NES/15/100. This update paper highlights the main areas of work within the Directorate and shows the direction of travel.

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1 NES Item 8c December 2015 NES/15/100 (Enclosure) NHS Education for Scotland Board Paper Summary 1. Title of Paper Optometry within NES Developing Primary Eyecare 2. Author(s) of Paper Dr Janet Pooley, Programme Director - Optometry Mr Donald Cameron, Programme Director - Optometry 3. Purpose of Paper This update paper highlights the main areas of work within the Directorate and shows the direction of travel. 4. Key Issues Scottish Government funding for Optometry is provided through NES to support the General Ophthalmic Services (GOS) regulations. This update paper outlines how NES continues to support the aims of GOS and to support the Scottish Government s 2020 Strategic Vision. 5. Educational Implications NES Optometry leads postgraduate optometry education in Europe and has developed world leading initiatives to support the care provided by community Optometrists. Joining NES in 2009, the department now offers a huge range of education to ensure that training can be accessed across Scotland. Our focus for the next five years is on improving the quality of our programmes with more blended learning and high quality clinical skills courses. 6. Financial Implications NES Optometry receives 1.05M annually from Scottish Government to develop the skills of Opotmetrists in support of the General Ophthalmic Services contract. This funding was negotiated by Optometry Scotland in lieu of an increase in Optometrists fees in 2009 and has remained fixed. 7. Which of the 9 Strategic Outcome(s) does this align to? A demonstrable impact of our work on healthcare services. Community Optometry has developed dramatically since 2009 with support from NES. Whereas referrals from Optometry to secondary care have dramatically increased in England, there is only a very small increase in Scotland demonstrating the huge amount more care being provided within community practices. This is coupled with many examples of patients being 1

2 discharged from hospitals to be managed by primary care Optometrists e.g. Ocular hypertensives. An excellent learning environment where there is better access to education for all healthcare staff. NES Optometry has developed educational programmes to support all practice staff to develop their skills in managing NHS patients e.g. the Certificate in Optical Care for optical assistants. We also run a continuous quality improvement initiative for all our training. For example our webinar programme is reassessed after every broadcast to make improvements. Leadership and management development that enables positive change, values and behaviours. LAMP for Optometry was piloted in November 2015 and will roll out to the profession in February. A range of development opportunities for support workers and new and extended roles to support integration. NES Optometry has supported the developing role of the community Optometrist e.g. independent prescribing Optometrists funded by NES are providing new community services, relieving the pressure from GPs and secondary care Ophthalmology. Improved and consistent use of technology with measurable benefits for user satisfaction, accessibility and impact. NES Optometry has developed a range of e-learning modules to allow Optometrists to gain their education on-line. A good example is a series of four glaucoma modules that were developed to support the new SIGN Glaucoma referral and safe discharge guidance. Consistently well developed educational support roles and networks to enable education across the workplace. The NES Optometry Peer Assisted Learning (PAL) Network was launched in November 2014 and has established local groups who meet to discuss patient cases. The feedback has been extremely positive and is encouraging peer support and learning. An effective organisation where staff are enabled to give their best and our values are evident in every day work. NES Optometry encourages all staff to present at conferences and undertake training to improve their teaching skills. 8. Impact on the Quality Ambitions NES Optometry run a continuous quality improvement initiative for all our training. Programme leads continually monitor course feedback, ensuring that subsequent courses are more productive and the education is of the highest quality. The whole team assess our performance annually, making sure that our reputation for delivering quality education is maintained. 9. Key Risks and Proposals to Mitigate the Risks The main risk to NES Optometry is our funding which has not increased since We are putting together a proposal for income generation to mitigate this risk. 2

3 10. Equality and Diversity NES Optometry has worked very hard to ensure that our education is accessible to as many Optometrists as possible around the country. The majority of courses run in the evening or on a Sunday to allow practitioners to attend and our e-learning packages can be accessed at any convenient time. Where possible we run regional training and when we hold national conferences, we provide funding to our remote and rural colleagues to support travel and overnight accommodation. In 2016/17 we have hands-on skills courses planned for the Highlands and Islands, an initiative we run every 3-4 years. We conduct a very detailed annual review of attendance and participation of all our training which is presented to the Optometry Advisory Board. 11. Communications Plan A Communications Plan has been produced and a copy sent to the Head of Communications for information and retention: Yes No A Communications Plan format template is available in the Meetings and Communications sections of the NES Intranet. 12. Recommendation(s) for Decision This paper is for information only NES December 2015 JP/DC 3

