04 September 2024
On an avenue lined with hanging baskets, there is a fried chicken shop, a bakery and bank.
While the streets of Barnoldswick may seem similar to many English towns, the attitude of its 10,913 residents to eye care is gradually shifting.
If a patient turns up at the pharmacist with a painful red eye, they are directed next door to the green frontage of James Bontoft’s optometry practice. Around the corner, at the town’s only GP practice, it is the same story.
“Once they hear the word ‘eye’ or ‘vision,’ they say ‘Go see the optician’,” Bontoft shared with OT.
Bontoft qualified as an independent prescribing (IP) optometrist in 2013 in one of the first cohorts to go through the specialist training.
Since then, every working day he has been treating conditions that patients would traditionally present to a GP practice or hospital with – from infections and allergic reactions, to dry eye and viral keratitis.
He has painstakingly removed flecks of metal and rust rings from the eyes of welders and metalworkers who manufacture fan blades for a nearby factory.
More than a decade after he started prescribing, Bontoft is still greeted by the occasional look of surprise when he explains what his practice can offer.
“It’s been a very slow process, but we are certainly fostering the idea that if you have an eye problem, you come to see me,” he said.
At a UK level, a significant proportion of patients continue to view their GP as the first port of call. An AOP online survey of 1016 members of the public in May found that 32% of respondents would approach their GP first for an eye condition.
These results come at a time when NHS Digital data shows that one in five GP appointments in April was scheduled two or more weeks from the date of booking.
Dr Stuart Bryan, a GP partner of Barnoldswick Medical Centre, shared that the service provided by Bontoft has eased pressure on his practice.
“Due to the current and ever-increasing pressures in primary care it does make a difference to our workload having this service,” he said.
Bryan shared that he felt confident referring patients to Bontoft knowing that they would be seen quickly and have a thorough assessment.
“Having James literally on the doorstep is a real bonus. It is really easy to get through on the phone to organise a same day appointment and if needed speak to the optometrist on the phone to pass on our concerns and differential diagnoses,” he said.
Close call
Burnley General Teaching Hospital is two bus rides away from Barnoldswick or a half hour drive.
An initial motivation for Bontoft to become IP-qualified was to provide convenient care to the local community.
However, as one of only three community-based IP optometrists who are actively prescribing in East Lancashire, he is now seeing patients from towns 45 minutes away by car.
“We are getting a lot of referrals from the hospital now. Our eye department is pretty much at capacity,” he said.
Bontoft’s area has had a minor eye conditions service (MECS) since 2001. There are funded services for low vision, glaucoma referral refinement as well as pre and post cataract services.
Plans are currently underway to refer stable glaucoma patients from Burnley General Teaching Hospital to be monitored within optometry practices.
Although there are funded schemes in place, Bontoft must keep the financial sustainability of his independent practice in mind.
“Capacity sometimes becomes an issue because I’ve got to have enough normal sight testing patients to make the day fund itself,” he said.
At the moment, Bontoft allocates around 18 appointments each week for IP patients. To avoid turning people away, he will work through his lunch break, start early, or finish late.
He finds that offering IP services has helped to build loyalty and grow his patient base.
“I wanted to do it from a personal interest point of view – it works for me and it works for my practice,” Bontoft shared.
He would like to see more optometrists become IP qualified in his area to distribute the workload and ensure patients are seen closer to home.
“My message to other optometrists is: do it. Be part of the change,” he said.
I am always looking to further myself. I didn’t want to sit in a room saying ‘One or two?’ all day
The IP crowd
Drew Thompson is an IP optometrist and the owner of Thompson & Hardwick Optometrists in Lytham Saint Annes.
Each month, he sees an average of between 90 and 100 patients for conditions ranging from blepharitis and conjunctivitis to the removal of foreign bodies.
Thompson, who works half a day each week in a hospital cornea clinic, also offers contact lens fittings for patients with keratoconus and ocular trauma in practice.
He shared that becoming IP-qualified was part of his professional development.
“I am always looking to further myself. I didn’t want to sit in a room saying ‘One or two?’ all day,” Thompson said.
Within his hospital work, the qualification also means that he no longer has to tap a doctor on the shoulder each time he needs to issue a prescription.
Thompson shared that within his area, most patients will still approach a GP or pharmacist first with an eye problem.
“I’d love to see that change. I’ve been talking about that with my patients personally, but it does take a while to change perceptions,” he said.
Thompson added that it is generally easier for a patient to get an appointment at an optometry practice and the patient is ultimately better served.
“Our profession has much more knowledge about eyes than a general practitioner. The patient often gets a resolution sooner because we are able to target the treatment,” he said.
IP optometrist and OT multimedia clinical editor, Ceri Smith-Jaynes, treats patients through the community urgent eyecare service (CUES) Lytham St Annes branch of Broadhurst Optometrists and through MECS at the Preston branch.
“Currently, most things are managed to resolution in the optometry practice,” she shared.
“The patients are grateful at not having to present to hospital and they are managed at an appointment time to suit them, in a convenient location,” Smith-Jaynes observed.
She will sometimes seek advice from the hospital before prescribing medication and arranging a follow up appointment at the hospital within a couple of days.
