Honey Rose manslaughter conviction
In April, locum Honey Rose became the first optometrist to face criminal charges relating to medical negligence. The 34-year-old, who was working in the Ipswich branch of Boots Opticians, was charged with the manslaughter by gross negligence after Vincent Barker, aged eight, suffered a fatal build-up of fluid on the brain, five months after an eye exam with her in February 2012.
Her trial began in July. The jury heard there were ‘obvious abnormalities indicating swollen optic discs in both of Barker’s eyes, which the prosecution argued she should have picked up on during the examination. At the trial, Rose told the court she had conducted all the required tests during the eye examination. She had failed to look at the most recent retinal photographs or examine the back of Barker’s eyes, which prosecutors said would have showed the abnormality.
The jury took just two hours to reach its guilty verdict, for which Rose received a two-year suspended prison sentence. She is now considering an appeal.
Such is the gravitas of this tragic, avoidable case, the full impact on the optometric profession is yet to be felt, and questions are still being asked on delegated functions, digital records networks and whether this case could be repeated.
‘As most of us predicted, the conviction of Honey Rose has had an impact on secondary health care provision,’ said Optician clinical editor Bill Harvey.
‘All optometrists know that papilloedema (the elevation of the optic nerve head due to raised intracranial pressure) requires same day referral to hospital. Even though most cases are due to cerebrospinal fluid build-up or slowly growing space occupying lesions, rare potential causes such as intracranial aneurysm might be imminently fatal and so for this reason it is one clinical presentation where caution is always advised – if any doubt about the definition of the disc margin, refer immediately. Unfortunately, in this case, poor management resulted from the discs not actually having been looked at by the optometrist at all.
‘The problem now is that, because of the seriousness of the outcome of this case, some optometrists are questioning their own confidence in assessing apparently swollen discs and this has resulted in many ophthalmology colleagues reporting a rise in unnecessarily referred suspicious discs. I would expect this effect to be transient and would still maintain the view that caution is a good policy with disc oedema assessment. More of a worry, I believe, is the impact on other professions. A GP colleague of mine recently told me that many of his profession are now minded to refer headache patients for scans rather than risk possible consequences. This certainly cannot be sustained and might, in the end, prove the bigger problem.’
BBC Watchdog’s blue light investigation
Few topics in optics stir up debate quite like the effect on blue light emissions from digital devices. This year’s instalment was a BBC Watchdog investigation in October. Undercover reporters visited five Boots Opticians practices and five Vision Express branches, recording what the ‘dispensing opticians’ said about the effects of blue light. Six out of 10 of the stores reportedly made health claims that have no concrete evidence behind them.
In the investigation, opticians stated that blue light from devices caused eye strain, fatigue, headaches and drowsiness. One Boots Opticians staff member went as far as to say that blue light rays killed retinal cells. Experts debunked the claims and the multiples were left looking like they had been pushing products of no real value to the patient. In overstating the claims of the ‘dangers’, genuine well-being use dispensing has been jeopardised.
With high street optometry already under the microscope following the Honey Rose case, a high profile investigation was the last thing the industry needed for its reputation, which optical PR consultant Janice English said was the most valuable asset a business possessed.
‘A damaged reputation can take years to repair, and yet sadly is often way down the list of company priorities. It would be interesting to know how many management hours are dedicated to ensuring that advice given to customers is technically correct, consistent and in a non-jargon form which the consumer can appreciate with ease.
‘Perhaps this should be the mantra for 2017: Reputation, reputation, reputation. It should underpin every aspect of UK optics in placing the industry and profession in a position of respect. Consumers want to trust the profession which looks after their most valuable sense, and yet how often are they “more than satisfied” in the service they receive? We have amazing diagnostic and dispensing technology, the most advanced contact lenses in the world and eyewear for every fashion and sporting need imaginable – let’s strive to make 2017 the year of excellence in UK optics.’
Capita’s mishandling of GOS provision
While the Honey Rose and BBC Watchdog cases hurt the optometric sector on a professional level, Capita’s attempts at managing the remuneration for GOS contractors has had a devastating effect on a business level.
Reports of late payments surfaced early this year, shortly after Capita was awarded the contract for GOS provision. Kate Webb, director of Cranmers Opticians in Minehead noticed immediately when the contracts changed hands: ‘It’s an administrative nightmare. It’s up to you to re-calculate how many contracts have been sent and when they were sent.’
It was the Association for Independent Optometrists and Dispensing Opticians that put its head above the parapet by writing publicly to the Secretary of State and the chief executive of Capita, calling the situation an ‘absolute disgrace.’
Interventions and help from the likes of the Association of Optometrists and Locsu eased the problems slightly, but not enough to help practices claw back delayed payments in a timely fashion.
