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What can we learn from optometrists?
  1. Adrian Nelson-Pratt, BVSc, MRCVS

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Adrian Nelson-Pratt runs The Veterinary Business Consultancy, which offers business development support, coaching, mentoring and leadership training to the profession.

We often compare the veterinary and optometry worlds as some of the key figures leading today’s veterinary businesses were previously at the heart of changes to the optometry profession.

There are lessons that we can learn from optometrists. But, we should interpret the comparisons carefully, as not all of the changes to their profession have been successful.

Seventy per cent of clinical examinations performed by optometrists are funded by the NHS. In fact, due to the evolution of minor eye conditions services commissioned by local NHS clinical commissioning groups, if you have one of these conditions (eg, conjunctivitis, sticky or wet eyes and floaters) you’re more likely to see an optometrist than your GP.

In practice, the average optometrist sees as many patients for clinical disease as for testing eyesight, all at a price fixed by the NHS. They are well placed to triage eye disease, refer to NHS ophthalmology services for more complex cases and take the pressure off the GP. However, doing all this for a fixed price undervalues the clinical service that they provide. Traditionally, they have been able to compensate this with retail sales of eyewear, but online supply of glasses and contact lenses is now eroding these revenues.

We must develop a clear value proposition around clinical fees

People are used to receiving ‘free’ healthcare so often don’t understand the value of the services they receive. This makes it harder for those same people to value the treatment we provide when they bring their pets for treatment at our veterinary clinics. Therefore, the first lesson to learn from the optometry profession is that we must develop a clear value proposition around clinical fees and widely communicate this to the public.

The second lesson is the impact of promotional pricing strategies. High street optometrists frequently offer discount vouchers for eyesight tests to bring people in. But this further reduces income from these tests and increases reliance on retail sales of spectacles. To ease this pressure, businesses source cheap frames from the Far East to cut costs and offer additional chargeable services, such as optical coherence tomography.

Offering additional assessments seems like good clinical practice, but I’m told it puts pressure on the optometrist to sell services. These sales are very hard to achieve in a profession already undervalued by the public. Do we suffer the same financial pressure to recoup promotional activities, such as dental promotions or fixed price neutering?

The final lesson is the risk around the optometrist-led team. When your profitability is under pressure one solution is to cut your staffing overhead.

Just like vets, optometrists must oversee and sign off all lens prescriptions and eye tests. Traditionally, they were supported by a dispensing optician and customer care team. However, the new role of optical adviser (trained but unregulated lay staff) in an optometrist-led team has reduced the number of regulated professionals and helped to reduce staff costs.

Optical advisers are well trained and undertake assessments, but salaries are a fraction of those received by optometrists or dispensing opticians. Despite this, and the fact that they have an increased clinical burden, I’m told that optometrists’ salaries have still stagnated.

This final lesson, then, is that certain versions of the vet-led team may not be a panacea. We must develop meaningful team roles, but guard against doing it for purely financial reasons. BVA recently published an encouraging vision of the vet-led team, so I hope that we can improve the delivery of clinical services without damaging veterinary or nursing salaries in the way it appears to have happened in the optometrist-led team.

If we use the lens prescribed by our optometry colleagues and learn these lessons, then I’m confident we can build animal- and client-centred businesses that demonstrate veterinary value and avoid relying on drug sales, reward clinical excellence and that keep veterinary professionals at the heart.

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