Seismic Changes in Wales

How long will it take to implement these changes?

The government has kindly agreed to a phased implementation over the next 18 months. They know that it’s a massive cultural shift. There will be legislative change around the sight test and that can’t happen until 2023, but there are some changes that are ready to go; for example, IP optometrists being able to run their clinics. Previously, practices had to tender for this kind of work in the community. Now, if you’ve got IP, you don’t have to go through that challenging procurement process.

Could you please shed more light on the financial reforms?

There are additional services that will be remunerated for the first time. Optoms need to do some clinical governance under what is called Bronze Level service. Qualifying for that involves taking a two-hour module and every person in the practice will need to do it (up to 10 people). Bronze Level practices will be paid £1,250 quarterly. Silver Level is around quality improvement; it isn’t mandatory, but if optoms want, for example, to do an audit on their low vision patients, they would get an additional services payment of £1,200 into their practice for completing that audit. To be clear, this isn’t “Mickey Mouse” stuff – we’re not asking, “How many cups of tea or coffee do you give to your patients in a month?” Ultimately, these levels are designed to help practices benchmark themselves against services in other areas of the health system; for example, local clinics giving flu vaccinations and COVID-19 boosters.

At the moment, dispensing opticians don’t get a CPD grant. But they will in Wales! The hope here is that dispensing opticians will be using their skills in a way they haven’t done before. And optometrists qualified in medical retina, high glaucoma, and IP will be able to collect fees ranging from £77 to around £765 for these services. Basically, the higher qualified you are, the more you will get. Payment for the new GOS Level 1 sight test in Wales, as I mentioned, is now £43. Level 2 has three bands of service – from standard low vision to enhanced sight loss services – for which payment increases accordingly: £26, £53, and £70. In sight tests, we’ll see more optoms checking the boxes that ask, for example, “Have you had a conversation with the patient about the number of cigarettes they smoke?” At GOS Level 5, the IP optom who gets £125 for a patient appointment can get £62 for a follow-up appointment.

In terms of NHS optical vouchers, there’s quite a stark change there. More like a bomb in the sector! It was well known that vouchers were the way a practice could top up what it was lacking in clinical fees. But Wales has reduced the vouchers to reflect what it truly costs to dispense a pair of glasses. For example, Voucher A for single vision lenses was £39.10, now it’s £22. We want optical practices to start looking more like clinics than places selling racks and racks of glasses. We may well go back to the days when the optom opened the drawer and there was a limited choice of glasses within the £22.00 voucher value, but the patient will have the option to upgrade.

There is a challenge here because it doesn’t remove the cross subsidy. Practices will still need to rely on private sales and on private sight tests, but there’s still an opportunity to deliver that still. It depends on how you want to build your practice.

You’ve been at Optometry Wales for 14 years and have been pushing for change for a long time. How does it feel to see these new measures coming into place?

Things have changed a lot in those 14 years. I can still remember sitting in government meetings and hearing people say, “Well, what do you even need to be an optometrist? It’s a GNVQ, isn’t it?”

I’m really proud when I go to meetings now – especially when we sit alongside primary care GPs. They used to say, “Oh, you sell glasses and work in a shop.” Now, they say, “Well, you are the GPs of the eye.” And I love that. We’ve reached a point in Wales where optometrists are receiving the kind of professional respect that I’ve never seen before. We’ve slogged away at this for years, but now we can say that we are clinicians and that we are providing a truly valuable service.