Ceri Probert, a specialist independent prescribing (IP) optometrist at Probert and Williams Eye Care, a Mid and West Wales-based three-practice business, was delighted for the independent to collect the Enhanced Optical Service Award last December.
‘We were up against an outstanding group of practices and a health board, including strong representation from colleagues here in Wales, so we were very surprised to have won,’ he says, adding: ‘Our trophy has taken pride of place behind our Aberystwyth branch reception desk.’
The judges commended the excellence shown throughout the enhanced services category and said: ‘The winner offered enhanced and adapted services throughout lockdown, has close hospital links and offers improved accessibility for patients.’
Identifying demand
Probert and his colleagues identified the growing need for enhanced services in practice after observing both the demographics and clinical needs of their patients and the future trends in eye care. ‘Our industry is changing rapidly and there is a need for us to take on more of the clinical care of patients and alleviate the burden on our secondary care colleagues,’ he says. Fortunately, Probert says representatives and local health boards in the region, and Wales as a whole, are keen to move care to the community so patients can be seen more quickly and closer to home.
Probert and co-director Clive Williams represent practitioners locally on the Regional Optical Committee (ROC) and Probert is the optometrist lead on the local primary care cluster, helping to improve relationships with other primary care colleagues, health boards and fellow eye care professionals. All optometrists at the independent are accredited for the Eye Health Examinations Wales scheme, allowing them to see patients for urgent conditions and those more at risk of eye conditions. It also helps refine their referrals in the case of suspect glaucoma or ocular hypertension and to see patients for post-operative care. By embracing enhanced services, Probert and his team have ‘improved the already strong relationships with the local hospital eye service’.
Enhanced services
In 2019, the independent became one of the first practices on the health board to be accredited to offer enhanced cataract referrals. Equipped with the skills obtained during clinical and surgical training sessions under a consultant ophthalmologist, the optometrists can provide patients with a more in-depth assessment of risk factors and comorbidities to ensure that they are suitable for surgery and that the conversion rate is maintained at a high level. ‘We make several cataract referrals a week and we’ve only had a small handful of clinic letters stating the patient decided against cataract surgery by the time they attended their outpatients appointment,’ says Probert.
In the same year, Probert and his wife Lisa, co-optometrist director for the independent, became two of the first IP optometrists in Wales and the first in the county. During the Covid-19 lockdowns, the practice became part of a health board-wide, fully funded IP service that allowed practitioners to examine and prescribe through the NHS prescription pad. This proved invaluable when the local eye department closed and local patients otherwise faced a three-hour round-trip to the nearest eye department. Probert explains: ‘We were the only IP or ophthalmology cover in the area at times. We treated cases of corneal ulcers, uveitis and neurotrophic and herpetic keratitis, to name a few.
‘With the IP service, we have a very high rate of retaining patients in primary care – 94% of presentations are followed up or discharged by us.’
Elsewhere, the independent is fully involved in providing low vision care to the local community through the Low Vision Service Wales scheme. ‘Our low vision service is incredibly popular with patients,’ says Probert.
On the horizon
Ongoing contract negotiations between Optometry Wales and the Welsh government are anticipated to provide increased clinical powers for optometrists and Probert looks forward to the wider profession further pushing the boundaries of what can be provided to patients locally.
‘We are excited about the prospect of our model of working changing to become more clinical and us being remunerated appropriately,’ he adds. Following the retirement of a contact lens practitioner in the local eye unit, Probert and Williams has also provided ad hoc specialist contact lens care to patients, which it hopes to add to its portfolio of enhanced services. Probert fully recommends upskilling and obtaining higher qualifications to ‘stay ahead of the curve’ and ‘put you in pole position to provide enhanced services once the opportunity arises’.
He says: ‘Keep an ear to the ground, become involved in local and national optometric representative groups and push for positive change. It means a better level of care for your patients, as a practitioner it ensures no two days are the same and, in most cases, stretches you clinically.’