Alcon’s Academy is a well-known destination for practitioners looking for contact lens education and training but it was outside broadcast vans making their way to the Surrey centre last week for the third annual Alconversation.
Chairing the discussion was Richard Edwards, consultant for the Optical Consumer Complaints Service and formerly an optometrist and senior optometry lead. He explained that for 2019, alongside the guests in the studio, was an online audience able to watch the discussion unfold and interject with their own thoughts and questions.
Sitting on this year’s panel were: Roshni Kanabar, clinical and regulatory adviser at the AOP, part time practitioner and City, University of London staff member; Max Halford, CLO and clinical lead at ABDO; and Professor Ed Mallen, head of optometry at Bradford University and president of the College of Optometrists. Unable to attend was director of strategy at the GOC Alistair Bridge, who provided written answers to some of the questions.
Alconversation host, Jonathan Bench, Alcon’s head of professional affairs UK & Ireland, introduced the first question which had been posed by the Alconversation’s online audience. He said one topic had stood out as the burning issue for practitioners and that was to hear the panel’s views on the optometry apprenticeship being proposed by the Trailblazers Group. If introduced it would see optometrists able to qualify through a work-based scheme rather than just full-time university study.
Edwards read out Bridge’s answer setting out the GOC’s position. It made it clear the GOC understood the widespread concerns within the profession to the proposal for an optometrist apprenticeship.
Bridge wrote that the GOC’s responsibility for setting standards for the profession would not be trumped by the Institute for Apprenticeships’ remit to create new routes to qualification. ‘Any apprenticeship would require our approval. The group [Trailblazer Group] has been made aware that the apprenticeship must meet those standards.’ Any scheme would be subject to the same quality checks as other learning pathways, he added.
Kanabar set out a number of reasons why the AOP had come out against the proposed apprenticeship. She said uppermost had to be the risk to patient safety and the ability of students to equip themselves with the necessary level of clinical skills while spending much of their time in a work environment. This could damage the credibility of the profession in the eyes of the public. ‘We at the AOP feel the risks outweigh the benefits. There are shortages [of professional staff] but there are other ways to tackle that,’ she added. The AOP felt that a fundamental part of optometry training was provided through universities. On a personal note Kanabar said the Trailblazer Group, which is putting the apprenticeship scheme together, is suggesting four years. That, she said, was the time it took her to qualify through full time study at university. She was concerned how a scheme proposing 80% of apprentices’ time in work would allow the necessary education.
Providing the ABDO perspective was Halford, who said he couldn’t remember any educational issue raising the level of emotion the apprenticeship had. He said ABDO’s concerns would be around the quality of the education and patient safety, but that the association did not want to make a statement on the apprenticeship process at the moment.
Prof Mallen said the emergence of the apprenticeship was not a shock to the academic community, which has been living through two years of potential shake up during the GOC’s Education Strategic Review. This was expected ‘to move some big bits of furniture around’, he said. ‘We have an optometric community that’s the envy of the world and we shouldn’t do anything to damage that. We don’t want anything that is going to create a two tier system.’ He made that point that the College, Bradford University and others were in the Trailblazer Group observing. ‘We want to be in the room where these discussions are taking place.’ He said as an educator with 20 years of experience he knew how difficult training optometrists is. ‘We [educators] will strongly oppose anything that undermines training or puts patients at risk.’
Picking up on the potential for an apprenticeship to broaden accessibility within the optometric profession, Halford said the ability to train on the job could be positive. ‘I trained on a three-year distance learning course as a mature student.’ He said continuing to earn was important as he had a young family. ‘Being able to earn while you are doing that is incredibly helpful. At the time it was the only way I could get into the profession.’ However, he added with the complexity of modern optometry he did not know if this style of learning was possible.
Edwards asked Prof Mallen what the experience had been on apprenticeships for other undergraduate study topics. Prof Mallen said, while engineering has taken this approach, optometry required high staff ratios and were expensive courses to run. Getting that right was crucial if courses were going to work. ‘The devil is in the detail,’ he said.
Discussion from the Alconversation audience suggested apprenticeship funding could be released for higher level training of optometrists such as for contact lens study or to broaden the skills for locums. Nick Rumney, of BBR Optometry in Hereford, said the optometry career ladder needed to be broadened. ‘We need a different way, an optom apprenticeship is looking through the wrong end of the telescope.’
Optician editor-in-chief, Chris Bennett, suggested the apprenticeship came about as a result of the problem large employers had recruiting clinical staff in the regions. This problem would not go away just by stopping the apprenticeship. How would the panel tackle the workforce issue?
