Before COVID-19
“I live in a small town in Kent where my wife and I run and own a two-consulting room independent practice.
“Like a number of local optometrists, we are contracted by the local CCG to provide community ophthalmology services in Kent. Patients come from a variety of sources; local optometry practices, GPs, and NHS111. The routine and the acute cases have a different triage system so that urgent cases are always seen rapidly. We work closely with the eye department of the local hospital trust and there is a two-way flow of patients; these are mainly glaucoma cases moving from the trust to community services. It’s not shared care and its not primary eye care services. But I like the challenge of the work, the diagnosing and prescribing, and the independence of the setting.”
COVID-19: the early days
“News is coming via Twitter and no one, and I mean no one, knows what’s happening. We have to shut, but we also have to stay open? We have to see patients, but we also have to do social distancing?
“We make plastic sheets to put on our slit lamps and wear cloth masks. Clinics are booked as normal but only some of the patients are coming in. Professional advice from different sources is sometimes contradictory and we have made a folder to keep them in and go through every day. The door to the practice becomes shut and posters go up. Reception seats are spaced and surfaces are cleaned to within an inch of their lives. Our answer machine message and text messaging system has official COVID-19 statements added. Clinics get cancelled.
“Some staff, our colleagues and friends, are furloughed as we try to keep them safe. Some are grateful. Some cry.”
Getting it together
“I’ve been to the hospital trust’s eye department meeting. They need us. The nurses and doctors are being redeployed. A hospital rapid access eye clinic will be set up to send patients to our community service.
“Then an A&E consultant gives us a call – can they do the same please? The consultant in charge of wet AMD asks us to see all first presenting cases; he only wants to see and treat those in hospital that definitely need an urgent injection. We set up another NHS email system to do this. Systems that would have previously taken months to negotiate are set up in hours.
“The staff in the CCG booking service are working from home. Non-urgent clinics are cancelled. We talk on the phone with the noise of their children and radios in the background.
“The optometrists providing community ophthalmology services are coping; some are scared, some have had to isolate for a period of time but we are all here. We’ve asked for PPE but we aren’t getting any, so we are buying our own. I’ve gone for a surgical face mask and gloves and we share photos of ourselves with each other. One of my colleagues has gone for full PPE, one seems to be in full hazmat gear, and one looks like they are wearing a mask used for sanding a floor. We laugh. It’s good to laugh.
“I’ve shaved my beard off to get the mask to fit better and my hair has grown. As a result, my phone has stopped recognising my face ID and I’ve had to reset it.
“I’m fed up of boiling washing my shirts and trousers at the end of each shift, so as of today I am now in scrubs too. It feels very, very weird indeed.”
Last week
“We are seeing about 10-12 face-to-face consultations a day as well as virtual telephone consultations. Case loads are a mix. Foreign bodies, uveitis that sort of thing. We all note lots more follicular conjunctivitis. Patients needing surgical post-op follow-up are now also being sent from the local trust and we are emailing reports directly back. I’m using more FP10s than I ever did and the clinical case mix is more challenging.
“It’s hard to limit the consultation time. It’s not just that the clinical cases are complex, it’s that patients are often lonely and want to chat. I don’t want to seem rude and I sit and listen as best I can while chivvying them along. An old man gives me a jazz CD; thank you Dr Deacon, says the note.
“It’s hot under the mask. You can’t take it off for a cup of tea or some food without replacing it, and they are in such short supply its better to go thirsty. I come home tired and grumpy after a day in clinic. Stories of optometrists who have removed foreign bodies or posted out glasses are all over social media. I have a little cry.”
Dr Deacon Harle FCOptom DipOC DipTp(AS) DipTp(IP) is an optometrist and director at Osborne Harle.
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