 'I think practitioners need to be reminded that this is a basic level only. The GOC needs to start talking about the points as a minimum level. And practitioners need to plan their education based around the needs of the practice and of their patients, not around how many points they will get.
'There are a few people who have attained far more points than necessary. Some people are getting close to 200 points and they will keep going - they just enjoy learning. At the moment you have some people who have just stopped and are doing nothing, and other people who are madly rushing around doing everything. They don't care what it is, they just want the points as quickly as possible. Neither group is benefiting. That is not what the GOC wants - CET needs to be regular and continuous. We need to start thinking about what we can do to prevent these situations in the next CET cycle.'
However, Robinson disputes that it is the responsibility of the GOC to prompt practitioners to do more than 36 points. 'It is difficult for the GOC, they can only set the minimum standard and some practitioners will only aim for that standard and no more. The GOC cannot change this,' she says. 'I would hope that going forward, practitioners will see the benefit of improving and refreshing their knowledge and skills as often as possible.'
Macnaughton has a suggestion that might help resolve the situation. 'If the CET cycle was a rolling three-year cycle, rather than a closed three-year cycle, this could result in a more even spread of CET for practitioners,' she explains. 'So in any successive three years, 36 points could be attained. This would help practitioners spread their CET, rather than clumping it all in the last year, and it would allow excess points to be counted towards the next year. It also gives flexibility to those who need to take time out, for example those on maternity leave.'
Bob Hughes suggests an entirely different approach, one which shifts the focus away from points, to a system that encourages practitioners to build a 'portfolio' of learning. 'The current system is focused on checking every single point, but it does not necessarily help people widen the scope of their knowledge and skills,' Hughes says. 'I think we should start looking at other schemes to see how they are run. Doctors, for example, must achieve a set number of core points, and then they have to look at building a portfolio of learning. Each year, a wide selection of practitioners is asked to submit their portfolios for assessment. This is far more focused on the learning, and not the point counting. I think the GOC could look at something similar. They could require that CET on key competencies is compulsory, and then ask for a portfolio of learning.
'The point allocating system can be limiting. People will choose an event for the number of points it attracts and not for the personal knowledge it will give them. Under the portfolio system practitioners would go because they were interested in a subject, rather than because it attracted points. I think the GOC could then assess between 5 and 10 per cent of the portfolios, and this would give them a good indication of the learning that is occurring across the profession.'
PRACTITIONERS
Attaining enough CET points has not - according to providers and practitioners - been a difficult exercise. A wide variety of events, articles and distance learning packages has provided ample opportunities for practitioners to acquire points.
'I have not found it difficult to attain my points,' says Andrew Gasson, optometrist and contact lens practitioner. 'I tend to go to meetings, such as those of the BCLA, which achieves a number of points. I was able to gain my points fairly swiftly. I am in a good position to do this as I am based in central London. Others in more remote areas may have found it more difficult.
'Overall I think there has been more good than bad in the CET cycle. Although I do think the system encourages people to focus on the specialist areas they are most interested in. What it ought to be doing is saying "Well you're a contact lens specialist, it's about time you went to some lectures on orthoptics". It does make it easy and comfortable to stay within specialist areas.'
James Conway, contact lens optician at Dipple and Conway, says that while gaining the points was not difficult, nor was it easy. 'It was manageable. But you do have to be quite dedicated in reading the articles and attending the meetings,' he says. 'It is true that once you hit your points targets, the motivation to continue is not always as strong. That is not to say that practitioners stop altogether, but I do think people tend to feel that they have done their bit and they tend to relax more.
'My only bug-bear with the system is to do with the funding. I have to attend events and lectures in my own time and at my own expense, and I have to gain even more points than optometrists, yet I get zero funding. It is very unfair to require us to do CET, but not allow us any funding for it.'
There are still a number of critics of the whole concept of CET. John Snelgrove, optician at Enhanced Optical Services, is among them. 'I don't think CET for dispensing opticians is particularly relevant. I can understand the need for optometrists, therapeutic specialists and even contact lens opticians but I do not think it is applicable for dispensing opticians. There is not really anything new in CET for dispensing opticians, there is nothing we really need to be brought up to speed on. If there were, for example, constantly new methods of making frames then, yes, CET would be useful. But there are not really the subjects available for dispensing opticians.'
Snelgrove has taken the decision to deregister from the GOC, after 30 years, and says he will not re-register unless laws change and he is required to, in order to dispense. 'I know a lot of other dispensing opticians who are feeling the same way,' he says.