Halford said the South West suffered from recruitment issues but the development of the Plymouth University’s course had not solved the issue. Kanabar suggested that bursaries and scholarships for underprivileged students could help. Prof Mallen said student intakes were very different from previous times. When he studied at Aston 20 years ago students came from ‘far and wide’, but today: ‘We have a much more locally focused student body’. He suggested that salaries overall had probably gone down over that time but the deviation between pay levels in different places had risen. ‘Perhaps it’s just a question of supply and demand,’ he suggested.
The topic closed with a discussion on the standards of education an apprenticeship could reach. A comment was read out from the online audience which asked how clinical skills could be entrusted to a commercial organisation. Another commented that the standards would have to be the same as current routes. Kanabar accepted that the GOC had said it would not accredit any courses that were not good enough but was sceptical on how it could work. ‘It will be interesting to see if that can be achieved.’ Prof Mallen concluded that the GOC had a clear remit to protect the public. ‘That will be under scrutiny.’
Stopping drop outs
Cooling passions slightly, the panel next took a question on the issue of drop outs. This prompted a high level of agreement among the panel that communication, education and the support of the whole practice team was necessary. Kanabar said do not over-promise and under-deliver, listen and make patients feel they are being listened to. Halford said ABDO had changed its advice on recalls but this relied on the practitioner understanding the patient needs and agreed that was key.
From the audience Cheryl Donnelly, BCLA, said drop outs occurred in the first two weeks of wear so what would the panel suggest practices do? Prof Mallen summed up the feeling and said investing more time was key and suggested phoning patients in the early stages of wear could help. From the audience Brian Tompkins of TKS Optometrists in Northampton, said waiting for two weeks was too long and said selecting the right lens to suit the patient was key. ‘Two weeks is too late, we call after a couple of days.’ He said avoiding drop outs started before the lens was even fitted: ‘We don’t let anyone go into a lens before we have analysed their tear flow.’
A second question on contact lenses, posed by Bennett, asked why more patients were not being fitted with modern, innovative lens designs such as those for presbyopia, myopia control or with extended depth of focus? Prof Mallen said myopia control was an easy sell to patients, particularly those who were myopic. It held out the prospect of slowing myopia in their kids and reducing the risk of the associated pathologies. The panel agreed that myopia control should become a major part of the profession’s interaction with the public. Kanabar said education was the key while Halford suggested training should be directed more towards CLOs. These are the people fitting the majority of lenses but funding for product and training is too often directed at optometrists.
From the chair Edwards suggested practitioners had to start talking about myopia management now. He also brought up the suggestion that patients who were not offered myopia control and later became short-sighted may resort to legal action. He asked the panel where they thought the tipping point for such action might come. Halford said he could easily see lawyers touting for business through TV ads on the issue while Prof Mallen used the example of amblyopia. Today the profession would not ignore that as they may once have done. Similar action on myopia will come but it was difficult to say when. He said the evidence base was still growing but conversations with patients should be taking place. Kanabar said her experience from practice is that there was a high awareness among patients and practitioners needed to stay educated. ‘As practitioners we have a duty to keep up to date,’ she said. On a personal level she expects to be in the profession for 30 more years so why would she not want to learn about something that will grow in importance? Prof Mallen made a plea to equipment manufacturers to develop the kit to make the measurements needed, such as axial length, and for practitioners to share data to build the evidence base.
Returning to the question of innovative designs Keith Tempany, former BCLA president, said education was the key to getting patients into new lens types. Rumney suggested contact lens education was being overlooked and the topic had lost its ‘sexiness’ when it came to CET.
The Alconversation concluded with another question about education. It proposed that participation in CET events was falling in the face of more convenient methods of learning such as online. A statement from the GOC’s Bridge said as part of the Education Strategic Review CET was evolving to become less of a tick box exercise. This should result in more tailored learning using methods that were future-proof against further changes, he added.
Kanabar said there are people who do CET just to get the points and a more meaningful continuous system was needed. The panel agreed that a positive aspect of the current system is that it did force registrants to do a minimum level of education. While that was good did anyone really want to simply achieve the minimum with their patients? It was agreed better methods, such as CPD, were available but the baby should not be thrown out with the bath water. There was general agreement that relevant tailored education was needed.
Offering the final point, Edwards concluded that: ‘As professionals it is incumbent upon us all to find out the latest information that’s out there.’