A manifesto that outlined a restructuring of the General Ophthalmic Services (GOS) system so the skills of optometrists are utilised and recognised nationally has been launched by the Association for Independent Optometrists and Dispensing Opticians (AIO).
Christian French, chair of the optical body, told Optician the AIO received unanimous support for the manifesto and its message for eye care provision in England to move away from a fractious way of working under Clinical Commissioning Groups to a unified national approach.
‘There’s this growing expectation of things we’re expected to do as part of a routine eye exam but the fee remains exactly the same year on year and there’s no improvement,’ French said.
He explained the AIO’s manifesto was an opportunity to wipe the slate clean with NHS England and create a positive image of eye care in general. ‘The manifesto moves the conversation away from optometrists complaining that they’re not paid enough for doing an NHS exam and addresses the major problem hospitals face when we come out of this pandemic, which optometrists can help with. It’s also a good opportunity for us to tidy up the existing problems and create a bit more faith in the GOS system,’ French said.
Following NHS England’s decision to freeze GOS fees for a fifth successive year, French shared that frustration was growing among AIO members. He said: ‘Everyone unanimously agrees that it’s not enough, so why is the negotiating committee settling with it just being static and not increasing?’ The Optometric Fees Negotiating Committee (OFNC) bid for an increase of at least 2.5% and the government has imposed the freeze without agreement from the OFNC. French criticised the OFNC for not representing the interests of independent optometrists adequately and for not fighting a strong enough case in relation to what optometrists were capable of doing.
French said that the current system is underfunded with eye health treated as an add-on to a vision check. ‘Our proposal is turning that whole system on its head and saying that we need to look at this from a different perspective because optometrists aren’t just there to check whether someone can see all right and then sell them a pair of specs. It’s bigger than that.’
The AIO wants to shift the perception of optometry from retail to clinical
The AIO proposed a menu driven approach focused on patient centred care, French explained: ‘Your patient comes in, you do your vision check then do a health check. If this patient has glaucoma for example then do contact tonometry, check their visual fields and image their optic nerve head.’ The patient returns six months later for a glaucoma check only and the practice submits a claim form for it, creating a simple trail of what the patient has received at each appointment. French added: ‘It means you’ve got an itemised list of things that you’re claiming for, so that you’re not over-claiming but you’re also not under-claiming; you’re doing it appropriately for each patient.’
He said that the current system had created a postcode lottery for supplementary schemes such as Minor Eye Conditions Services and glaucoma referral refinement, which should be offered nationally.
The AIO’s system is designed to support hospitals post-Covid-19 and demonstrate how treating and managing patients this way could become the norm for optometry. ‘There is going to be a huge backlog of patients, with hospitals reviewing all the routine patients whose appointments have been cancelled during the lockdown period, but then also reviewing the patients that would have been coming in anyway,’ he explained. Inspiration for this model has been taken from the virtual or co-management clinics used within the hospital eye service during the pandemic. French explained that a patient who is diabetic or has glaucoma will see an ophthalmic nurse or an optometrist at a hospital who will do the relevant checks rather than a consultant. The data from those checks are then reviewed virtually when the patient isn’t there and a management decision is made. The AIO wants this to be moved into primary care to ease the burden on hospitals. Stable patients are reviewed by their optometrist and if they believe something has changed or needs intervention, the patient goes back to hospital. ‘It frees up the consultant to work on those newly diagnosed cases and the problem cases that aren’t responding to treatment or require surgery,’ French added.
French said that the model could improve optometry’s relationship with GPs and hospital colleagues, as well as shift the mindset of the public. ‘If you wake up with toothache you don’t phone your GP, you phone your dentist. It should be the same for optometrists. If you wake up with anything wrong with your eye, whether you can’t see or your eye’s red, you speak to an optometrist first.’ He explained that if optometry services were commissioned on a national level, the profession would be considered in the same sphere as dentistry and pharmacy. French added that the patients do not currently think of optometrists as the first port of call because of advertising by multiples that are about buying spectacles. ‘It’s only within the last year that they’re starting to have this shift in advertising towards, “Actually, we do offer a clinical service as well,” but the damage has been done. They’ve engendered this perception that we’re all about selling glasses.’ He added that this is not experienced by other primary care professions because patients attend appointments for clinical needs rather than retail.
In order to implement the proposed changes, the AIO has sent its manifesto to the health and social care secretary, Matt Hancock, and NHS England. French explained that the first step to change is making external bodies realise the benefits and then follow up with detail provided by optical bodies. ‘The key thing with our manifesto has been that it’s not just about independent optometry. It’s about a complete shift in the way eye care is delivered in England,’ he shared. French cited models in Scotland and Wales that can be used as examples but noted that change needs to be focused on patient choice. He said: ‘It doesn’t matter where they live or who they go to see, that care is the same standard and the clinician who is offering it is paid appropriately.’ French warned that there is a growing faction of optometrists who could walk away from the current system if GOS fees do not increase. ‘It’s unfortunate that there are providers who are at the point of frustration that they’re saying, “Actually, my patients losing out on an GOS eye exam is preferable to me putting up with this really inadequate remuneration from the GOS system”.’
French concluded that the manifesto is not radical and is a redesign of the current system so that it is benefiting everyone involved. ‘Patients will get the same high quality of eye care wherever they live. For the hospital eye service, they are getting their workload eased and for optometrists we’re doing the job that we are capable of doing now, but with the appropriate recognition for it. We’ll be co-managing patients and will be adequately remunerated for it. There will be a greater amount of job satisfaction because it brings the main focus of our profession back to being what it was always intended to be, which is a clinical remit,’ he said.