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Technological advancements, education reform, a sustainability focus – OT hosted a roundtable, in partnership with five Hakim Group practice owners, to discuss what the optical landscape will look like in a decade
With challenges and opportunities abounding, what might independent optometry look like by the time we reach 2030?
Technology is a key driving force for optometry over the next decade, with forward-thinking equipment heightening the level of service that independents can offer. The panel Brian Tompkins, TK&S Optometrists Clodagh McGovern, owner of 10 independent practices across Ireland Martin Steels, Martin Steels Independent Optometrists & Contact Lens Practitioners Neil Hilton, owner of four independent practices in Merseyside Nicholas Rumney, BBR Optometry. Neil Hilton, who owns four independent practices in Merseyside, is clear about the opportunities available, citing Optomap as “a game-changer” in terms of safety during the pandemic and ortho-k as a highlight of his 20-year career. He also pointed out the fact that optical coherence topography (OCT) was once on a pedestal, before being installed across various multiples – something that he believes should make independents want to “take it upon ourselves to go one step further.” “As the independent sector, we absolutely have a duty to stay ahead of our multiple counterparts,” he said. “I absolutely believe technology is imperative to us moving forward as a profession.” Investing in services like ortho-k, he said, should not instantly lead to questions about how much money can be made per patient. Instead, he offers a different way to assess value: “It’s not just about making money off that particular individual. It’s about drawing the families in and doing something cool and special, that the multiples don’t always want to. “I think that’s what the independent sector should be aiming towards. We absolutely should be investing in technology.” Martin Steels believes that charging correctly for the level of eye exam that this technology can provide is the key to independents being able to compete with multiples. “We need to be charging correctly,” he said. “These machines have to be purchased and funded efficiently so that we can use them. We are showmen, in terms of being able to use the equipment and show the patient what we can do with it. The technology is moving at pace.”
On a micro level, by 2030 Steels hopes he will have a field screener that keeps focus on the back of the eye even if the patient moves. “If we had a curved screen that could match the movement of the eye we’d always be tracking the movement, and would be able to get a more solid field screen,” he said. “That’d be great.” On a wider scale he believes that artificial intelligence (AI) will be a bigger part of the landscape by 2030, but that there might be challenges sustaining it at High Street level. Again, the biggest challenge that he foresees is finance: “Developments to AI that already exists will be driven by appropriate funding, whether it comes from patients or somewhere else,” he said. “That hopefully will come with time.” Nick Rumney believes that technology will impact the ‘relatively simple’ tasks of refraction and contact lens fitting, and that “within the next five years there will be deregulation of refraction, because we're already working with equipment that can give an incredibly accurate response.” He added: “The job of the optometrist will remain maximising the optical outcome; that’s our expertise.” He predicts “a real segmentation of roles within the practice. It may well be that as an optometrist, I will end up seeing the patient for 20 minutes, not 40, and collating the information to make the final decision on the treatment.” It’s something he finds an exciting prospect.
I absolutely believe technology is imperative to us moving forward as a professionNeil Hilton In Ireland, Clodagh McGovern agrees that refraction is going to become more automated. She believes that this will increase the prevalence of remote clinics, also aided by AI. “On the telehealth side of things, I definitely see stronger connections building between hospitals and primary care,” she said, “and that will be aided by better technology. That will have a positive impact on the development of optometry, because patients will have to travel less, and optometrists will oversee their eye care by connecting digitally with ophthalmologists. It’ll free up hospitals and allow ophthalmologists do their surgery.” Although McGovern believes that technology can greatly assist working practices between primary and secondary care, she cautions that it needs to “become more intuitive and faster” to be effective. Sometimes staff can find themselves battling with technology, she said, “when their time should really be focused on the patient.” She added: “The optometrist needs everything to be moving much more smoothly in the test room.” Technology’s key role, she emphasises, is to give us more time. Steels agrees: “Joined up thinking is what we need, between the machinery and the people who are actually looking at it.”
