Download Primary care inquiry - the General Optical Council

Primary care inquiry - Eye health – General Optical Council response
About us:
1. The GOC is the regulator for the optical professions in the UK. Our purpose is
to protect the public by promoting high standards of education, performance
and conduct amongst opticians. We currently register around 28,000
optometrists, dispensing opticians, student opticians and optical businesses.
2. An optometrist tests sight and can diagnose eye conditions. They can also fit
and supply glasses, low vision aids or contact lenses. An independent
prescribing optometrist is qualified to treat eye disease, although they may not
undertake surgical procedures. A dispensing optician is the person who fits
and supplies your glasses or low vision aids. A contact lens optician is a
dispensing optician qualified to fit and supply contact lenses.
3. Ophthalmologists, including ophthalmic medical practitioners, (doctors
specialising in the eye) are registered with the General Medical Council.
Orthoptists, who deal with problems relating to the movement of the eye and
work in hospitals, are registered with the Health and Care Professions
Council.
How appropriately trained and qualified opticians can play a greater role in
providing NHS primary care services
4. The ageing population will have many health needs, including eye health
needs. One in five over-75s and half of over-90s are currently living with sight
loss, with high rates especially prevalent among women, BME groups and
adults with learning disabilities. RNIB predicts that by 2050 nearly four million
people in the UK will be suffering with sight loss.1
5. The ageing population suffering from increased sight loss will place a strain
on Hospital Eye Services (HES), with ophthalmologists facing the challenges
of managing increased number of patients with glaucoma whilst dealing with
the rising demand for operations such as cataracts. According to the latest
Hospital Episode Statistics for England 8.3% of all outpatient attendances at
NHS hospitals were in clinics run by Ophthalmologists – the third highest of all
outpatient specialties and an 11% increase since 2011.2
1
2
http://www.rnib.org.uk/knowledge-and-research-hub/key-information-and-statistics
Health and Social Care Information Centre Hospital Outpatient Activity 2010-11 and 2013-14
6. Community optometry can help to ease the burden on ophthalmologists and
secondary care, and is already starting to do so in Scotland, Wales, Northern
Ireland and some parts of England where CCGs have commissioned
enhanced services. This means that optometrists with the right level of
education and training can carry out work over and above the traditional role
of carrying out sight tests. This work includes acute eyecare services,
glaucoma repeat measures, and pre and post cataract assessment.3
7. Dispensing opticians can also carry out enhanced services. With their
advanced competencies in the dispensing of complex low vision appliances to
people with partial sight loss, they could be actively contributing to a real and
vital improvement in the standard and availability of low vision care.
8. In England, opticians can play a large role in the New Care Models set out in
the NHS Five Year Forward View (5YFV). Optical practices might therefore
have a role in the Multispecialty Community Providers model, carrying out
work such as management of minor eye conditions and post-operative
cataract assessments.
9. With extra training to register with the GOC as an independent prescriber,
optometrists could provide services using more than just their core skills – for
example the management of glaucoma patients.
10. Under the Primary and Acute Care Systems model, optical practices also do
more, working to provide more services that are provided by Hospital Eye
Services at the moment. For example this is currently happening in Bedford,
where the Moorfields Eye Centre at Bedford Hospital contracts local optical
practices to carry out pre-and-post cataract optical assessments.
11. In Scotland, optometrists carrying out enhanced services are more common.
There is funding for the optician to be the first port of call for patients with
acute eye problems – a ‘GP for the eyes’. Funding is also available for NHS
primary care optometrists to perform supplementary eye exam allowing
optometrists to review results of eye exams and manage a greater range of
eye conditions. This is helping to free up both GP appointments and HES
appointments, to the benefit of patients and the NHS alike. Similarly in Wales,
Eye Health Examination Wales (EHEW) is allowing optometrists to do far
more examination in the community, working with Hospital Eye Services.
12. The Scottish Intercollegiate Guidance Network (SIGN - the Scottish equivalent
of NICE) have recently produced guidance for optometrists. This best-practice
3
The developing role of optometrists as part of the NHS primary care team, Parkins et al Optometry in Practice 2014 Vol 15
Issue 4 p177
guidance provides advice on which patients should be referred into secondary
eye-care services. This guideline also provides guidance on which patients
may be discharged from secondary care and safely followed up in the
community.4 This helps to free up resources in HES.
13. In England, whilst NHS England has responsibility for the General Optical
Services contract – which covers the basic NHS sight test - any enhanced
services have to be individually commissioned by CCGs. This is taking place
successfully in some areas, but not on a national scale. CCGs are
successfully collaborating in some areas on a regional level though, such as
the London Eye Health Network.
Education and standards:
14. Optometrists with an independent prescribing (IP) qualification are particularly
able to undertake enhanced service work. The qualification, which enables
practitioners to enter onto one of the GOC’s specialist registers, allows them
to prescribe drugs for ocular conditions within their scope of practice.
Qualified independent prescribers will take responsibility for the clinical
assessment of a patient, establish a diagnosis and determine the clinical
management required, including prescribing where necessary.
15. Currently, a far higher proportion of optometrists in Scotland are IP-qualified
than in England. In England just 1.5 per cent of optometrists are registered as
independent prescribers, compared with over 8 per cent in Scotland5.
