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Panel meets to discuss ‘Multidisciplinary Working – What are the barriers?’

2 December 2016

The RCOphth hosted an evening event on Thursday 1 December 2016, at which a panel discussed: “Multidisciplinary Working – What are the barriers?”. The new Common Clinical Competency Framework was also discussed, and was available on the day.

A photo gallery of the event is available here.

Panel members

Carrie MacEwen – President, The Royal College of Ophthalmologists

Tracy Luckett – Director of Nursing and allied health professions, Moorfields Eye Hospital

Mary Ann Sherratt – President, The College of Optometrists

Rowena McNamara – President, The British and Irish Orthoptic Society

The chair was Don Grocott, Master of the Worshipful Company of Spectacle Makers, who skilfully encouraged the 45+ guests to make thoughtful and sometimes controversial contributions to the debate.

A recurring theme of the evening was the need for good communication between the different professional groups. It was noted that high quality care was most likely to be delivered where there was a culture of respect for different disciplines, but sometimes extended roles were viewed with suspicion. It was acknowledged that tensions between different groups existed but many of these could be overcome by effective clinical leadership.

Communication should include systematic feedback on referrals. It was observed that there was a significant variation in the quality of referrals into the hospital eye service; most were of a high quality but a small minority of optometrists were too ready to refer and audit was a good tool for identifying those who needed specific support. It was observed:

  • that the introduction of new technologies often led to initial over-referral but this tended to settle down as patterns of work became established
  • anecdotal reports are that the quality of cataract referrals are high but over-referral of glaucoma remains an issue in some areas
  • the good work of optometrists of dealing with patients who do not need to be referred is not always recognised
  • referrals from GPs are also of variable quality. The RCOphth is trying to address this by improving the ophthalmic content in medical undergraduate courses

The importance of monitoring clinical outcomes was pointed out, as was the perhaps predictable lament about IT systems which failed to join up data. It was commented that information governance is often used as an  excuse to prevent data-sharing.

Healthcare professionals work within a highly regulated environment (though as Don pointed out the colleges are not regulators and “have no teeth”). The General Optical Council did not want to stand in the way of multi-disciplinary working but recognised the difficulty of responding to team-based care.

There was general assent that all professionals need to be trained for the job they are doing as a minimum but that there was also an appetite to maximise the skills of the work force. This would require initial resource and a commitment to continuing professional development.

The cultural and contractual clash between the NHS which is free at the point of delivery and optometric practices which offer commercial services was discussed. The aspiration of a business model that drove quality was aired, followed by a brief exploration of the short-comings of the GOS contract which often conspires to encourage bad practice.

It was generally acknowledged that relationships were improving, particularly at a national level, but the audience was challenged to consider whether ophthalmology lagged behind other specialties.  This sparked an interesting discussion about the success of nurse injectors and the evidence that they have been well received by patients as presented at a recent Macular Society event.

The Royal College of Ophthalmologists, The Royal College of Nursing, The College of Optometrists, The British and Irish Orthoptic Society and the Association of Health Professions in Ophthalmology have worked together to create the Common Clinical Competency Framework, demonstrating that there is clearly an appetite for collaboration.