Doug Perkins has become something of a focal point at Optrafair in recent years, delivering keynote addresses on structural issues surrounding the profession’s future.
This year, in a double hander with Paul Morris, director of professional advancement, he laid out his view of what optics needed to do in the face of imminent competition from online refraction technologies and increasing powerbases within the multinationals.
Setting the scene Perkins spelled out the value of the relationship optics enjoys with the NHS which delivers 15 million patients through the doors of practices each year. ‘The NHS has brought hundreds of millions of patients over the years,’ he said, but that might not always be the case as technology, such as online refraction, advanced.
‘A lot of these threats have been around for a long time, when are they going to hit?’ asked Morris. He spelled out the Doomsday scenario: In the US Visibly, formerly known as Opternative, offers a remote refraction in 10 minutes using a smartphone and computer. In one year the firm grew its user base from 200,000 to 1,000,000 simply by asking users with expired prescriptions from online contact lens sellers if they wanted an online refraction. That technology is coming to the UK, says Morris. Maybe not tomorrow or even this year but sometime soon. ‘It might be illegal in the UK but you could set up in the Isle of Man or take any fine from the GOC as a business expense’. In that case what would the NHS, or its Government paymasters do? Scrap GOS? GOS is not something the profession should take for granted, he warned.
‘I believe the future of optics is within the NHS,’ says Perkins and he says to ensure that future optics has to rebrand itself in the minds of patients and the NHS. ‘We can’t wait for someone to do that for us. We have to give patients a reason to come back and increase the number of services that we provide. Optics enjoys one of the few uncapped budgets, £500m, optometry must be a friend to the NHS,’ he said.
His latest point is a well worn path but a path the professional bodies have singularly failed to make progress along. The NHS’s latest 10 year plan hardly mentioned optics, said Perkins: ‘We need an action programme.’ The pressures the Hospital Eye Service labour under are well known as are the possible cost savings. Optics has to act differently to get a different outcome. ‘We have seen how pharmacists have got into the tent,’ optics has to do the same he added.
Referral presented an opportunity, but it had to be right. ‘If optics floods the NHS with false positives it will lower the profession’s standing not raise it. Through training and use of data it could be done. ‘Bring data together to rebrand optometry so it becomes difficult for the NHS to push us aside.’
Echoing Perkins’ passion Morris outlined how optics needed to expand the scope of its services to demonstrate value to the NHS, policy makers, researcher, insurers, healthcare providers and patients. This could be achieved through effective data collection and record keeping but it had to be right.
Paul Morris
In 2016-17 1.93m ophthalmology referrals were made in England. Nearly a third, 29% of first appointments, were false positives a waste of £50m. Practitioner education is valuable as the level of referrals decreases 6.2% for every year qualified and referrals are 2.7 times lower in areas with an optom-led community service.
Patient education also plays a key role with 12 to 14% of patients failing to attend first appointments and a staggering 11 to 12% failing to attend follow ups once diagnosed.
Morris suggested in that gap of around 2.5 years between visits patients were bombarded with marketing offers so practices had to act. Recall is the most powerful asset a practice owns, it needs to be used intelligently to fit patient need, inform and educate. ‘It shouldn’t purely be marketing,’ adds Morris. ‘This is where record keeping comes in. Make notes on glaucoma or AMD if relevant and use that in education and recalls. Get inside their heads, that’s the right thing to do. Let them know about the service if you offer it. Patients have got to feel it’s important for them to visit the optometrist to have their health checked.’ He cited to way dentists have acted. ‘We should be fighting to be on the same level.’
Optician asked Perkins and Morris what practices needed to do to effect change. ‘We’ve tried the corporate approach to change down in London and it’s not going to work,’ said Perkins. Specsavers had trained thousands of professionals but leadership, talent and passion was needed. ‘Wopec training is basic infrastructure. We need to find facilitation and support that is extremely intense. That’s going to happen when people see the threat and they are fighting for the future of their profession.’
‘The way I look at it at the moment,’ said Morris, ‘is that we are blessed with volume and we have got our hands full of sand and it doesn’t matter if some of those grains come through. As soon as that internet threat comes in, and it’s going to come, we’ll be left grasping for what’s left.’ He said practices don’t take the metrics seriously. ‘It’s a leadership thing within the sector. The College of Optometrists has published a lot of papers on running a good clinical audit, running a practice, etc. Where’s the practical guide?’
