OPTOMETRY FIRST

local GP, and so the IP qualification felt like a “natural extension,” and is now an integral aspect of the practice. Cameron said: “It’s part of everything we do.”

For the practice, Cameron explained, the ethos is: “Where possible, you keep the patient in practice, and you don’t refer them on or clog up NHS clinics unnecessarily. IP is essential to that if you are trying to manage eye problems and keep them out of other places.”

“That’s why, in my practice when I’m taking on somebody new, they need to be IP-qualified. Because it’s absolutely built into the fabric of how we run the place and how we expect optometrists to deal with the patient in front of them,” he added.

Having a high number of IP-qualified optometrists in the practice means the team can share learnings, or ask questions and gain a second opinion.

Evolving practice models

Dr Peter Frampton, practice owner of Aaron Optometrists, a Hakim Group independent practice in Ashington, Northumberland, told OT: “I find it difficult to imagine working without IP. It’s absolutely fundamental to all aspects of our business – not only ocular emergencies – IP is essential for our contact lens business and general optometry services.”

Frampton was one of the first 30 optometrists through the IP qualification. He told OT: “I am very proud to have been in the vanguard pushing the clinical envelope: 30 IP

A key focus for LOCSU is Optometry First, which seeks to utilise the core competencies of optometrists, supported by practice teams and higher qualified primary care practitioners, across a network of local optometric practices. Optometry First recognises the increased scope of care that can be delivered in teams including optometrists with IP, Richmond said, telling OT: “In the future we won’t look to our own practice team capability in isolation, but will work across a network of practices, recognising and fully utilising optometrists, many in the hospital system, did not leave a lot to expand general community 'eye casualty’ services. However, it did allow time to evolve slowly and try a plethora of practice logistics to accommodate this new skill base.”

“Even now, there is no single recipe on how to incorporate IP into community optometry. Every practice has different sets of logistical, educational and service coverage challenges,” he shared.

In 2022, the practice introduced a new fee-based system for general eye exams. Under the new model, patients can see non-IP optometrists for a certain fee or via the NHS, or can opt to pay a top-up fee to see an independent prescriber.

“We think it’s a very fair system,” Frampton said, emphasising that the practice has not become completely private. While he initially had concerns around pricing, he described the uptake as “outstanding,” adding that it would appear “because we charge for this now but give people the choice, they value it more.”

He acknowledges, however, that the shift to the new model required the practice to have the reputation in prescribing to support it.

The cost to value ratio

IP optometrists described the value of the qualification, with Cameron sharing: “It makes my patient interactions and clinical work more enjoyable because I can use my skills and help people where I can. What I want to do as an eye care practitioner is look after people’s eyes and this helps me to do that,” he added, “I think it’s a practice builder.” the skills in the wider team to best meet patient needs within local communities.” While this happens in ‘pockets of excellence,’ the approach seeks to make this commonplace. Making the best use of these skills, Richmond emphasised: “Practitioners should not be required to hold the same higher qualifications, but should be able to identify an area of personal interest and integrate care across a network of practices, based on local need, to make full use of their skills and maintain confidence and clinical exposure.”

However, the profitability of IP can be a trickier part of the equation.

“Seeing people for IP appointments is not as profitable as selling them a pair of glasses,” Cameron said, but added: “I think it’s important for the practice, and to progress the practice, and my optometrists, to give them and me job satisfaction, and to benefit my patients.”

“Even if financially, it is not the most profitable thing I can do with my time, I think it is overall sufficiently profitable in other ways that it is worth doing,” he summarised.

Frampton suggested: “General 'emergency eye’ management is more financially challenging, especially when many schemes, such as MECS and CUES, come pre-budgeted.”

“You have to restructure what you do and think outside of the box, developing practice processes that work to the budget” he advised, but recognised the hurdle this can present: “Managers tend to think in terms of replacement theory: they see it replacing the sales of spectacles, which does not necessarily make sound business sense. What you have got to try to do is come up with a business strategy where it is an alternative, additional supply – not a replacement one.”

He explained his view that a “different paradigm” is needed for IP optometry: “I think of them as two different businesses under one roof. The IP business may not be as profitable as our traditional core model, but practice processes ensure, ideally, it represents an auxiliary revenue stream rather than replacement.”

Reflecting on the ways IP optometry has changed, Frampton adapted the adage of ‘educate then legislate’ to ‘educate then instigate.’ For practices just starting out with prescribing services, the journey may be tougher.

“In my opinion, we have done it the correct way, but that has been a financially stressful process, because we had to commit to the educational and

Eilidh Thomson, vice chair of Optometry Scotland and an optometrist for Black & Lizars logistical processes before we offered a valuable service. Here I am, 12 years on, and it is coming to fruition.”

Morris suggested that practitioners interested in higher qualifications shouldn’t wait for a service to train, explaining: “What I’ve learned over years and years of working with commissioners in audiology, as well as optometry, is that if the skillset is there, people will use it.”

Volume and workforce

With numbers of IP optometrists growing, Hampson explained that looking at the spread of the workforce, as well as the distribution of workload, would be important.

He suggested: “There is definitely an argument for – if you’ve got the workforce already, it makes it easier to then commission something.”

This is particularly true when taking into account that the IP qualification is an approximately two-year process.

“However, having the workforce in place is more complicated than simply having the IP optometrists – it is the distribution of them as well,” he continued, highlighting existing recruitment challenges, such as ensuring IP optometrists are established in more remote and rural places.

Future focus

“Where are we going with all this? I think it’s about the new contract and good communication between primary and secondary care,” Drake told OT “Independent prescribers need to be able to do what it is that they want to do, but they also need to fit into the big scheme of things as well. I think there’s lots of scope for expansion, as long as it’s done in a collaborative way.”

Thomson reflected that the demand for IP training is already there amongst graduating optometrists, sharing: “If I’m undertaking an interview with a relatively newly-qualified optometrist, one of the questions I always ask is what their career aspirations are for the future. I can’t remember the last time that somebody didn’t mention IP.”

Cameron also noted that Scotland has a significant cohort of IP optometrists, suggesting: “I feel the pendulum shifting towards that being part of the culture here.”

With the glaucoma service, and referral between optometry practices in the pipeline, he said: “If you want to be a player in any of those things, you’re going to need your IP.”

Looking at the current scope for independent prescribing, and considering the future, Soteri reflected: “I think we need to think more widely about the scope of contribution that optometry can play into helping people receive care closer to home, more conveniently, in a more timely manner, and that optical practices in the community do that at a time when our patients otherwise would have to go to a secondary care setting or hospital, wait a long time to see an appropriate professional, and those services are really overburdened right now,”

Considering what an expanded IP workforce might mean for optometry, and healthcare more broadly, Richmond reflected: “There is a need to better understand the current eye care workforce, as well as future workforce requirements of our new models of care. I’ve no doubt there’s a role for an increased number of optometrists with higher qualifications and IP in England, as we move to delivering more eye care locally and releasing capacity within hospitals for those with the most complex health needs.”

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