Within a short space of time NICE has issued new guidance on both cataracts and glaucoma. Both these sets of guidance potentially have a profound effect on daily practice life. Looking at the glaucoma guidelines they now make it very clear that routinely, prior to referral, optometrists will be required to do far more checking than currently.
We will be expected, before referral, to offer central visual field assessment using standard automated perimetry using either full threshold or supra threshold methods, optic nerve assessment and fundus examination using stereoscopic slit lamp biomicroscopy and OCT or optic nerve head image if available, IOP measurement using Goldmann type applanation tonometry and peripheral anterior chamber configuration and depth assessments using gonioscopy or, if not available, or patient prefers, the Van Herick test or OCT.
Now while this is all highly commendable and will certainly assist in sending fewer people to eye clinics unnecessarily the inevitable question that immediately surfaces is who is going to pay for all of this? Moneo would not wish to stand in the way of progress but most of these new guidelines are outside the scope of a normal GOS examination.
Of course a lot of these tasks are core competencies for optometrists and that is not the problem. For too many years we have added more and more to what we do for a paltry sum of money from the NHS. It has got to the point where we now just seem to roll over and accept we will add more and more to what we do for no extra fee.
I cannot understand how our representatives who advise NICE have not pointed out that these new guidelines will not be introduced into a primary care setting without the promise of appropriately economically viable funding to support the introduction.
I fully expect our representatives outside of NICE to now point this out to NICE and to make a public statement making it clear that, as a profession, we will institute these guidelines at such a time as the funding is made available to allow for them to be incorporated into a routine sight test. Anything less than such a public statement sends optometry further down the road of economic non-viability. To expect optometry to support these proposals with no additional funding is unrealistic.
The guidelines have been out for a while now and as I write this there has been a deafening silence from the AOP on this while the College of Optometrists has helpfully published briefing documents on the new guidelines but neatly, yet again, ignored the fact that none of this is within GOS or funded in any way.
This is just not acceptable. I would suggest that, until further funding is made available, we should follow these guidelines but with one addition. We should point out to our patients who may require the extra refinement processes that we can carry out the necessary extras but, for the time being, they are clearly outside the scope of the NHS and as such they will attract an additional private fee.
Should the patient not wish to pay that fee they will be referred to their GP pointing out the extra tests requested by NICE are not funded under the NHS but were offered privately to the patient who declined to pay privately and now requires referral under the NHS as previously.
It is only by taking this sort of action will we, at the front line, make it clear that we are willing to do the work and assist secondary care when we are funded. To do the additional work without funding is to save the local eye unit and the CCG money while we lose more money.
This is economic suicide. I would expect every LOC and every LOC company to be making this clear at a local level while the AOP and Locsu make it very clear at a national level. I would also expect to see this topic very high on the agenda at the NOC and I a very clear public statement to come from the NOC saying we will not be able to introduce these measures without the correct funding. No public statement will be the biggest betrayal of optometrists in recent history. We have the opportunity to make it very clear that enough is enough.
We have the skills and tools to play a key role in eye care but we cannot do any of this for free. Nothing is for free in this world. I look forward to seeing our professional representatives fighting for us in the days ahead.
The only worry to date is the deafening silence from them. The good news is that this can all be reversed at the NOC where I am sure they will ensure the message is heard by government. That is, of course, if they truly are our representatives and are going to stand up for us and have the stomach for a fight.