Moneo writes: Becoming centres of holistic primary care
It seems to be the norm nowadays for optometry practices to ally themselves with audiology specialists. I note from last week a leading firm of opticians announcing a tie up with the Ida Institute in Denmark to further enhance delivery of hearing care. This symbiotic relationship between eye care and hearing care has grown like topsy in recent years. Why is this the case? And why is it just audiology that seems popular? Is it that optometry and audiology are inextricably linked when it comes to health care, or could it be that it makes sound financial sense? Why is it that optometry does not expand into other areas of primary healthcare?
I find it quite interesting nowadays to see reports on how important it is to team up with CCG areas such as the Stop Smoking Services or the Falls Services. There are those of us who have been talking about the importance of this sort of alliance for well over two decades now. This is not new to optometry. It is welcomed that the profession now looks to these areas but let us not forget that we are very late coming to the table. The question that maybe we should ask is, why has it taken so long for us to get here? However, my worry would be that we would spend another 20 years answering the question rather than actively engaging in providing these services.
Optometric outlets are uniquely placed to deliver a whole plethora of other health services to their patients. Why are we not teaming up with podiatry, or physiotherapy, or chiropractor services? Many of our patients fall into the category of ‘elderly’. That is to be expected as visual difficulties arise due to presbyopia. It is this age group where we begin to see the greater need for allied services. With the increase in type 2 diabetes our patients are burdened with having to attend various appointments such as retinal screening, foot care clinics, diabetic reviews, all of which further impact on their daily lives and impinge upon their work time. Surely it makes sense to develop ‘one stop’ review clinics where a full review can be carried out at one visit.
What better place than the optometrist? Recent reports show just how poor the take up is of the over-40 health check. This was heralded as a gateway to increased healthy living by the Government when it was introduced. I have commented some years ago on the scheme and its poor take-up. At the time I suggested that optometric outlets were ideally placed to take on this work. After all pharmacy outlets had become involved and the fees were very attractive at the time. So why the seeming disinterest? Maybe we have to wait another 20 years before our leaders start seeing the worth of these alliances?
It seems apparent that our so-called negotiators appear to have given up on any hope of being able to obtain any form of sensible fee for the NHS sight test. There appears to be no change to their approach. Certainly there is no sign of any dialogue with optometrists themselves and so I suspect that, even with the lavish promises of cash flying everywhere in the future from the two prospective Tory Party leaders as they bring an end to austerity measures, there will be little if any chance of a meaningful rise in the NHS sight test fee. It therefore makes sense to look at other ways to generate income as well as provide a more fully rounded service for our patients.
My fear here is the dependency on all things optical. We look to shore up the NHS sight test fee with pre and post-cataract screening services and with Mecs services. While this is not a bad thing I have yet to see any scheme that is really financially viable. How many cataract schemes have been running for years now but not seen an increase in fees? All of these additional services carry with them the onerous burden of achieving compliance with NHS Contracts, but few if any of them provide any form of financial support to achieve that compliance. We see time and time again a desire to further the profession of optometry but with no real imagination in that furtherance. Adding additional services that are not properly funded on to a service that all agree is woefully inadequate for today’s society both in content and funding is truly building a house on sand. A recipe for disaster.
We need to look at ways to develop existing optometric outlets to deliver high quality eye care, and become the centre of holistic primary care on the high street available to all. That way, not only do we increase the awareness of the importance of eye health care, but we become the go-to place for general primary health care away from the traditional GP setting. And yes, of course, diversify our income generating base allowing us to move away from dependency on the failed funding scenario that currently exists.