NES Item 8b October 2012 NES/12/90 (Enclosure) NHS Education for Scotland Board Paper Summary 1. Title of Paper Optometry within NES Developing the Profession 2. Author(s) of Paper Dr Janet Pooley, Programme Director Optometry Mr Donald Cameron, Programme Director Optometry Dr David Felix, Dean of Postgraduate Dental Education 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 Earmarked, SGHD funding for Optometry is provided through NES to support the General Ophthalmic Services (GOS) contract. This update paper outlines how NES continues to support the aims of the contract and deliver enhanced patient care. Key developments include: Optometric Teach and Treat Clinics. Appointment of a NES Chair of Clinical Ophthalmology by the University of Edinburgh. Development of a structured career ladder to enable upward mobility of all staff through various educational programmes. 5. Educational Implications The educational structures we have established mean Scotland is ahead of the rest of the Optometry world in Europe. Our UK regulator and professional body are both based in London and see things from an English perspective. We are aware that Scotland is diverging and the contractual demands on Scottish optometrists are greater than on our English colleagues. Thus, we are setting a standard and creating new ways of educating our profession. We are planning a joint programme evaluation project in 2013 with our Welsh colleagues who receive Welsh Assembly funding for developing their formalised postgraduate training. 6. Financial Implications We are fully funded by an earmarked budget of 1 million annually and we work within the budget set each year to deliver this workstream in support of the GOS contract. 1
7. To Which NES Strategic Objective(s) does this align? We will deliver consistent evidence based excellence in education for improved care. We will continue to build co-ordinated joint working and engagement with our partners. We will develop flexible, connected and responsive educational infrastructure which covers people, technology and educational content. 8. Impact on the Quality Ambitions From April 2006, Optometrists had to demonstrate a baseline level of competency by examination in order to become NHS contractors. NES Optometry continues to build on this base level of skill with targeted education programmes and professional support to continue to develop professional skills. NES Optometry also supports the development of practice staff who provide care to NHS patients including Dispensing Opticians and Optical Assistants. In addition to providing education and training which supports Optometrists in the management of acute patients within Primary care, we are also focussing on improving the quality of referrals to the Hospital Eye Service, in particular, glaucoma referrals. Our national conference will focus on human error and patient safety within Primary care and update Optometrists on the latest research into retinal implants. 9. Key Risks and Proposals to Mitigate the Risks - N/A 10. Equality and Diversity Impact Assessment N/A NES is required to assess the equality impact of all new or proposed policies, functions and workstreams, and to have due regard to equality considerations when making decisions. a) Briefly describe your arrangements for assessing the equality impact of any proposals outlined in this paper. b) What potential or actual impact on people from different equality groups or other equality considerations have been identified? c) What actions have been taken or proposed to address the issues you identified? See guidance note on how to complete this section (available on Intranet, Meetings section). Your paper should include relevant details, including assessment of alternatives if required. 11. Communications Plan N/A 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. 2
12. Recommendation(s) for Decision This paper is for information only. NES October 2012 DC/JP/DHF 3
Update Report to the NES Board: Optometry within NES - Developing the Profession Section Report Contents Page 1 NES Optometry 2 2 Strategy 2009 2014 2-3 3 Teach and Treat Clinics 3 4 Continuing Professional Development 4 5 Multi-Disciplinary Training 4 6 Support Staff 4-5 7 Postgraduate Optometry Educational Institute 5 8 Independent Prescribing (IP) 5-6 9 Working with Other Organisations 6 10 Workforce Analysis 7 11 NES National Optometry Conference 7 12 The Future 7 1 of 7
1. NES Optometry Optometry is a profession of nearly 1350 practitioners in Scotland. The majority are NHS contractors providing General Ophthalmic Services (GOS) within private community practices. Funding for training to support the 2006 GOS regulations was negotiated by Optometry Scotland in lieu of an increase in examination fees. In January 2009, the earmarked funds were made available to NES to enable postgraduate education for Optometrists and supporting staff. NES Optometry sits within the Central Dental Directorate with Mr Donald Cameron and Dr Janet Pooley job-sharing the Programme Director role (1WTE) with support from 5, part-time Regional Optometry Tutors (2WTE). All of the team are practising Optometrists. The administration support for Optometry is provided through the central dental team with Dr Heather Ellis playing a key role. NES s Optometry Advisory Committee 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 and the Vision Sciences Department of Glasgow Caledonian University. An Orthoptic Representative also sits on the committee. 2. Strategy 2009 2014 The strategy was presented to the Board in November 2009. NES Optometry s key objectives remain: To provide the clinical experience, training and education which Community Optometrists need to improve their performance within the GOS. To provide opportunity for undergraduate Optometry students to work in clinics where they will see and learn to manage patients with active eye disease. To ensure that there is easy access to high quality training for all Optometrists in Scotland which is relevant to local needs and service provision. To establish a career path for Optometrists and their support staff to encourage Lifelong Learning, to formalise Postgraduate Optometric Education and encourage academic research as an essential part of a health care profession s responsibility to demonstrate evidence for its behaviour. To assist in revalidation of Community Optometrists with the GOC. To facilitate the development of regional educational networks to help develop closer working relationships between primary and secondary eyecare services. 2 of 7
