At the last GOC meeting the principal item on the table was the forthcoming education review and an approach based on a call for evidence to be submitted. In paraphrased words of Gareth Hadley ‘this is not a “nice to have” it is fundamental to the profession’. In this context it’s vital the GOC’s unique role is not forgotten. Many optometrists and dispensing opticians ask ‘what has the GOC ever done for us’ and before thinking of Brian and the Romans it should be remembered that, despite the ignorant wailings of Lord Newby, the GOC’s sole role is ‘protection of the public’.
It is therefore heartening that the GOC has woken up to its role and responsibility that the safety of the public is not being maintained by a primary eye care system that is slipshod, haphazard and regarded as a nuisance to the power brokers in the Department of Health. Forcefully rebutting the opinion of the College president who feels optometrists are in a position to ‘do more harm’ (Optician; passim) the GOC clearly recognises the principal risk to public health lies elsewhere. Eloquently put by Barbara Ryan and Nic Sheen the problem lies in optometrists being unable to control the numbers at the gateway to secondary care. This has led to unsustainable numbers being managed in secondary care by a diminishing number of ophthalmologists and a long overdue recognition by all candidates for the presidency of the Royal College of Ophthalmologists that co-operative (or controlled) working with the rest of the sector is the future.
A wholesale GOC review, which alone has the ability to statutorily reform optical education, must deliver at three levels; short, medium and long term.
First, is the thorny subject of terminology. I have railed on this before in these paragraphs but essentially what is increasingly being called ‘Enhanced Services’ is nothing of the kind. There are large corporate bodies building their future on that term. The only thing that is enhanced are services beyond the nonsense that is the GOS. Every single enhanced service is nothing more than the potential autonomous domain of every single optometrist. In many cases, mostly in the independent sector, it has been for years, well before they were able to contract the NHS to pay for it through CCGs. Most, within the interpretation of core competence and while one appreciates the work of the College in devising higher qualifications to address the need for the NHS to have contractual compliance, enhanced services are nothing more than core to the true definition of level 3 optometry as defined by the WCO. All are permitted in the private sector and within the Opticians Act. Remember the defined scope of practice of an optometrist is that within the Act and not within the GOS.
Short term: It is an absolute scandal newly registered optometrists (when they can negotiate the Kafkaesque performers registration that is the government’s most incompetent agency; Capita, and get on the list) are unable to move immediately into offering so-called enhanced services. This must stop and I would suggest a target of one year hence (new entrants post-2018) is the absolute minimum. Will it need more practical experience? Possibly. The GOC will need to mandate to the sector (university and College) to deliver it and the defence bodies to support it.
Medium term: We need a faster entry to the now proven safe record of optometric prescribing, if necessary using the exemptions from Medicines Act route. Additional Supply is withering on the vine and so an AS-lite as an immediate follow-on from registration needs to be delivered. Entry level competence already includes differential diagnosis of bacterial, viral and allergic conjunctivitis by default. The starting point must be new entrants. It will be up to existing registrants to catch up, like they did when Volk lenses and OCT came out. This will equip new registrants to be able to deliver Mecs and/or Pears from the outset.
Long term: At registration, or immediately afterwards, therapeutic prescribing competence. Whether this involves a fifth year of mixed placement and residency or a restructured undergraduate course into a registerable degree is to be determined. We remain the only jurisdiction with the right to achieve therapeutic optometry to have failed to plan for its introduction at undergraduate level.
I would encourage the GOC to be bold and start with the patient not the practitioners. Look at what the public needs from primary care practitioners to deliver for their ophthalmic safety. It is not the GOC’s business to be constrained by cost or practicalities, that is for others. If a registerable degree course that is recognised as a clinical discipline is needed so be it, make the stand and lobby to overturn the funding anomaly that has optometry as a non-clinical discipline. If this needs to review student contact time within university years so be it. There is clearly no lack of interest in young people wanting to study optometry under today’s university funding system.
Finally, it is all very well to call for evidence on the educational review but I think they should more actively seek it abroad where there are any number of optometrists with UK knowledge (even UK trained) but with experience of teaching and delivering optometry in more advanced jurisdictions; in Australia, Canada and the USA. The knowledge base in optometric education does not solely reside in the UK and even within the UK the different experiences of Scotland and Wales must be brought in to educate the English.