So what else can be done to bring optics closer to the NHS? ‘I think we are in a very privileged position,’ adds Morris, ‘that budget [GOS] is one of the last ones that’s, as yet, uncapped. My concern is that if it was ever seen not to be [good value] there would be the same cuts that you have seen in dentistry and pharmacy.’ If optometry wants an increase in fees it needs to demonstrate more value not just say: ‘Give us more money because it’s been two years.’
Perkins understands the enormity of the task but action has to happen, he said. ‘One of the reasons it hasn’t been done before because it is quite complex.’ So if the professional bodies have failed to, does the grass roots profession now have to take charge? ‘Without a doubt, I’m not blaming them [professional bodies], the whole thing has to start in practices, I don’t think the College, AOP or FODO control practices.’
But can that be achieved in the context of commercial rivalries? ‘Any process that requires reengineering requires a huge amount of passion. If there was an object from today [presentation at Optrafair] it was to look for kindred spirits among the organisations where we can work together. It can’t be about one company, it has to be as wide an estate as possible. It’s a call on everybody.’
Optician suggested some independents may be sceptical given Specsavers marketing-led approach in the past. Perkins said the real competition today does not come from the high street but from the internet. ‘It isn’t about the competition we have in the UK. It’s nothing to do with that. The competition is coming from the disruptive forces using globalised tools to attack the traditional industries. They are going to do it even though they are part of the traditional industry – say no names.’
Morris said Specsavers is not the only company that free eye exams offers and that affordability is not the key to patient loyalty. ‘You can’t scare people into having a sight test.’ People have to be positively encouraged in. Free eye tests are a benefit for people who have to choose between paying for an eye exam and school shoes for their kids. ‘If you measure your professionalism by how much you charge for stuff you’re probably not in the right [place].’
Patient retention is about education and a lifetime relationship build on education and service not getting a free eye exam. Patients will be enticed daily by other providers and online in the 2.5 years between eye tests so there has to be a relationship to get them to come back, he said.
Optician took the opportunity to ask Perkins where he felt the market was heading. ‘The next big growth will be online and the profession can fight from its current position but if the NHS were to see online refraction and decide, “we don’t need these guys in the high street”, it would be much better if we get momentum going on this now.’
Morris said the ease with which contact lenses are offered online with little regulation could be repeated by a refraction service. He does not believe in overregulation but under the same GOC rules if you can do it for contact lenses there is nothing to stop someone coming in, being based in the Isle of Man and adding a sight test to the offer. Perkins said the international players have a different view. ‘A lot of people like Grand Optical are used to commodity markets and if they had to take out their NHS systems it wouldn’t bother them, it would just become like Turkey, Netherland, Italy, Spain. They have got a model for this and it wouldn’t affect them that much.
‘We are not just doing this in the name of Specsavers but we will join with anyone who will join us. We can make a difference to the way we operate so that makes a difference to the way we are perceived.’
Morris said the whole basis of professional optometry depends on the primary health side. ‘I fervently believe the best place for patients to access eye care is through eye care professionals. The future I see, unless we do something now, is a future with a load of glasses shops with auto refractors.’
The key is leadership and rank and file optical professionals. ‘It’s a journey we are on. We have developed a team,’ added Perkins. But he admits there are lots of traditionalists that think the past is still the future. ‘It’s going to take a lot more leadership.’
When pushed by Optician to comment on the industry giant formed by the merger of Essilor and Luxottica, Perkins was candid. He agreed that EssilorLuxottica will look to buy a retail channel, possibly a chain to go to market. ‘They have done it in the States and I have no doubt they will do that in the UK as well.’ While the timing remains uncertain he would expect a similar push online and then a move to link online and the high street together.
Returning to a doomsday scenario Morris said: ‘Someone is going to put all the pieces together, that’s my worry. What if Visibly was bought up by Essilux and integrated into Glasses Direct? It’s game over.’
The Specsavers PR minder suggests this is a gloomy note on which to end discussions but Perkins interjects: ‘The game is not over.’ Before repeating: ‘Essilux, the game is not over yet.’