To reduce the number of unnecessary referrals from Primary to Secondary care, thus facilitating the shifting of the balance of eyecare into the community. To provide a framework for the training of dispensing opticians and optical assistants to allow them to assist in the provision of NHS care. To establish a programme to evaluate postgraduate optometric education and to support evaluation/audit of the effect of education on the provision of eyecare within the community. 3. Teach and Treat Clinics The Teach and Treat Clinic concept for postgraduate Optometry training was based on the dental model. It is a clinic supervised by a Consultant Ophthalmologist with Community Optometrists managing and treating NHS patients. The clinic provides the opportunity for Optometrists to see a range of ocular pathology and learn how to manage cases in a safe environment and to gain confidence in clinical decision making as a result. Treatment options are explored with the supervisor and case reviews at the end of the session provide the opportunity for peer review and shared learning. The Lothian Optometry Teach and Treat Clinic (LOTT) was officially opened in February 2010 by Nicola Sturgeon. The clinic represented a major financial investment by NES with state of the art clinical equipment provided within the Lauriston Building, Edinburgh. The teaching facility is a joint venture between NHS Lothian and NES. Initial clinic audits have shown that the Optometrists are benefiting from the training and that patients are happy with the care (Tochel et al, 2011). There is now good evidence for changed behaviour by those attending the clinics once they go back to their community practices. The model has been replicated with two small teaching facilities within NHS Grampian (at Aberdeen Royal Infirmary and Dr Gray s Hospital in Elgin) and a large, dedicated clinic which opened at the end of August 2012 in the West Region. NHS GG&C initially supported a pilot clinic within the A&E department of Gartnavel General Hospital (Pooley et al, 2012) before the new clinic was equipped within Stobhill Hospital, Glasgow. The clinics are very popular with Community Optometrists but enthusiasm for these clinics by employers is restricted by the fact that there are no payments for out-of-practice expenses to attend. The training is accredited with the General Optical Council (GOC) and supports both general CPD training and the Independent Prescribing clinical placement. 3 of 7
4. Continuing Professional Development Optometry CPD is organised through the four regions in Scotland. There is a national training strategy but courses are designed to meet local needs and requirements. This year for the first time, a complete annual programme has been developed to allow Optometrists to plan their training. All course bookings are made through Portal and since November 2011, 60% of the profession have registered. The key priorities for 2012/13 are to support practitioners in managing acute conditions within primary care, improving the quality of hospital referrals and paediatric eyecare. In particular we are focussing on areas where patients may have previously been referred on to Secondary care, e.g. foreign body removal, investigating symptoms of flashes and floaters, acute red eye disease. We are also running a glaucoma referral roadshow to improve the quality of glaucoma referrals, and training to support the examination and management of children in community practices. Delivery of our courses is frequently provided not only by Optometrists but also by Ophthalmologists, Pharmacists, General Practitioners and Orthoptists. NES Optometry aims to ensure that all courses deliver robust training as well as being enjoyable. We provide as many practical training courses as possible with hands-on experience of techniques and high trainer to Optometrist ratios (typically, 1:4 or 1:6). We are moving away from lecture based learning to more interactive training in small groups with peer interaction and model patients. Where possible, the Optometrist is also provided with pre-course reading material and some of our courses also provide follow-up sessions to ensure positive learning outcomes. 5. Multi-Disciplinary Training Joint training courses have proved to be very popular. NES Optometry has worked over the last few years with colleagues in Pharmacy to run training and this year we are also running a course with GPs in the West of Scotland. Orthoptists have some common training requirements with Optometry and we are working with NMAHP to provide training courses through Portal which both professions will be able to attend. 6. Support Staff Optical Assistants (OA) NES Optometry has developed a formalised programme of training for optical assistants in collaboration with The Worshipful Company of Spectacle Makers (WCSM). A Qualification in Optical Care has been accredited to the Scottish 4 of 7
