Communication became an impromptu theme at this year’s Alconversation which was once again ably chaired under the quiet confidence of Richard Edwards, the Optical Consumer Complaints Service’s clinical adviser.
The discussion was introduced by Alcon UK business unit head Ray Pasko. He said the discussion was not about Alcon but about the profession and the challenges it faced. ‘Alcon is proud to sponsor this,’ he said, ‘It’s an opportunity to think about some of the things that are going on in 2018. A positive conversation to build the industry we want.’
Edwards echoed those sentiments describing the Alconversation as an opportunity to stop and pause to think about some of the issues facing the industry. He also revealed that the discussion was being broadcast live across the internet.
Taking the panel hot seats were ophthalmologist Dr Colin Parsloe, specialty doctor in ophthalmology; Colin Davidson, vice president of the College of Optometrists; Gordon Ilett council member of the AOP and chairman of SeeAbility; Andrew Price, National Clinical Committee member of ABDO; and Alistair Bridge, GOC director of strategy.
Securing optometry’s position in primary care has been a long-running goal for the profession. Optician posed the question asking the panel what it thought was the best approach for optometry to take in forging links with ophthalmology to offer more comprehensive medical care in the high street.
Ilett said he had enjoyed a long and good relationship with local ophthalmologists in his area but admitted a divide still existed. He suggested this was borne out of poor communication, in both directions. This fostered a lack of trust which left ophthalmologists thinking ‘not another poorly considered referral’. He said an ophthalmologist worked within his practice one day each week and had done for the past 15 years. Where relationships and trust had been built up ophthalmologists understood how much optometrists can do for them but it needed two-way communication. ‘All referrals deserve a response,’ he concluded. Funding also mattered.
Parsloe said he was passionate about both professions working together and praised the contribution optometrists could make. ‘You have the kit, you have the diagnostic skills and there are so many good training courses.’ He said the workload pressures on the hospital eye service meant primary care needed to be conducted in the high street and surgeons freed up to use their skills. He said as a surgeon he wanted to be doing surgery not doing ocular hypertension follow ups. Picking up on Ilett’s funding comments Parsloe said the current system made poor use of money. ‘A practice sending a corneal abrasion [to HES] is costing £150, that would be better dealt with in the community.’
Returning to the original question Parsloe suggested optometrists took practical steps to expand their network with local ophthalmologists and hospitals. ‘Refer it but request more information. It’s important that you manage the patient, it’s not just about referrals.’ He said medicine used an apprenticeship model for supported learning and that was difficult in the community. Clear, two-way communication was the key. He admitted that he had no idea how much optometrists could do. The structure was piecemeal, patients may have seen numerous optometrists and ophthalmologists struggle to understand what level of education the referring optometrist had.
He suggested optometry’s governing bodies should be more proactive in seeking change to secure standard structures, push for response to referrals and get access to NHS.net for optometrists.
Price said he admired Ilett’s model of cooperation and while everyone would love to see that set up ophthalmologists simply don’t have the time to spend in optical practices. Further training in therapeutics, minor eye conditions and placements in hospitals were all logical steps for optometry but the system made change hard. ‘It’s the bureaucracy in the HES that we are all encountering,’ which is the block on change, he said.
Davidson agreed that communication was key. In the past optometrists did not get feedback on referrals so did not know how effective their referrals had been. He agreed with Parsloe’s points on communication but said the current roll out of schemes was the best route. ‘Looking at the Mecs schemes we have available we need to persuade CCGs that they are the way forward. If we have practices offering these types of schemes we won’t have so many people turning up to hospital with things that can be done in the community.’ How quickly that can happen ‘is a tricky one’.
Bridge said many of the issues around skills fell within the GOC’s current discussions on education. He said the regulator had been looking at education ‘so that professionals are ready for the new roles that will emerge’. He also suggested while the flow into hospitals had been considered so should the flow out of hospitals and into the community. Ilett said of the 8m HES outpatient appointments a third could be treated by optometry. All the panellists agreed that a national framework, fair funding and a higher profile for optometry on a political level were needed.
Ilett said as a member of the Optical Fees Negotiating Committee he got to talk to the DoH once a year: ‘briefly’. He suggested the DoH preferred control moving out from the centre but he saw clustering of CCGs, as is happening in south east London, as the best way forward. ‘It would be great if we could get the DoH to say, “let’s do Scotland across the whole country” but it’s not very likely,’ he concluded.
The panel then discussed some of the issues around skills needed for new areas of care and how that might be imparted. ‘We [optometrists] come out after three or four years and are expected to be able to do everything with everyone without any support of learning,’ said Ilett. Davidson said while topics such as therapeutics could be added to undergraduate training you ‘couldn’t just put it [therapeutics] in the degree and expect people to be able to do everything’. He became IP qualified in 2011 but continues to learn all the time, he added.
The next question touched on communication to the general public and promotion of optometrists as the GP of the eyes. Parsloe said a 20 minute eye exam that could save your life was a powerful message. Price reiterated his call made at last year’s Alconversation for the contact lens companies to pool their resources for a consumer media push. ‘We haven’t been great at publicity for what optometrists could do for your health,’ said Davidson. He quoted College research which showed that 8-9% of the population will never have an eye examination. He said schemes such as those run by the police with drivers’ vision had been effective in encouraging people into practices. Price said awareness of the role DOs play in eye health is also needed.
Ilett said one of the most neglected groups was men between the ages of 18 and 50 and the profession needed to engage with them. He also said the half hour optometrists have with their patients was a great opportunity to get a range of health messages across. Bridge said education did not need to be about budget, eye care professionals could use the time they have with patients to get key messages across.
A supplementary question asking how contact lenses could be better promoted raised the issue of what products eye care practitioners (ECPs) should be recommending. Price said recommendation of contact lenses was essential but questioned the time available in some consultations and the attractiveness of contact lenses to independents. Davidson said the College’s view was that discussion of all eye care options should be covered with the patient but admitted time could be an issue. Ilett questioned whether ECPs were short of time or simply needed to organise their workloads better. He agreed with Price that patient interaction was the key and suggested practices need to incentivise ECPs to offer products such as contact lenses.
Price said sadly that was not currently the case. This could be down to a lack of time with the patient, but, he said: ‘It’s not helped by the large number of locums who have difficulty relating their work, that over time may have an effect on the business.’
Parsloe, who has been working on training ECPs in his specialism of dry eye, said he was shocked by how much went on in a short eye exam and suggested messages could be imparted elsewhere in the practice. Perhaps telephone holding messages with information or support staff with ‘ask me about contact lenses’ badges. Ilett said the immediacy of return may make some practices favour spectacle sales over contact lenses. There were ways to solve this issue such as direct debits but: ‘a lot more education still needed to be done’.
Outside of the Alconversation, over dinner, delegates were still musing the questions posed and considering how change could be brought about. Those Optician spoke to suggested the NHS and CCG structures were the biggest obstacles. There was also a feeling that the optical bodies needed to be more effective in securing a voice in parliament and getting eye care messages across. Many agreed that it was action on the ground that would effect change, a point predicted by Edwards in his summing up. He concluded the Alconversation by thanking the panel adding that the profession could succeed if it pulled together. He signed off paraphrasing Jerry Garcia of the Grateful Dead: ‘Someone has got to do something, the scary thing is it’s going to have to be us.’