Michelle Dyoss, Selph

Michelle Dyoss, Public Health Specialist and Healthy Living Practice Lead and Director of Selph Consultancy, considers how optical practices can support the general health and wellbeing, as well as eye health, of each person they see.

In the summer of 2015, whilst working for Dudley Office of Public Health, I was introduced to Shamina Asif. Shamina is Chair of Dudley Local Optical Committee and had been writing to our Director of Public Health for several years asking for a joined-up campaign highlighting the dangers of smoking to eye health.

Shamina and I explored going further than just a stop smoking campaign and considered using optical practices (opticians) to provide commissioned services including smoking cessation. My experience was in working with community pharmacies; developing public health services, promoting health and wellbeing messages to the public through pharmacy, and leading on Healthy Living Pharmacy (HLP).

I have been a Healthy Living Pharmacy Lead since 2010, supporting many areas across the the country, and have seen the difference HLP has made to pharmacy contractors, commissioners and the public.

Building on the success locally and nationally of HLP, I developed a similar framework and quality criteria to enable optical practices to become ‘Healthy Living Optical Practices’ (HLOP), initially in the borough of Dudley. This project, that began as a pilot, has shown some great successes, and commissioners at Dudley Office of Public Health have continued to extend and progress the initiative.

Right from the start of this journey I witnessed the positives of the project for optical practice managers and staff, commissioners and most importantly the public. Many patients accessing an optical practice may not have seen any other healthcare professional for years, they may have undiagnosed health conditions or may be putting their health at risk due to lifestyle choices.

Optometrists, opticians and their staff can have a huge impact on the health and wellbeing of every patient they make contact with through advice, signposting and support.

Many lifestyle choices also have an impact on eye health:

  • Smoking and/or poor diet has been shown to increase the risk of age-related macular degeneration (AMD) which can lead to blindness. This is relatively unknown amongst the general pub-lic (and even healthcare workers) and yet highlighting the risk to many is more of a motivator to quit than many of the other well known health conditions caused by smoking
  • Smoking has been linked to thyroid eye disease (TED)
  • Heavy smokers have up to three times higher risk of developing cataracts compared to non-smokers
  • Eating a well balanced diet that is rich in vitamins A, C and E may have a role in protecting against cataracts, and vitamins C and E might help ward off AMD
  • A patient with undiagnosed or poorly controlled diabetes risks damage to the retina
  • Being overweight can put you at risk of health problems including high blood pressure, stroke and type 2 diabetes which can all have an adverse effect on the eyes

In addition, sight tests can pick up high blood pressure, high cholesterol and patients that may have diabetes or be pre-diabetic. So a HLOP, highlighting some of these risks, can start to identify and support patients with their eye health and general health.

I was made redundant from Dudley Office of Public Health in March 2017 but couldn't let this project go - it was my baby! I therefore used my own company, Selph, to show the commitment both Shamina and I have to rolling out the HLOP initiative across the country. With no funding or incentive we put together a report, evaluating the Dudley pilot and have since spoken at many local and national conferences.

It is my belief that optical practices should be seen as Health Hubs where the public can access information, advice and support on any element of health. Optical practices are proving they are interested in the general health, as well as eye health, of each patient they come into contact with and as such are providing a holistic approach to care. Being aware of local health priorities, offering brief advice and signposting into local services are the key elements of being a HLOP.

Early this year, I was approached by David Cartright, Chair of Nottinghamshire and Derbyshire Local Eye Health Network with the view of initiating and supporting HLOP across his two areas. In May, Shamina, Liam Stapleton (a pharmacist with local knowledge and experience of HLP), David Cartright and I arranged launch events to speak to local optical teams. There was a great turn out over the two evenings, with over 50 delegates attending eager to hear more about HLOP and how their practices can get involved.

Derbyshire and Nottinghamshire has a combined population of just over 1.5 million, with considerable inequalities, particularly in the cities of Derby and Nottingham. Some of the main priorities across both counties are to reduce smoking, particularly in pregnancy, reduce alcohol specific hospital stays in both adults and under 18s, reduce levels of adult obesity, increase recording of people with diabetes and decrease number of excess winter deaths.

Optical practices, with the support and training involved in becoming a HLOP, can offer brief advice and signpost to local services, which would have an impact on the health and wellbeing of their population.

Training days to include Leadership Skills for optometrists/practice managers, and RSPH Level 2 Award in Understanding Health Improvement for optical staff in order for them to become ‘Health Champions’, is now being planned. This training is essential for all optical practice staff as it gives them the knowledge, skills and confidence to initiate conversations around health with a customer who may just want to purchase some spectacles.

As well as the training schedule, I will be supporting each practice to develop an evidence portfolio demonstrating their understanding of local health priorities, demographics and services in order to be able to effectively support and signpost patients that may want to make a positive lifestyle change.

On meeting all criterion for HLOP, I will award practices with their quality mark which demonstrates to the public and local commissioners their commitment to improving the health and wellbeing of the community. Commissioners in Dudley have seen this commitment and have commissioned services such as Smoking Cessation, Alcohol Interventions and NHS Health Checks to HLOPs.

I will be working with NHS England, Local Authorities and Local Optical Committees to consider whether these services and others such as Dementia Screening, Falls Prevention and Diabetes Screening could be commissioned in a HLOP.

I am really excited to be supporting this great initiative and hope lots of other areas soon see the benefit of using optical practices - the untapped resource!