4 Update Report to the NES Board - December 2015 Optometry within NES - Developing Primary Eyecare 1. NES Optometry 1.1. Optometry is a profession of approximately 1350 practitioners in Scotland. The majority are NHS contractors providing General Ophthalmic Services (GOS) within private community practices. Funding for training to develop this primary care service has been provided through NES and has remained unchanged since 2009 at 1.05M annually Donald Cameron and Janet Pooley job-share the Programme Director role (1WTE) supported by 6 part-time Senior Post-Graduate Optometry Tutors (2.3WTE). All of the team are practising Optometrists. The team is supported by our Optometry Project Coordinator with some assistance from the Dental team The NES Optometry Advisory Board oversees the directorate s educational provision and comprises external stakeholders representing Optometry and Ophthalmology, namely, The College of Optometrists, The General Optical Council (GOC), Optometry Scotland, Eyecare Scotland and the School of Life Sciences of Glasgow Caledonian University. An Orthoptic Representative also sits on the Board. 2. Strategy NES Optometry s key objectives are: To provide the clinical experience, training & education which community Optometrists need to support their patients within GOS. To ensure that there is easy access to world leading high quality training for all Optometrists in Scotland which is relevant to local needs and service provision. To establish a career pathway for Optometrists to encourage lifelong learning and practice based research, and to formalise postgraduate Optometric education. To facilitate the continued development of safe, high quality eyecare within the community. 1

5 To provide a framework for the training of dispensing opticians and optical assistants to allow them to support the provision of NHS care. To continue to evaluate and review the impact of our postgraduate optometric education. 3. Teach and Treat Clinics 3.1. The Teach and Treat Clinic project has been successfully running for 5 years. The model runs in four centres: Edinburgh, Glasgow and two small clinics in NHS Grampian (Aberdeen Royal Infirmary and Dr Gray s Hospital, Elgin). Each clinic is supervised by a consultant Ophthalmologist and hospital patients are managed and treated by the community Optometrists. The clinic is accredited by the GOC for CPD and provides opportunities for general training and for independent prescribing clinical placements In 2014/ community Optometrists attended the clinics. The NHS Grampian model only offers single sessions, but many Optometrists in the central belt attended for their full 24 independent prescribing (IP) training sessions. The clinics aim to develop clinical decision making skills and to support Optometrists to manage patients within their own practices, rather than referring patients into the hospital. The Ophthalmologists are skilled in teaching and offer a supportive approach, following clinics up with tutorials to consolidate the learning Patient and practitioner surveys are conducted on an ongoing basis, and individual attendance and CPD sessions are constantly monitored. Patient numbers are kept low and patient feedback is always exceptionally positive. Practitioners consistently report an increased level of confidence following their attendance and claim to manage and treat more patients within primary care. A full review of all four clinics is presently underway and will report in March Continuing Professional Development 4.1. Optometry CPD is developed nationally but local events are, where possible, tailored to meet local needs and requirements. All the courses are GOC approved. In 2014/15 NES Optometry ran 67 courses (including webinars and e-learning modules) which resulted in 1540 places taken up by practitioners. The programme was Care of the Older Patient and included courses on macular degeneration, cataracts, dry eyes, supporting the visually impaired and dispensing appropriately for older patients. Courses included clinical skills, simulation sessions, clinical scenarios, case discussions and small group tutorials. We included video lectures, pre-course material and e-learning packages to ensure that the courses could be accessed by as many practitioners as possible. 2

