One of the biggest threats to UK general practice is the high street optician. (Hear me out).
Rarely do I sift through my daily paperwork without stumbling upon a letter from the local SpecSavers asking for an onward referral. The dilemma then comes: do I refer immediately (easy, job done), or do I take more time and effort (difficult, the paperwork is mounting), contact the patient, discuss whether they actually want to be referred and, with cataracts, do they actually qualify?
Like many localities, we have to complete a prior approval pro-forma for cataracts. It’s an irksome little document.
‘Question 1: Is the acuity equal to or better than 6/12 in the affected eye?’
Then, a tricky collection of qualifying questions follows.
The process feels like skiing a slalom: miss one gate and your patient’s stuffed; their eyesight consigned to 6/11 at best (in the affected eye) for the next 12 months.
So, by the time you’ve tracked down the patient, discussed their optic oddity, gained their consent to refer, negotiated a prior approval request that will suffice and dictated a referral, that’s a good six minutes of invaluable GP time down the tube. Would it not make more sense for the optometrist (clinician who measures vision) or optician (technician who fits spectacles) to go through this fraught process themselves?
This issue’s been a GP bugbear for aeons, but I’m still new(ish) to this game and I’ve seen some worrying developments in the offing.
Last week, a local optometrist wrote the following in their report: ‘Patient appears lost to ophthalmology follow-up, suggest you investigate and rectify. Patient will contact you next week and expects an update’ without so much as a ‘please’.
I wrote back: ‘Suggest patient could be encouraged to investigate this for themselves, or perhaps optometrist could chase? Will update patient suggesting this if contacted.’
And just yesterday, one I contemplated framing for the coffee room: ‘Vision normal, routine review 12 months. Of note, she has a lesion on the right cheek. Please refer to dermatology as I think this may be a BCC.’ Much more polite this time, and even features a please, but shouldn’t I probably have a quick look at the ‘BCC’ first?
It looks like we’ve become superfluous, glorified referral machines with needless clinical acumen. Next time I get my eyes tested, I intend to discuss an ingrowing toenail, a mild seborrhoeic dermatitis and the pros and cons of vasectomy.
Dr Tom Gillham is a GP in Hertfordshire and specialty doctor in A&E. You can follow him @tjgillham.