I absolutely believe technology is imperative to us moving forward as a profession
Business-wise, by 2030 McGovern believes that support functions, such as HR, IT and digital marketing, will be faster and more intuitive, which will “ultimately free up our biggest resource, which is time, allowing us to focus on the clinical and customer service aspects of business. I think that in the future as technology improves, all of this will become much easier.”
Steels expects increased demand for optometry services in the coming decade, but has concerns about whether practices in their current form, with commercial pressures and compact sites, often located on High Streets, will be able to meet this need. “I fear for the fact that there is all this demand for our services, which we’re not going to be able to fulfil unless we go out of town, open a branch next door to a B&Q, and have multiple eye examination rooms and a car park,” he said. “That’s one of the big issues. Our mindset is to be on the High Street. Maybe we don’t have to be.” Rumney cautions against decisions that might cause practices to lose engagement with inaccessible groups who are potentially at risk from vision problems, warning that “it becomes difficult as an organisation or as a profession, if you’re moving away from being able to access those particular people.” Vulnerable people, he pointed out, are most likely to attend a practice in a market town or a secondary shopping centre, where independents are still most likely to be found. Cross-subsidies, he said, can help ease the shortfall that might come from General Ophthalmic Service fees: “If we’re on a strong economic footing as a practice, we can start to look at cross-subsidies for people that can’t otherwise afford it… I think we need to be cautious.” Returning to the subject of refraction, Brian Tompkins also believes that technology will speed up the process. This will allow greater communication with patient, he said, allowing practitioners to “give them full education about what's going on.” This will be especially important for speciality work such as contact lenses and myopia management, where technology is already allowing cuts to waiting and consulting times. He believes that 10 years will see further improvement in technology, which will “make the efficiency of the process better.”
We're not testing eyes, we're examining them. I think to say 'eye test' suggests that it's a quick test, not a thorough, comprehensive review and examinationBrian TompkinsHe added: “It’s not that we will have to charge less because we’re spending less time. It’s our years of education and knowledge that is going into our fee structure, not the 10 minutes it takes for us to take that scan and pass it to the lab. It’s the problem solving. The more complex the patient, the more skillsets are going to be utilised.”
We're not testing eyes, we're examining them. I think to say 'eye test' suggests that it's a quick test, not a thorough, comprehensive review and examination
Tompkins believes that communication will be key over the next decade, and that the way optometrists speak about appointments should change to encourage loyalty. “We’re not testing eyes, we’re examining them,” he said. “I think to say ‘eye test’ suggests that it’s a quick test, not a thorough, comprehensive review and examination.” He added: “Language is going to be important. The more the patient is educated about what we’re doing, how we’re doing it, and why, the more compliant they become and the more loyal they’ll be, so we’ll retain those patients for longer.” He is, he said, currently seeing his fourth generation of patients – the grandchildren of those he saw when he first started working in practice.
Another opportunity comes from audiology, which more optometrists are incorporating into their practice. Hilton has been using Amplify Hearing for five years and has seen year-on-year growth. “The challenges that we face in optometry are just mirrored in audiology,” he said. “With an ageing population, eye and ear problems increase.” He believes that, as optometrists upskill and take on more work from primary care, the same is true within audiology: “As an independent sector, we should absolutely embrace it. The feedback we have is nothing but good. Patients love that they can come here for their eyes and ears. “We’ve started moving into a subscription-based model, tying in audiology. Again, that’s working well. I think there’s a perfect opportunity for optometrists to get involved.” Patients ask Steels if he offers an audiology service daily. As a result, he is about to roll out Amplify in his Emsworth branch. The similar business models, he says, mean the two services are “absolutely perfect bedfellows.” Rumney has a further endorsement for branching out in this way: “Two years ago, there were a few months where we actually sold more hearing aids than glasses.”
