An Education Strategic Review by the GOC takes on new meaning with each week that passes by.
The regulator’s call for evidence ran from December 2016 to March 2017, collecting feedback on 17 wide-ranging questions from 55 stakeholders.
On launch, there was no questioning the consultation’s timeliness, when in March 2016 the profession was given a glimpse into its future through the launch of the £100,000 Foresight Project.
Foresight predicted a high-tech future for optics, dealing with disruptive technologies such as 3D printing, online refraction and app-based disease monitoring. In response, a new generation of eye health practitioners would need to be garnered to keep up with an ageing population and rising prevalence of eye diseases.
Just this week yet another optometry course has been proposed for the Scottish Highlands, hot on the heels on an announcement by the University of the West of England (Optician 07.04.17). It would take the number of UK optometry courses to 13, and bring an opportunity to rejuvenate the core syllabus.
Further to this, qualified optometrists are showing an increased willingness to carry out more clinical work as NHS secondary care faces continued pressure. The introduction of OCT across the Specsavers network spoke volumes when it was announced last month, and more training will be required.
Optician has picked out a selection of the most striking published consultation responses, focusing on the qualifications and future role of professionals.
View from the practice
Nick Rumney
Optometrist Nick Rumney expected the advanced scope of optometry to shift from hospitals to the high street.
He added: ‘In my opinion common law will not permit the separation of refraction from eye examination as this has been established and linked for over 100 years. Thus calls for DOs to be able to refract are not the logical way forward. However, developing a model to enable DOs to “test sight” within the legal definition will be feasible with the advent of better and better imaging systems and algorithms.
‘Optometrists will separate into two tiers; non-IP and IP. Non-IP will expand their role slightly but IP will be seen as the appropriately regulatory target for keen graduates.’
Peter Black
DO Peter Black responded to the consultation with a wide-ranging and patient focused outlook.
Black said: ‘I can foresee the resurgence of pharmacist opticians able to supervise both functions in supermarket and large retail health and beauty stores, but also a potential new mode of practice linked to GPs, or as stand-alone businesses in smaller towns and remote or rural areas. An independent prescribing optometrist with an ophthalmology qualification working alongside a refracting optician who is also qualified as a pharmacist or audiologist could be a very powerful means of bringing quality eye and hearing care to elderly populations in their communities and satisfying the needs of this rapidly expanding demographic.’
He added that protectionism should be outlawed to meet patient demand.
Specsavers
A consultation response from the optical market’s biggest retailer unsurprisingly forecast expanded clinical roles.
For education, it suggested blended learning may become a preferred way to organise teaching with some time spent online and the remainder in the classroom.
‘The basic method of teaching (optics is no different) has not changed for decades if not centuries. Small group of students, assembled in front of a teacher, delivering a session of broadly same duration and pace, to a fairly rigid curriculum – and one size fits all,’ it said.
Specsavers added that DOs would need to have greater knowledge of pathology and management, while taking on some of the core learning and training from the CLO programme. This way the CLO programme would become more about demonstrating experience and fitting contact lenses, it said.
University challenge
University of Bradford
Because of uncertainty in how the role of the average optometrist in a high street practice role may change, it is unclear how the role of dispensing opticians might alter, said academic staff.
OOs were likely to be more involved in diagnosis, monitoring and treatment of eye disease, but while DOs were backed to upskill it was not thought they should take responsibility for refraction.
Cardiff University School of Optometry and Wopec
In the last decade, Wopec has trained and accredited over 10,000 UK optometrists in Pears, Mecs, glaucoma referral and refinement, cataract referral and refinement and post-operative cataract management. It said this met demand and the desire of optometry and dispensing opticians to enhance their skills.
Optometry courses should include monitoring and managing patients with AMD, glaucoma, cataract and acute eye conditions, rather than just detection and referral pathways, it was stressed.
Glasgow Caledonian University
A different skill set will be required of optometrists in the future, with entry level needing to rise to what is currently IP level.
Graduates would require solid clinical skills, along with further specialisation at post-grad level.
Glasgow Caledonian’s response also stressed the regulation of optometric education needed to allow for more flexible adjustment of the syllabus.
Optometry Schools Council
A response by the Council poured some cold water on the calls for radical changes.
It said: ‘It is our view that the content and delivery of existing optometry programmes already ensures students gain the skills and behaviours required to enter pre-reg practice. We are not aware of any evidence to support a view that radical change in optometry programming is necessary.’
The Council described the rise in the number of optometry schools as ‘unsustainable’.
University of Manchester
The university said due to technological developments eye care professionals will move away from being ‘data collectors’ to spending more time interpreting and communicating clinical data.
Its responses added that the GOC should not specify in detail the content for undergraduate education, because such specification made it harder for institutions to be nimble in reacting to change and ‘stifles innovation’.