Credits and Qualifications Framework [SCQF] at level 5 and level 7 to provide an entry and advanced level of training. The courses have also been made available to orthoptic assistants within the hospital eye service. 100 OAs have now been through the training at level 5 and 32 assistants at level 7. Career Pathway The advanced qualification at SCQF 7 allows OAs to apply for the dispensing optician (DO) course. Once qualified, the DO can apply for the Optometry degree course and ultimately a Masters and/or PhD studies. The resulting ladder provides a complete career pathway through Optics and Optometry to encourage lifelong learning. This is the first such structured ladder to be available in the UK. Dispensing Opticians (DOs) This small professional group dispenses spectacles under the GOS. In particular they are important in the dispensing of spectacles to children and blind and partially sighted patients. The group is regulated by the GOC and NES Optometry provides 20,000 per annum to support their training in collaboration with the Association of British Dispensing Opticians. 7. Postgraduate Optometry Educational Institute We are keen to foster a more formalised postgraduate education structure and have just concluded an agreement to appoint Dr Baljean Dhillon to the NES Chair of Clinical Ophthalmology. This is University of Edinburgh s first substantive chair in ophthalmology and his connections with NHS Lothian s Princess Alexandra Eye Pavilion mean his involvement with our Teach and Treat Clinics will greatly enhance their status and capacity. A modular programme of taught and distance learning materials for Community Optometrists is being developed with the University of Edinburgh in a collaborative partnership with Glasgow Caledonian University. There is an enthusiasm within some sectors of the profession to undertake further study and we hope this will encourage a more qualified profession with primary care research agendas and community specialisation. Prof Dhillon will use his international research credentials to stimulate research based in the community. These initiatives will improve the quality of care which can be provided within the community. 8. Independent Prescribing (IP) The Review of prescribing, supply and administration of medicines (The Crown Report) 1999 paved the way for non medical prescribing within the UK. Optometrists along with Nurses, Pharmacists and some Allied Health Professionals, with appropriate training, can prescribe to allow faster patient access to medicines; better use is made of the skills of these professional staff and a more efficient level of care is provided to the patient. 5 of 7
NES has made funds available through Glasgow Caledonian University to support Optometrists to undertake Therapeutics training. The course and ongoing clinical placements are regulated by the GOC and overseen by the College of Optometrists. Over 300 Optometrists in Scotland are now at some stage of the training and 75 Optometrists are qualified to prescribe ocular preparations in Scotland. We await the SGHD agreeing to make prescription pads available for such qualified optometrists so that patients gain from the free drug prescription policy in Scotland. The ongoing CPD requirement of these Optometrists is clearly important. Joint training with the other non medical prescribing groups is being explored. In addition, through the Edinburgh and Glasgow collaboration, we anticipate using the Edinburgh University medical distance learning platform to develop an MSc programme for optometry to develop these practitioner s skills further. The intention is that Optometry should become the principal provider of community eyecare. Part of that development requires other primary care professionals to understand when it is safe and reasonable to refer patients to optometrists for management rather than to the Hospital Eye Service. 9. Working with Other Organisations NES Optometry works in collaboration with Optometry Scotland, the main professional representative body with SGHD. The organisation promotes the work of NES through its membership, and plays a key role on the Optometry Advisory Committee. We also work, where possible, with our regulator body the GOC and our professional body, The College of Optometrists. Both organisations are UK wide and based in London. 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 ( 53,000 in 2012) and sits on the Advisory Board. NES Optometry is developing a working relationship with Welsh colleagues who, through funding from the Welsh Assembly, have also developed a formalised postgraduate programme of training. We are planning a joint programme evaluation project in 2013. At our national conference in 2011 and again this year, NES Optometry makes stands available free of charge to charities, professional and non-profit making organisations, e.g., RNIB, International Glaucoma Association, NHS NSS PSD. 6 of 7
10. Workforce Analysis NES Optometry is presently compiling workforce data. There has been only very limited work conducted in this area throughout the UK. We are planning to present a report in early 2013. 11. NES National Optometry Conference Flying High with NES Optometry is the 2012 Annual Conference in Glasgow on 4 th November. The conference will focus on safety within primary care and update Optometrists on the latest research into retinal implants to enable them to better explain these techniques to their patients. 12. The Future Optometry has developed very quickly within NES, learning from other professional colleagues and benefitting from the vast experience and resources within the organisation. Whilst we have been lucky enough to learn best practice from those more experienced than ourselves, we hope that our own experience will soon be able to support other colleagues within the organisation. In the field of Optometry, NES leads the way in Europe. In addition, the Teach and Treat Clinics are a unique postgraduate development; there is nothing anywhere in the world which provides this level of training to qualified Optometrists, far less to undergraduates. 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 plans to develop a more formalised education programme and build 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 October 2012 7 of 7