Data shared by the AOP has highlighted that around 1.35 million GP appointments are taken up with hayfever-related eye conditions each year.
Smith-Jaynes shared that while hayfever does not fall under the current CUES specification, she will often prescribe privately for the condition.
“Patients don’t want to bother their GP and prescription medication can be better than the over-the-counter medication,” she said.
Once they hear the word ‘eye’ or ‘vision,’ they say ‘Go see the optician’
Low vision support
Through her role at the Gateshead community low vision clinic, optometrist, Stephanie Cairns, is providing people with a level of personalised care that cannot be offered in a 10-minute GP appointment or busy hospital eye clinic.
Sense Ability Matters provides holistic support to people with sensory loss in Gateshead and South Tyneside.
After a referral, the person who has been referred will be contacted within 48 hours to set up an initial appointment to determine their needs. From there, they will be directed to a range of support services – including low vision where appropriate.
“It’s very different from how the hospital system works, where you can refer someone and they may sit and wait for four to six weeks for their first appointment,” Cairns explained.
The charity employs a visual rehabilitation officer, who will make home visits to see if any adaptations are required and assist with mobility and orientation.
There is also a digital technology specialist, who can provide people with free support to enable access to digital magnifiers, virtual assistants, mobile phones and tablets. This can include helping with funding applications, if required.
Including time for paperwork, Cairns has around an hour and a half for each appointment – which gives her time to build trust with patients.
“Some people are quite guarded. For ages, they’ve been telling everyone that things are ok
Cairns will tailor the support and equipment to the person before her – from talking clocks, magnifiers and lighting solutions to anti-glare lenses.
“When you explain that you are going to be able to give people this equipment free of charge you can visibly see them relax,” she said.
Aside from equipment, Cairns added that sometimes it is the intangible support that people appreciate.
“Some people benefit more from having a chat because it may be the first time anyone has actually spent the time listening to them and walking them through what has been going on with their vision,” she said.
The support offered by Sense Ability Matters helps to reduce pressure on other parts of the health service – for example, by reducing the risk of falls, helping people instil eye drops properly and reading their insulin devices.
“We have been able to help people continue to manage their medication by themselves,” Cairns shared.
People are referred to Sense Ability Matters through a range of avenues, including eye clinic liaison officers, the community nursing team and the housing association.
Cairns would like to see more direct referrals from optometry practices with patients who are Gateshead residents, as often referrals come through after a patient has been certified as visually impaired.
“It’s really important that people get access earlier. Often when they come to me, they have already given up and you have to reignite that motivation,” she said.
Optometrists should not assume that a patient has already been offered support, Cairns added.
“If you’ve got somebody who you think could benefit from help, and they are happy to be referred, then get in touch,” she said.
Providing reassurance
Bernie McColl, who has diabetic retinopathy and bilateral macular ischemia, shared with OT that she appreciates the way that Cairns listens to her and gives explanations in a way she understands when she comes in for an appointment.
“You see the same people each time. There’s that familiarity – it feels more like a friendship than a clinic,” McColl shared.
Through the service, McColl has received magnifiers and been guided through adaptations – such as highlighter strips and a one pot boiler – in her kitchen to make cooking easier.
She highlighted that there is not the same time pressure that there might be in a GP appointment or at the hospital.
“If you go to a GP, they are talking to you, but they are looking at their screen. You’re not sure if they are listening to you properly,” she said.
Her daughter, Kerry Dezayi, who also attended McColl’s most recent appointment, added: “The doctors talk to you. I think Stephanie was talking with you.”
McColl became worried recently after she began seeing strange things – such as a person in the corner of the room or a bird out the window.
She shared that Cairns explained that these hallucinations were a symptom of Charles Bonnet Syndrome.
“I was relaxed after she told me that. I thought, ‘I’m not going cuckoo.’ Before, I would point something out to the grandchildren and they would say ‘Oh nana, not again’,” she recalled.
Dezayi shared: “When she told mum it was Charles Bonnet, it reassured her that everything was fine and normal. She explained in layman’s terms that it was the way the brain compensates for eyes, which makes perfect sense.”
McColl observed that she appreciates being able to talk with people who understand the challenges of living with sight loss.
“It can be a very lonely world when you cannot see properly,” she said.
GP campaign
As part of its One Million Appointments campaign, the AOP is calling on the Government to make investment in primary care a priority, as well as supporting minor and urgent eye care pathways.
AOP chief executive, Adam Sampson, shared that at present unnecessary demands are being placed on GP practices.
“Our latest data shows 1.35m GP appointments alone each year are used to treat common eye conditions relating to hayfever. And this is the tip of the iceberg. Millions more appointments are used to deal with other eye health issues that optometrists on the High Street are trained to manage,” he said.
AOP clinical director and optometrist, Dr Peter Hampson, shared that optometrists are qualified to treat a broad range of eye conditions, and have the capacity to do more.
“Optometrists on the High Street have the premises, the equipment and most crucially, the clinical expertise to deliver specialist eye care that is accessible,” he said.
To get involved in the One Million Appointments campaign, access the campaign tool kit – including social media assets and digital resources.
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