6 4.2. NES Optometry has embraced the evening webinar as an effective mode of education to support all our courses. We also now run a summer webinar programme on topics as diverse as Tropical Ocular Disease and UV and the eye NES Optometry was closely involved with SIGN in the development of the new guideline on the detection and management of glaucoma in the community. Four e-learning modules were launched on the same day as the guideline was published (March 2015), and this learning is to be supported with a national roadshow to teach and refine clinical skills in February and March Multi-Disciplinary Training 5.1. NES Optometry is running a clinical skills course exclusively for orthoptists this autumn in our Teach and Treat Clinic in Glasgow. 16 senior orthoptists from around the country are attending. In addition almost all Optometry courses are open to dispensing opticians and orthoptists throughout the year free of charge. 6. Support Staff 6.1. Optical Assistants (OAs) In collaboration with The Worshipful Company of Spectacle Makers (WCSM) and the Association of British Dispensing Opticians (ABDO), NES Optometry continues to support a qualification in Optical Care that has been accredited to the Scottish Credits and Qualifications Framework at level 5 and level OAs have now been through the training at level 5 and 50 OAs at level 7 since the launch in The financial support has been slightly reduced and employers now contribute 20% of the cost of the course. This has not reduced demand significantly Success in the advanced qualification at SCQF 7 allows OAs to apply for the distance learning or residential dispensing optician (DO) courses. Once qualified, the DO can apply for the Optometry degree course which could lead on to Masters and/or PhD studies. The resulting ladder provides a complete career pathway through Optics and Optometry to encourage lifelong learning Dispensing Opticians (DOs) This small professional group dispenses spectacles under the GOS. Dispensing of spectacles to children and visually impaired patients is restricted to DOs and Optometrists. The group is 3

7 regulated by the GOC and NES Optometry continues to provide 20,000 per annum to support their training in collaboration with the Association of British Dispensing Opticians. In 2014/15 we trained 32 DOs on a Back to Basics skills course, and launched the NES on-line child protection course aimed specifically at DOs and accredited by the GOC. 7. Independent Therapeutic Prescribing 7.1. NES Optometry continues to fund the Optometry therapeutic postgraduate certificate at Glasgow Caledonian University (GCU), and provide clinical experience through the Teach and Treat Clinics. Over 550 Optometrists in Scotland are now at some stage of the training, 251 have completed the 3 module diploma course and 140 Optometrists are qualified to prescribe drugs for the treatment of disease of the eye and surrounding tissues. NHS prescription pads have now been made available by all Health Boards for qualified optometrists The ongoing CPD requirement of these Optometrists is clearly important. NES Optometry ran our annual IP training day in Stirling attended by 65 practitioners and is developing a new set of training modules to support prescribing. 8. Masters degree in Primary Care Ophthalmology 8.1. In collaboration with the University of Edinburgh s College of Medicine and Veterinary Medicine, NES Optometry is supporting an MSc Programme in Primary Care Ophthalmology aimed at community Optometrists. We have just completed the first of the three year on-line distance learning course, with many of those receiving the NES 50% scholarship gaining a pass at distinction level. 9. Working with Other Organisations 9.1. The Directorate of Optometric Continuing Education and Training (DOCET) is a national body providing distance learning materials to all GOC registered Optometrists in the UK. The Departments of Health around the UK fund this training proportionally. Scotland provides funds through NES ( 54,000 in 2015) and Dr Kathryn Morrison sits on the DOCET Advisory Board for NES NES Optometry is presently working with the RNIB Scotland on an educational e-learning package to support adults with learning disability, stroke or dementia to access community eye care services. A further project with Autism Scotland and the Scottish Government 4

8 has developed eyecare pathways for patients with autism. This programme has been supported with webinars and an on-line lecture series At our annual national conference in the autumn NES Optometry makes stands available free of charge to charities, professional and non-profit making organisations, e.g. International Glaucoma Association, Guide Dogs, Macular Society. This encourages interaction between the profession and the third sector. 10. Return to Work Programme Recognising the lack of confidence that a career break can engender, NES Optometry developed our first Return to Work course: an intensive two day course with tutorials and practical workshops. Twelve delegates signed up for our first course in April 2015 and the feedback was very encouraging. Courses are now planned to run with appropriate modifications every six months. 11. NES National Optometry Conference Each year the conference attracts around 180 delegates with a mix of workshops, lectures and clinical skills training. The event is an ideal opportunity for NES to engage with members of the profession and advertise the work of NES optometry. 12. Pre-registration Optometrists NES Optometry is piloting a new pre-registration model for trainee Optometrists to better reflect the demands of the GOS contract in Scotland. With an emphasis on increasing exposure to clinical conditions and gaining a better understanding of patient care, the pilot for up to 3 Optometrists will aim to equip the trainee for working within primary care. The pilot will run with support from GCU and NHS GG&C, working with the College of Optometrists. 13. The Future Ultimately our training needs to relate to an improved quality of patient care, and Optometrists practising in Scotland are now managing many more patients in the community. NES Optometry looks forward to developing a more formalised education programme and building on the early success with a body of evidence to support the training which we are providing. Dr Janet Pooley, Optometry Programme Director, NES Mr Donald Cameron, Optometry Programme Director, NES December