Primary Care Ophthalmology: Considering the Scope for GPs with a Specialist Interest in Ophthalmology

As the current Co-President of my university’s ophthalmology society and general practice (GP) societies, I’ve always considered whether I could marry these interests when it came to pursuing my career in medicine. Several clinicians have thought similarly, with some GPs developing an ‘extended role’ (previously known as a ‘specialist interest’) in ophthalmology. These clinicians may run specialist clinics at GP surgeries for ophthalmological complaints or work part-time as ‘hospital doctors’ whilst continuing to be a GP.

Primary care is an important part of the NHS. It is the first point of contact for patients and ensures continuity of care within a healthcare system, as well as being responsible for referring and coordinating other specialist care that patients might need. GPs and eye health services (such as opticians) are the primary care services that are likely to deal with ophthalmological complaints. Despite public perceptions that community opticians just sell glasses, opticians are also responsible for managing ongoing refractive issues and are involved in screening for eye problems such as glaucoma (1). GPs, on the other hand, are involved in referral to specialists for conditions like age-related macular degeneration, retinopathy and cataracts. They would be expected to prescribe to treat minor eye conditions, such as viral/bacterial conjunctivitis, and screen children during ‘baby checks’- at birth and again at 6-8 weeks - for any eye abnormalities (2).

Currently, eye problems account for 2-3% of consultations in general practice, with the majority of these consultations being about inflammatory external eye disease and visual disturbances (3). 26% of patients with eye problems present to their GP as a first port-of-call, rather than an optometrist (4), but despite this, a survey released in 2014 revealed that only a third of GPs were confident in diagnosing age-related macular degeneration, 48.8% were sure they could recognise the symptoms of diabetic retinopathy, and 49.3% could recognise refractive errors, respectively. Furthermore, the poll highlighted a lack of GP training in supporting blind and visually-impaired patients (5). It is accepted that a greater emphasis on training for GPs in ophthalmic care may help improve clinicians’ understanding of such conditions, leading to better patient outcomes.

One of the reasons that ophthalmological conditions are not as well-understood in primary care may be the lack of formally registered GPs with a specialist interest in ophthalmology. There is currently no minimum requirement for a GP to call themselves a ‘GP with an extended role’ (previously known as a specialist interest) in ophthalmology. To date, the only suggestion that has been given by the Royal College of Ophthalmologists is that the minimum standard for could be to have a Diploma of the Royal College of Ophthalmologists (DRCOphth) qualification. Accredited GPs should then be competent to manage certain conditions and recognise more serious pathology, such as neuro-ophthalmic conditions, which require referral and would be life-threatening if missed (6).

In future years, I believe that, with adequate training, GP surgeries could provide services that are currently exclusive to outpatient eye clinics (such as injections for patients suffering from macular degeneration). Being able to reorganise the role of primary care physicians may reduce burdens on hospital medicine. However, this would require adequate training of staff, as well as funding and greater resource allocation specifically to these services. At present, since there is no formal register in the UK of GPs with an interest in ophthalmology, there is a need to provide a framework enabling GPs to train as specialist-interest doctors. This should involve undergoing continuing professional development (CPD) to meet the relevant requirements, as well as guidelines for their revalidation. This need is something that the Royal College of General Practitioners (who are not involved in the accreditation of speciality interests) and the Royal College of Ophthalmologists will have to consider over the next few years.

 

Written by Niha Mariam Hussain

References

1. INGRAM D. Ophthalmologists and optometrists---interesting times? [Internet]. 2021 [cited 11 October 2021]. Available from: https://bjo.bmj.com/content/85/7/769

2. Robinson A. Managing common eye problems in general practice. Prescriber. 2017;28(2):22-26.

3. McDonnell PJ. How do general practitioners manage eye disease in the community? Br J Ophthalmol. 1988 Oct;72(10):733-6.

4. McCormick E. Over a quarter of patients with eye problems use GP as the first port of call [Internet]. Aop.org.uk. 2021 [cited 12 October 2021]. Available from: https://www.aop.org.uk/ot/industry/high-street/2016/01/13/over-a-quarter-of-patients-with-eye-problems-use-gp-as-the-first-port-of-call

5. Low GP confidence in diagnosing major eye conditions [Internet]. RNIB - See differently. 2021 [cited 12 October 2021]. Available from: https://www.rnib.org.uk/health-social-care-and-education-professionals/nb-online/eye-health/low-gp-confidence-diagnosing-major-eye-conditions

6. Hornby S. Primary Care Ophthalmology Care. Royal College of Ophthalmologists; 2016 p. 4.

Image credit: Eye screening clipart - Clip Art Library [Internet]. Clipart-library.com. 2021 [cited 31 October 2021]. Available from: http://clipart-library.com/clipart/1623265.htm