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Embracing MECS.

OT poses a monthly scenario from a practitioner. This month, we look at accreditation for Minor Eye Condition Services (MECS)

The scenario

Mina, AOP member

"Since the Local Optical Committee Support Unit (LOCSU) published its Breakthrough Strategy, I keep hearing that practitioners should get involved in MECS.

I find it both confusing and daunting, especially balancing additional education with full-time practice. What is MECS, why should I be offering it, and what does accreditation involve?"


The advice



Trevor Warburton, director of LOCSU and chair of the Confederation of Greater Manchester LOCs, and Matt Jinkinson, director of LOCSU and a lead assessor for LOCSU/ WOPEC courses

LOCSU's Breakthrough Strategy ( details a new and aggressive approach for the expansion of community services, particularly with regards to MECS. It also sets out challenging targets for the number of new services to be created in the near future.

The unit has already developed a number of pathways that cover services such as cataract referral, post-operative cataract management, learning disabilities, low vision and children. However, the pathway that is the focus of expansion--and referenced in the Breakthrough Strategy --is MECS.

Why is accreditation worth the effort?

There are two very simple reasons why practitioners should become MECS accredited. The first is that it allows optometrists to use their skills with fewer restrictions--something that we, as a profession, have long complained about with regards to NHS sight tests. The second is that it means, when MECS is commissioned in an area, the patient does not need to pay for a service that the NHS should provide, bringing additional earnings to a practice. However, there is also much more to it than just that.

There are many challenges that optical practices will face in the future. The Foresight Project Report ( /1UI7Lt4) spells out the possible changes that technology might bring to the profession, with deregulation among the doomsday scenarios.

As practitioners, we all know that the core functions of sight testing and dispensing are what pay the majority of the bills in practice. Yet retreating into those core functions and refusing to get involved in wider NHS services is a recipe for disaster because it will allow others around us to provide eye care services such as MECS, ocular hypertension and glaucoma monitoring, and so on.

The defence we usually hear is: "Well, we detect eye disease in the sight test." While this is true, it might not be enough on its own if those surrounding us can offer other innovative ways of doing the same thing and at the same time eyeing the dispensing.

The General Optical Council's 2015 Public perceptions of the optical professions report ( found that only 19% of people with an eye problem would present at an optical practice as their first port of call. In addition, we have already seen one attempt to amend the Opticians Act to allow the sale of negative-powered spectacles over the counter in the House of Lords. And there are websites in the US offering refraction online. So how do practices guard themselves against these potential threats? The answer is to make sure the practice has roots that are firmly embedded in the NHS. This requires the whole profession to get engaged in community and public health services.

Taking action

LOCSU has expanded its team so it can help drive forward and increase the rate that services are being developed. It is also asking LOCs to increase their LOCSU levy contribution from 0.4% to 0.5% in order to fund the expansion.

It is important for LOCs to recognise that we are all in this together. While a particular area may already have a lot of services, in order to protect the profession, optics as a whole needs to offer more enhanced services.

The profession needs to ensure that it has a workforce that is ready and willing to provide MECS. For this reason, and those outlined above, LOCSU is calling on all optometrists who have not taken the LOCSU MECS accreditation course to do so in the near future. This is regardless of whether or not a practitioner thinks that there is an immediate prospect of MECS in their area.

Having completed the course ourselves, we can reassure practitioners that it is simply a refresher of core skills and knowledge and, as such, provides reassurance to commissioners that the workforce is competent, ready and willing to provide MECS--a rather different service from the sight testing service commissioned over the last 60-plus years.

So what does the course involve?

The course is provided by WOPEC and divided into two manageable parts. The first part is purely distance learning and consists of seven online lectures. On completion, practitioners will gain seven CET points, as well as the MECS Part 1 certificate.

Part 2 is a series of Objective Structured Clinical Examinations (OSCEs) that are designed to check a practitioner's skills with a Volk lens, as well as their knowledge of the ophthalmic conditions. All of the conditions assessed will have been covered within the distance learning online modules.

OSCEs--what do they involve?

The notion of OSCEs can make some practitioners nervous. However, the pass rate is very high and there is no reason to be worried.

The examination is designed to cover core knowledge, not new learning--its purpose is to validate a practitioner's core competence ability. However, performing lots of Volk on patients in the weeks leading up to attending the OSCE should ease any nerves.

For those looking to complete the OSCE, there are a number of assessment events available over the latter half of 2016. The College of Optometrists will run two OSCEs on behalf of LOCSU, and corporate companies within the sector are also hosting their own MECS OSCEs with assessors accredited by WOPEC.

This latter point is important to note--the corporate sector is fully on board with this strategy and is rapidly getting its entire workforce validated via LOCSU's MECS accreditation course.

How does MECS affect the running of a practice?

MECS add variety to practitioners' days, offering a break from the routine sight test and presenting them with an opportunity to use their skills and knowledge to differentially diagnose patients with a range of symptoms.

Common conditions that could present include flashes and floaters, conjunctivitis, various manifestations of dry eye, blepharitis or meibomian gland dysfunction, foreign bodies and uveitis.

Most MECS have either urgent (24-hour) or routine (five working days) appointment timescales, depending on presenting symptoms. Therefore, it is advisable for small practices in particular to leave an open appointment in the diary, which can be filled from a cancellation list if the time is approaching and no MECS patients present.

In larger practices with multiple practitioners, MECS appointments may be able to be absorbed into the rolling clinic. The split between urgent and routine tends to be about 60:40 and therefore more urgent cases presenting can be a challenge. Generally, practices are required to find the patient an appointment if they do not have one available. Therefore, building relationships with other MECS providers within the same area is important.

More information

Turn to page 49 to read about LOCSU's key achievements since it was established in 2007

More information

A booklet on the distance learning element of MECS accreditation can be viewed at It comprises seven lectures and MCQs to be completed. The course costs around 135 [pounds sterling]. In many areas LOCs will support this cost.
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Title Annotation:Workshop
Publication:Optometry Today
Geographic Code:4EUUK
Date:Aug 1, 2016
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