We the undersigned would like to present our beliefs about the current situation and our views about the proposed apprenticeship ‘degree’ in optometry.
Some of us were involved in the GOC Educational Strategic Review (ESR) which culminated in recommendations concerning core competencies in optometry. The recommendations of the detailed review identified needs for improvement in areas of diagnosis, referral and treatment of eye disease. Deficiencies in sight testing were not identified as an area in need of improvement. With the current application for an apprenticeship in optometry – principally led by corporate retail optical chains, it is highly unlikely that such a requirement will be met. The reasons are provided below:
1. Practice-based optometrists are not trained educators: The core scientific, independent fact and evidence-based training cannot be provided in-practice, by individuals focused on their day-to-day workload. Although a block release to universities is proposed, it will never be able to replace the full-time comprehensive learning experience of well-accepted full-time undergraduate studies.
2. The apprenticeship is being driven by retail corporate chains: The influence of corporate business in shaping optometry training will potentially devalue the profession and result in reduced medicalisation of optometry. Indeed, the GOC’s own report states ‘There was concern from universities that to form these relationships would involve transferring significant power to the corporates to dictate what is studied, how it is studied, and how it will work.’
3. There is little transparency in the trailblazer group: The individual members of the group have not been disclosed. The GOC ESR review document demonstrates their concern regarding the involvement of corporates. It said: ‘There was some concern about the influence of companies to impact on the nature of education delivered, especially if the company was the “lead” provider for apprenticeships.’ Not only is it clear that a single corporate will have a majority lead in the apprenticeship, but a member of the largest corporate group is also a GOC councillor and education lead of the governing body that ultimately approves the course. In addition, that member is also a joint venture partner and head of enhanced optical services. Without knowing the names of individuals within the trailblazer group there is little visibility of any other conflicts of interest.
4. Limited demographics at retail store location: Most high street practices have a different patient demographic to suburban practices. Trainees will not gain suitable experience over a wide range of patients, including the elderly and children.
The role of the GOC?
The GOC is there to protect the public. However, the GOC also has powers in approving or accrediting university courses and the College of Optometrists as a body responsible for professional qualifying examinations.
Over the years we have seen a large increase in the number of accredited university courses for optometry degrees and an increase in the number of optometrist registrants. There is no dispute regarding this. A clear marker of this fact is that salaries have reduced in real terms. Patients have little or no waiting times for eye examinations, further supporting the fact that supply is more than meeting demand.
The evidence from the ESR, petitions and the recent announcement by the Association of Optometrists to withdraw its support for the optometry degree apprenticeship indicates that a course driven by corporate optometry will not deliver on the core needs of improving or even maintaining standards.
Moreover, with entry to the course being made more ‘inclusive’ standards will likely drop. The inclusive nature refers to the fact that students will be eligible to enrol with five GCSEs and either NVQ, BTEC or two undefined A-level pass grades – two E grades or higher, for example.
For comparison, Aston University’s entry requirements for 2020 are AAA to AAB including a minimum of two science subjects from biology, chemistry, maths or physics. A-level results are not the ultimate criteria for entry to optometry. The profession has examples of some excellent clinical and research optometrists who started their careers as optical assistants then qualified as dispensing opticians and finally optometry, independent prescriber and even to PhD degree level. However, their achievements were part of a longer career progression through a robust level of training.
The ageing population, together with advances in medicine means that there are insufficient numbers of ophthalmologists to cope with demand. Without optometrists enhancing their skills, there is a real risk of people losing their sight through untimely delivery of treatments and diagnosis. Optometry around the world is stepping-up to meet this demand, by treating a broader range of disease than ever before, with an increased number offering independent medical care to help lessen the burden on the medical profession. Effectively, it results in more accessibility to expert ophthalmological care when patients need it.
The role of the College?
Fundamentally, the College’s role is to implement the Objective Structured Clinical Examination (OSCE) that allows optometrists to register with the GOC. Apprenticeship degree optometrists would have to pass the OSCE’s to be eligible for GOC registration. The College has stated, in their own public communication, that they are part of the trailblazer group to ensure that standards of education, patient safety and professional practice are upheld.
The College has also stated publicly that it cannot stop an optometrist degree apprenticeship as it is enshrined in law. It is the GOC who approve undergraduate courses in optometry and as such, the system has worked well for many years providing independence for each body resulting in accountability albeit the fact that the GOC provides accreditation to the College.
The College of Optometrists has a key role in pressuring the GOC and the Institute for Apprenticeship and Technical Education (IATE) to reject the proposed apprenticeship degree programme. The College is funded by optometrists through its membership fees and in keeping with the 11,000 respondents of the change.org survey, should be supporting the abrogation of the apprenticeship.
A wider view:
Looking further afield to countries with the highest standard of clinical practice like the United States, Canada, Australia and New Zealand where optometry graduates have a post-graduate qualification with independent prescriber status, their approach already addresses the GOC educational strategic review.
There is a need to separate corporate involvement in the core undergraduate learning and training of optometrists. Corporate optometry has historically demonstrated to the public that it is prepared to undervalue clinical services, namely promoting ‘free’ eye exams. As the apprenticeship is being led by corporate entities it is inconceivable that it will be without influence.
We believe that an apprenticeship degree cannot fulfil the requirements of the GOC educational strategic review without compromising the long-term integrity of the optometric profession and in turn public safety.
We have concerns about the process and transparency by which this has been undertaken, not to mention the potential conflict of interest of more than one of the leadership groups within the trailblazer group.
Until all these concerns are publicly addressed and remedied, we cannot support or endorse the apprenticeship degree as it has currently been suggested.
Dr Trusit Dave, Optometrist, Coventry, UK
Sheraz Daya, Consultant Ophthalmologist, London, UK
Professor Nicholas Rumney, Optometrist, Hereford, UK
Associate professor Jennifer Craig, Optometrist, New Zealand
Professor Simon Barnard, Optometrist, London, UK
Suzanne Efron, Optometrist, Australia
Chris Hemmerdinger, Consultant ophthalmologist & Optometrist, Manchester, UK
Dr Khalid Husain Sachak, Optometrist & GP, Northampton, UK
Dr Keyur Patel, Optometrist, Northampton, UK
Professor David Gartry, consultant Ophthalmologist & Optometrist, London, UK
Professor Lyndon Jones, Optometrist, Canada
Alan Hawrami, Optometrist, London, UK
Dr Peter Frampton, Optometrist, Newcastle, UK
Caroline Christie, Optometrist, London, UK
Professor Sunil Shah, Consultant Ophthalmologist, Birmingham, UK
Mr Michael Parker, Ophthalmic dispensing Student, Cambridge, UK
Mr Faisal Jabbar, Optometrist, Yorkshire, UK
Professor David Thomson, Optometrist, London, UK
Apprenticeship in Optometry, Optometry Apprenticeship