Bodies of opinion
ABDO
The expansion of Mecs was identified by ABDO as a shift towards ECPs using their full clinical skillset, but DO skills were ‘underutilised’ post-qualification.
It stressed DOs were competent to deliver low vision services, paediatric dispensing, dispensing to vulnerable adults, bespoke eyewear, referrals and eye-health advice. Practical refraction could be delegated more as technology advances, it said.
ABDO called for more emphasis on low vision and paediatrics for student DOs, plus the inclusion of Mecs training. It also called for a host of post-registration qualifications assessed via CPD.
AIO
Representing independent optical practices, the AIO said students should spend more time with OCT, ‘actually acquiring the images, not just interpreting’. AIO also suggested Goldmann tonometry be performed more than twice, as currently required for the pre-registration scheme.
AOP
Optical practices of tomorrow should be the ‘GPs of the eyes’, the AOP set out in its response.
Optometry would extend to therapeutics, disease management and some aspects of surgery. OOs and DOs could work closer to orthoptists, ophthalmologists, ophthalmic nurses, GPs and pharmacists, it noted.
As for optometry programmes, the AOP did not advocate proposals for all optometric undergraduate courses to become four year MOptom or the US model of a doctor of optometry. It also stressed IP should not be part of undergraduate education.
BCLA
The BCLA called for the development of anterior eye schemes to involve CLOs, while noting the growing popularity of telemedical communication in the US.
Dispensing opticians would need to take the responsibility for instrumentation such as auto refractors and gain low vision training, its response added.
College of Optometrists
The College warned technology was likely to remove some of the activities ECPs undertake on a regular basis, as will the increase in online sales. This is particularly true for dispensing.
It forecast more large corporate brands and fewer small independent practices, and said ophthalmologists may move into community practice. The ageing population was also likely to drive an increasing domiciliary and low vision workload.
FODO
Increasing demand for hospital ophthalmology departments, A&E and GP services would open the door for high street practitioners to evolve, said FODO.
The new Austin Friars Diagnostic Treatment Centre in Newport and the AMD services in Brighton and Hywel Dda were examples of a wider clinical remit, with additional roles such as prescribing ‘likely to become core’.
As a result, optometry degrees would have to cover more competences. But because a fourth year puts extra pressure on universities and students, FODO suggested registrants add to their competencies over the course of their career according to their personal, clinical and employment ambitions. This would mark a shift away from CET.
Optical Confederation
In answering how the roles of OOs and DOs are set to change, the OC also referenced extended primary eye care services. But this would rely on practices and professionals seeing sufficient remuneration attached to the new services.
It was noted in Wales, much of glaucoma and medical retina care has moved into primary care.
The OC expected optometrists to take on many more roles in the future, perhaps even performing minor surgery in clean room environments. Optometrists were expected to pass some aspects of their current core roles to DOs.
It welcomed educational approaches that increased the amount of patient contact throughout the course, which included community, hospital and GP placements.
The Worshipful Company of Spectacle Makers
The Company noted modern patients were already ‘more demanding and more litigious’. It meant eye health professionals would need to ‘communicate very clearly with their patients, to explain what images mean, to provide reassurance and to be able to give broader health advice’.
WCSM has long maintained there is a need for nationally recognised qualifications for staff who are working in practices and labs. Below the registered professions, it said qualifications for support staff helped provide essential career paths.
The devolved nations
Eye Health Examination Wales
Future roles for optometrists include independent prescribing, medical retina and glaucoma, but the public needs help understanding the differences between members of the optical profession and their differing levels of education, the Welsh body pointed out.
It added that optometry programmes needed a renewed focus on the value of clinical placements, while dispensing courses needed to incorporate basic optometry pathology recognitions skills.
Optometry Northern Ireland
OOs and DOs in Northern Ireland will be required to have closer collaboration with other health care professionals, it was expected. More optometrists will also look to become independent prescribers.
Education would benefit from exposure to a wide range of patients in hospital clinics, added Optometry Northern Ireland, but also through e-learning.
It said there was currently no clear career progression path for post-registration optometry and this is ‘something that needs to be addressed’. The organisation also called for mandatory hospital placements for student dispensing opticians.
NHS Education for Scotland
NES said the optometrist was part of the health service in Scotland already, and the wider practice team had an important role to play caring for NHS patients.
In the next 20 years, it said both OOs and DOs must also improve their skills in leadership and management to support patient care, adding it was ‘no longer enough simply to be a good clinician’.
Beyond optics
The Brain Tumour Charity
The charity has found demand among optometrists for training in soft skills to better communicate with patients about different neurological conditions.
The charity also flagged up its HeadSmart campaign’s resources to help optometrists assess signs and symptoms suggesting a brain tumour. It follows the prosecution of locum optometrist Honey Rose last year, which highlighted the risk that optometrists could face from gross negligence charges through a missed diagnosis or referral for a scan.
Read the responses in full at https://tinyurl.com/y7pb6ebl.