Staffordshire optometrist and contact lens practitioner Brian Hitchin was just one of those who had got into serious financial trouble as a result of the Capita takeover and subsequent missed payments. He has had to rely on funds from his pension and family members to keep the practice running and even had to turn away patients because he could not afford to buy specific equipment.
But it was not just money that was tight; time was too. Trying to speak to anyone at Capita was a problematic, lengthy process and when money was paid, practices had to then spend time matching payments.
‘Capita and NHS England have apologised for the problems with GOS payments and delays to the administration of performer list applications that have caused difficulty for businesses and individuals in optical practices across England,’ said new Locsu chief operating officer Richard Whittington.
‘A new senior management team was instated at PCSE in the early autumn and NHS England experts, with support from Locsu, have been working with Capita to get reliable recovery plans in place to stabilise the service.
‘As we enter 2017, it is crucial that the steps being taken to recover the service are translated into significant improvement which is visible to practices on the ground. When the work to stabilise the service has been concluded, compensation for the significant business interruption and losses the sector has faced needs to be resolved through negotiation with NHS England and the focus can go back to transforming the agenda including the development of a modern eGOS solution.’
Specsavers targets Enhanced Optical Services
Technological change, an overstretched NHS, increases in eye conditions and professional bodies’ involvement have created a perfect storm for high street optometry.
It is clear the role of the optometrist and dispensing optician has to adapt, and according to General Optical Council research published in November, 87% of registrants do expect to see their role change in the next five years. The same number supported enhanced optical services (EOS). This would mean additional work in areas such as glaucoma management and low vision, generally with extra training and qualifications.
EOS can also include high street practitioners being a first port of call for patients with minor eye conditions (Mecs) such as redness or objects in their eye. Specsavers has been particularly active in this area during 2016, not without raising a few eyebrows. Earlier this month the AIO reacted furiously to a letter from Specsavers co-founder Doug Perkins addressed to independent practices. In the letter, the AIO said Perkins expressed the intention that the multiple would bid for NHS and CCG contracts for Mecs services, which would see it break ranks from a commitment from multiples to participate in optometry-led community services via LOCs/LOC Companies.
Specsavers has acknowledged with Locsu that the letter could have given the wrong impression and confirmed that version of the letter would not be used.
‘From the broad perspective of the nation’s eye health, the move by Specsavers into providing a more extensive clinical offering can only be a good thing,’ said Mike Ockenden of the AIO.
‘It is of course the case that patients of most independent practices have been benefiting from what Specsavers calls EOS, and indeed more extensive examination procedures, for many years. So will Specsavers move put even greater pressure on an independent sector that has been decimated by the multiples in recent decades?
‘Perhaps not. The independent sector has become more resilient to external pressures in recent years and has stuck to the basics of treating people who come through its front door as patients and not customers. The public who use independents know and appreciate this and that is why they come back again and again. The challenge for the sector is to expand the awareness of the general public as to what it offers – long term eye health care.’
Unsupervised online RX eyewear sales to children
Essilor’s online retail activities have been the subject of intense scrutiny over the year. Acquisitions like that of the Myoptique group, which includes glassesdirect.co.uk, made the industry sit up and take notice, but Optician first investigated the scope of the retail portals much earlier in the year.
In the fallout of the Myoptique purchase, Optician happened upon eyebuydirect.co.uk and noticed it offered frames for children under the age 16. This was also the case on lensway.co.uk and framedirect.com sites. All three are owned by Essilor.
Optician was able to purchase a pair of children’s Rx spectacles from the site with no age-related warnings or restrictions before or after completion of the transaction. Statutory regulation within section 27 of the Opticians Act 1989 restricts the dispensing of prescription spectacles in children under 16 and patients who are registered as blind or partially sighted. Sales of spectacles to persons in these cases can only be made by or under the supervision of a registered practitioner.
Following the report in Optician, Essilor removed the products from sale on the UK versions of its sites.
‘When this was brought to our attention, we immediately made the changes to take the product off sale temporarily,’ said Peter Smith, regional vice-president of Essilor UK & Ireland
‘Eyebuydirect.co.uk was a copy of the American .com site and some of the children’s inventory was carried over by mistake during a website upgrade by our international teams. We are working within the laws of local legislation,’ added Essilor Europe president Bernhard Nuesser during a specially convened press conference to address some of the issues raised by Optician over the course of the year.
ABDO’s head of policy and development, Barry Duncan, said: ‘This was particularly disturbing news and sent completely the wrong message out to members of the public, presenting a potential eye health risk to the child and blatantly dismissed the skill and expertise of registrants in the UK. It was most alarming and deeply disappointing that this was allowed to happen.’