On a more clinical note, what does the panel make of the sector’s increasingly close links with, and perhaps movement towards, ophthalmology? Rumney has a cautionary tale of referral, which he believes highlights the importance of Montgomery consent: where the referrer has an obligation towards the outcome. It is something he doesn’t believe optometry has yet fully embraced. “We’ve had two very poor outcomes,” he said. “We felt obliged to refer these people because during lockdown their vision had become significantly impaired through cataract, and they were no longer able to drive.” He explained that the local hospital was unable to see the patients within a reasonable timeframe, so external practitioners were brought in to perform the surgery. The negative of this, he said, was that the practitioners had not seen the patients beforehand and were not around for aftercare.
The future of independent practice lies in peopleClodagh McGovern Unfortunately, there were complications, “and our local trust is now picking up the pieces.” The lesson here is about communication: the optometrist being clear with all those involved about the required result. “It’s down to us to tell the ophthalmologist what the end stage outcome ought to be,” Rumney said. “If we’re not doing that, we’re causing problems. And I don’t think that we’re educating our optometrists to be argumentative enough over that. We’re still kowtowing a little bit to the senior doctor.” Montgomery consent, he believes “has not really impacted optometry yet. I think we have a fundamentally important role in guiding patients through to what the end stage outcome would be.” Steels agreed: “You need to have that discussion with the patient before you send them away. It is very important that both the patient and ophthalmologist know what they’re dealing with.” Tompkins has a good relationship with local ophthalmologists, so much so that “they trust us and refer things that they know we're going to work with better. We’ve even got a consulting room for an ophthalmologist once or twice a month. We're working very closely.” He added: “I don’t think we would be threatened as independents by any multiple or link to another practice.”
The future of independent practice lies in people
Environment and sustainability are subjects that practices might only just be starting to invest time and resource in, but they will need to remain a priority going forward. McGovern is cautious of greenwashing (effectively leading customers into thinking a product or service is sustainable when it is not), but sees sustainability as a key feature of her businesses’ future – so much so that she believes things like recycling and energy usage will become key performance indicators in the near future. She is also very aware of the sustainability practices of suppliers, and sees this as a focus up to and beyond 2030. Steels highlights the business opportunities that come with an increased focus on sustainability: taking on product ranges that are made from reclaimed fishing nets has “resonated massively’ with younger customers, and encouraging patients to come into the practice to recycle used daily contact lenses has increased engagement and footfall. “People are very enthusiastic,” he said. “That has a very interesting side effect, because it gets people through the door who we’d only usually see once a year. They’re coming in, engaging with the staff, looking at products. We’re having more contact with patients, more frequently. “There are little things that you can do, and in the patient’s mind you are doing something to help the environment. I think that’s always positive.”
Nick Rumney: Limitations on our horizons. If we put our minds to it, the pandemic has given us the opportunity to change the way we approach things. I think that is the key to the whole independent practice sector. We’re not bound by a simple retail approach; it’s much more complex and nuanced than that. We’ve got to be in the driving seat for it. Clodagh McGovern: I see the future for a solo independent practice as quite challenging. I feel it’s an unprofitable, difficult place to be. When you look at the Hakim Group values, the culture, the profitability of the model, I see that as the smart choice for independent practices. Neil Hilton: I think it’s going to swing more clinical again. With the ageing population, we’re going to see a big shift to more shared care, and patients being kept within primary care. Hospitals are bursting at the seams already, so hopefully there’ll be more services popping up across the country to keep patients closer to home. I think we’re perfectly positioned to get involved with that. Martin Steels: There’s enormous pressure on education. There are many invested people pushing towards simplifying becoming an optometrist. I think that that is something we need to look at, otherwise we could be heading for a problem. I’m optimistic for the future, though. I think with the right people in the right place, then there's an enormous potential for us to take on the overspill from the secondary care. Brian Tompkins: My fear is that optometrists will still be afraid to charge a proper fee. We shouldn’t be afraid to charge for our services. Most independents are trying to compete at the level of multiples, and they’re not going to manage. There’s no capability in a single practice to match multiples’ buying power. This is where the Hakim Group model comes into its own, giving you the best of both the independent world as well as the commerciality of the larger players.
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