Ensuring that practitioners have access and the incentive to train is crucial to
the success of this work.
16. As the regulator, we are considering how models of education can best equip
practitioners with the necessary skills for them to fulfil their potential – both in
considering the training they undertake at undergraduate level, and their
career-long learning as part of our Continuing Education and Training (CET)
scheme.
17. We have also recently reviewed our Standards of Practice for optometrists
and dispensing opticians. One of the reasons was to ensure our standards
reflect the way the professions are developing in the UK, and will continue to
develop in the future.
4
5
( include the full title of the document in the footnote) http://sign.ac.uk/guidelines/fulltext/144/index.html
Source: GOC registers
18. The standards are flexible enough to deal with future developments in
practice across the four nations of the UK. They are also flexible enough for
registrants to apply regardless of whether they are employees, locums or
business owners and whether they work on the high street, in hospital or in
domiciliary settings.
19. The standards are consistent with the standards of other healthcare
professionals and so will help registrants who wish to provide enhanced
community services as part of teams spanning primary and secondary care.
20. The standards will also help us to ensure that we are meeting the
recommendations of the Francis Inquiry – for example in ensuring registrants
comply with the duty of candour, demonstrate care and compassion in their
work and report concerns that may place patient safety at risk. To help embed
the new standards, all opticians will have to complete CET on them in the next
cycle.
21. More information is available at
https://www.optical.org/en/Standards/index.cfm
22. We are also currently consulting on a voluntary code of practice for online
contact lens sellers, aimed at ensuring they require patients to have regular
checks and aftercare. This approach is designed to improve public awareness
about how to buy and use contact lenses safely, therefore reducing the need
for them to need primary care.
Public perceptions:
23. One barrier to optometrists undertaking more of this work is the public
perception of optometrists. Because most work in a commercialised high
street setting, many patients and members of the public do not necessarily
associate opticians with the healthcare side of their work.
24. For example, recent GOC research6 showed that 68 per cent of people’s main
association with opticians (optometrists and dispensing opticians) is testing
sight for the purpose of prescribing glasses or contact lenses compared with
just 16 per cent whose main association with them is detecting eye health
problems. Only a third associated opticians with detecting eye health
problems at all. Meanwhile 54 per cent of people would go to their GP if they
had an eye health problem, compared with just 19 per cent who would go
6
https://www.optical.org/en/news_publications/news_item.cfm/goc-research-shows-high-level-ofconfidence-in-opticians
their optician. GPs, however, will rarely have the full range of equipment that
optometrists do to thoroughly examine eyes.
25. Overcoming this gap between the public perception of what opticians can do
and what they are trained and qualified to do is crucial in ensuring that the
public feel confident in receiving enhanced services in the community
Regulation as an enabler of new models of care
26. Regulation must ensure patient safety while enabling optometrists and
dispensing opticians to develop their scope of practice and maximising their
role in delivering healthcare. As noted above, one of the major drivers behind
the recent revision of our standards was to ensure that they are suitable to
allow for the way the professions are developing in all four countries of the
UK.
27. However to fully maximise the potential of opticians, legislative changes may
be necessary. The Opticians Act has not had any major revisions since 1989,
and many of those changes were aimed at deregulating the optical market
and increasing consumer choice. As a consequence, in terms of the new
models of care the legislation is fairly rigid – for example, it is highly specific in
terms of which healthcare professionals can carry out which restricted
functions. This outdated and restrictive legislation may not be ideal as care
services move to a more multidisciplinary environment with the expectation
that healthcare professionals will work together more closely and with some
clinical tasks being delegated to a wider range of practitioners than before.
28. We are also keen to see deregulation in other areas of our work. We are the
only healthcare professional regulator that regulates students, a position we
do not see as necessary or proportionate. However, we remain under a
statutory obligation to do so.
29. We are also keen to reform our system of business regulation. Our preferred
method being to extend registration to all businesses providing restricted
functions and to revise our code of conduct for businesses to make it more
aligned with the risks associated with business practices. There would also
be scope to simplify regulation by, for example, removing the requirement for
a majority of directors to be registered optometrists or dispensing opticians.
30. We had hoped to achieve these changes through the Professional
Accountability Bill – this was drafted by the UK Law Commissions, with the
aim of modernising and bringing more consistency to the legislation
underpinning ourselves and the other eight UK professional regulators. The
Bill would also bring other benefits such as improving the efficiency of our
fitness to practise process. We note that the Government still wishes to
legislate when Parliamentary time allows, and would urge that this happens at
the earliest opportunity.
Conclusion:
31. Optometrists and dispensing opticians have significant potential to undertake
more work in a primary care setting – both acute work and in the management
of long-term conditions. The optical professions are rapidly changing, and
practice is increasingly diverging in the four nations of the UK. With the right
training and the right regulatory framework in place optical professionals
operating in primary care settings can make an important contribution to lifting
some of the burden on the NHS acute sector, while ensuring patients get
treatment in a community setting which is appropriate to their needs. We
would be interested in discussing these issues further with members of the
committee, and how regulation can enable new models of care to develop.