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Designing Change in Eye Care DeliveryWith a focus on the future, Optometr y Australia is implementing initiatives to evolve and sustain a robust Australian optometr y sector. WRITER Skye Cappuccio As the year draws to a close, it often feels like a time to reflect on the challenges met, the achievements made, and the goals and opportunities ahead. At Optometry Australia we have been reflecting on progress toward realising preferred futures for optometry and eye health, and the current opportunities we can harness to steer towards these. In 2018, using proven futures studies techniques, Optometry Australia consulted with optometrists and stakeholders nationally to identify trends shaping the future of health care, preferred and plausible futures for optometry, and some of the critical steps toward realising them. From this, we launched Optometry 2040, our 20-year roadmap to evolve and sustain a robust Australian optometry sector. This future vision holds optometrists well-integrated into the health system. It sees them working with increased specialisation and inter-professional collaboration to best meet the growing chronic needs of an ageing population, within a world where less complex care is increasingly automated. When we are immersed in the ‘doing’ of daily life, it’s not easy to identify progress against such long-term, big-picture goals. For Optometry Australia we believe it is critical that we ‘get on the balcony’, so that changes happening to our profession locally and internationally are more obvious. Internationally, we continue to see the scope of optometric practice evolve, with our New Zealand neighbours providing a prime example. At home in Australia, changes in the way optometry integrates within the health system are notable. More and more optometrists are working alongside ophthalmology in private practice, and there is a gradual increase in optometry ’s role within public health. Across the country, we are witnessing pockets of innovation and evolution as optometrists expand their personal scope and extend the remit of their practices. BEHIND THE SCENESBackground work being undertaken purposefully to build toward a preferred future for optometry is also notable, if not always public. At Optometry Australia: • We have nearly completed a comprehensive review of the entry-level competency standards for the profession, designed to ensure they support a scope of practice that works for an evolving professional future, • We are progressing a project designed to harness the potential of big data to propel forward the development of optometry practice, • We continue to chase new Medicare items to support tele-optometry, • We are progressing a new system for recognising advanced optometry practice in particular areas, and • We are pleased to be engaged in discussions with a breadth of stakeholders around endeavours to increase the implementation of collaborative care models. FEDERAL GOVERNMENT ADVOCACYWhile we continue to work to ensure all political parties are made aware of the critical contribution of optometry to community health and optometrists’ mission to meet the changing needs of our population, it is important that we gain Federal government support to meet many of our Optometry 2040 commitments. Hence, on 30 November and 1 December, representatives from Optometry Australia and our sector joined our President, Margaret Lam, to attend a series of advocacy meetings in Canberra. Our delegation included several members who shared their experiences of how making optimal use of their full clinical skill set can support better patient access. LOOKING TO 2023 AND BEYOND On our analysis, 2023 presents significant opportunities to chase a preferred future for optometry. The pressures of a global pandemic have placed a spotlight on the strain that our health care systems are under. On coming to office in 2022, Federal Health Minister Mark Butler described primary care as being “in worse shape than it’s been in the entire Medicare era”. Public hospital outpatient wait lists are, in many parts of the country, simply deplorable. Yet fees associated with private care are a significant access barrier. The Grattan Institute has reported that in 2020–21 nearly half a million Australians decided not to seek necessary specialist care because they couldn’t afford the out-of-pocket fees.“ This future vision holds optometrists wellintegrated into the health system. It sees them working with increased specialisation and inter-professional collaboration...”This highlights a system in want of reform. While global health system reform feels like a dream, we proport there is abundant opportunity for optometry to be part of change to systems critical to supporting better access to eye care for patients.“ ...we proport there is abundant opportunity for optometry to be part of change to systems...”Optometrists are a highly skilled, and almost uncommonly well-distributed workforce, whose expertise is greatly under-utilised. There is opportunity to use these skills to alleviate pressure on our public health system and to support better geographical access to eye care. There are already multiple examples nationally of programs, or approaches, that seek to better use the skilled resources optometrists provide. Some of these are formal programs and some are examples of local ingenuity addressing unmet need. Lions Outback Vision in Western Australia provides a ready example. Its teleophthalmology services work with outreach optometry clinics and local optometry practices, to connect patients, optometrists and ophthalmologists in real time, and to fasttrack diagnoses and management planning. In a metro setting, Community Eye Care (C-Eye-C) in NSW provides a wellevaluated example. It triages patients with glaucoma, referred to a public ophthalmology outpatients’ clinic, to community optometrists for examination and initial management recommendations, maintaining ophthalmology oversight and input. We know well-designed referral pathways and collaborative care models can reduce waiting lists and need for hospital appointments, increase patient attendance rates, and reduce health system costs. A key challenge for 2023 is then: how do we fast-track progress so that instead of isolated examples, these become the norm of how our system works? This is a challenge Optometry Australia is committed to pursuing. At the same time, we will continue to support our members with quality education, professional support, and up-to-date profession information. OUR COMMITMENTSOur Strategic Plan, FY21-24, outlines Optometry Australia’s commitments to advance optometry and community eye health, with many of these aligned to our Optometry 2040 goals. Importantly, Optometry Australia has a high calibre team that is deeply committed to working with our members to advance optometry in Australia, and to ensuring the full breadth and depth of our skilled optometry workforce is used to support better community access to eye health. Skye Cappuccio is the General Manager – Policy and acting National Chief Executive Officer of Optometry Australia.