Wow! They say a week is a long time in politics, well two weeks certainly is. With a new PM having a day of the long knives and establishing her untrammelled future vision, perhaps radical vision is the order of the day. With a GOC review of education signalled as a major plank of business perhaps now is the time to take the opportunity for optometry and dispensing optics to do some horizon scanning of its own.
A lot has been talked about the Foresight Report but in reality was this an opportunity missed?
Unremittingly negative, everything seemed to be positioned as a threat, sadly an attitude that seems to come easily to the optical sector. It is of course always possible that the legacy of Foresight is bringing forward the GOC Education review.
We have yet to see the form that this review will take, will it be radical, will it be internal? How will strong vested interests in the status quo be managed? If the outcome is expensive will it even be possible? So here are a few ‘hints’ the review might like to consider.
First, although understandably the concentration has been on harmonisation in Europe it is at least arguable that the UK, while acting as a beacon for enhanced optometric scope of practice in Europe, has lost track of its cousins in the USA and the former Commonwealth. There is no doubt that while the UK has some of the very best optometric research in the world, the education and clinical training in the USA, Canada, Australia and New Zealand is significantly more advanced. Take Victoria, Australia, for example, therapeutic legislation arrived in 1995 having taken less than 14 years from the legalisation of diagnostics. All Australian optometrists now graduate with therapeutic competence and top-up higher diplomas are almost nonexistent. Further afield Hong Kong Polytechnic University graduates its optometrists with therapeutic competence at registration.
What makes this happen? Ultimately the single biggest reason is that all of these countries have a registerable degree. Fundamentally the UK is an outlier having registerable access through only one professional body (apart from Manchester’s four-year masters). Universities have an independent impartial quality assurance (QAA) system that ensures degree equivalence, the College of Optometrists has the GOC visiting cycle. This limits choice and arguably stifles development because of the vested interest in an expensive examination system. In addition, by remaining fixed in competencies over 20 years old students are ill prepared for a world of clinical decision making that no longer mandates referral, nor are they competent in the use of new equipment that is increasingly mainstream.
In a world where enhanced primary care services have been around for 10 years or more, no new registrant can engage with those services until they are retested on subjects they have just graduated in. Either the courses are inadequate, in that the competencies are not appropriate, or, more likely in my opinion, competence is confused with contractual capability given that the GOS sight test is useless for most health-related examinations.
Fundamentally other countries elevate the scope of practice faster and they do it by ensuring the next generation of registrants adopt the newest skills right away. Those already qualified then have a greater incentive to catch up. In the UK with soon to be nearly 6% new registrants per year it would only take five years to hit 25% of all registrants. This is a far cry from the barely 40 new IP specialists joining the register per year. I do not believe that our current system, with competing organisations and one monopoly provider is in any position to deliver this. That this is self evident is borne out by the development of a course in Hertfordshire that delivers nothing new other than an ersatz masters that should not be considered a registerable degree.
Like Brexit, writing a polemic article means that you don’t have to have the answers, although at least one might come from reviewing the course’s contact time and comparing current semesters with the term times of a few years ago. Nothing needs to be dropped (I do not call for ophthalmic dispensing to be reduced) but the course should become near-continuous from summer of Year 2 adding two extra semesters in the final two years rolling into IP placements at the start of what would be Year 5. You would have new IP registrants inside four-and-a-half years.
Two additional things need to happen. First the Department for Education would need to insist that the Higher Education Funding Council (HEFC) regarded optometry as a clinical discipline and not as a basic science course with derogatory staffing levels. Secondly, optometry has no NHS-funded teaching positions yet other medical disciplines do, such as medicine, nursing, physiotherapy, etc. In this brave new world the NHS would need to fund at least one lecturer per optometry school. If Aston Pharmacy school can secure millions to establish an independent prescribing course what is wrong with optometry’s negotiating ability? Send for Theresa!